TY - JOUR
T1 - The future of precision medicine in opioid use disorder
T2 - Inclusion of patient-important outcomes in clinical trials
AU - Sanger, Nitika
AU - Panesar, Balpreet
AU - Rosic, Tea
AU - Dennis, Brittany
AU - D’Elia, Alessia
AU - Hillmer, Alannah
AU - Chawar, Caroul
AU - Naji, Leen
AU - Hudson, Jacqueline
AU - Constantine Samaan, M.
AU - De Souza, Russell J.
AU - Marsh, David C.
AU - Thabane, Lehana
AU - Samaan, Zainab
N1 - Funding Information:
This work was supported by the Canadian Institute for Health Research (CIHR; award 156306).
Publisher Copyright:
© 2021, Associacao Brasileira de Psiquiatria. All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Objective: Opioid use has reached an epidemic proportion in Canada and the United States that is mostly attributed to excess availability of prescribed opioids for pain. This excess in opioid use led to an increase in the prevalence of opioid use disorder (OUD) requiring treatment. The most common treatment recommendations include medication-assisted treatment (MAT) combined with psychoso-cial interventions. Clinical trials investigating the effectiveness of MAT, however, have a limited focus on effectiveness measures that overlook patient-important outcomes. Despite MAT, patients with OUD continue to suffer negative consequences of opioid use. Patient goals and personalized medicine are overlooked in clinical trials and guidelines, thus missing an opportunity to improve prognosis of OUD by considering precision medicine in addiction trials. Methods: In this mixed-methods study, patients with OUD receiving MAT (n=2,031, mean age 39.1 years [SD 10.7], 44% female) were interviewed to identify patient goals for MAT. Results: The most frequently reported patient-important outcomes were to stop treatment (39%) and to avoid all drugs (25%). Conclusion: These results are inconsistent with treatment recommendations and trial outcome measures. We discuss theses inconsistencies and make recommendations to incorporate these outcomes to achieve patient-centered and personalized treatment strategies.
AB - Objective: Opioid use has reached an epidemic proportion in Canada and the United States that is mostly attributed to excess availability of prescribed opioids for pain. This excess in opioid use led to an increase in the prevalence of opioid use disorder (OUD) requiring treatment. The most common treatment recommendations include medication-assisted treatment (MAT) combined with psychoso-cial interventions. Clinical trials investigating the effectiveness of MAT, however, have a limited focus on effectiveness measures that overlook patient-important outcomes. Despite MAT, patients with OUD continue to suffer negative consequences of opioid use. Patient goals and personalized medicine are overlooked in clinical trials and guidelines, thus missing an opportunity to improve prognosis of OUD by considering precision medicine in addiction trials. Methods: In this mixed-methods study, patients with OUD receiving MAT (n=2,031, mean age 39.1 years [SD 10.7], 44% female) were interviewed to identify patient goals for MAT. Results: The most frequently reported patient-important outcomes were to stop treatment (39%) and to avoid all drugs (25%). Conclusion: These results are inconsistent with treatment recommendations and trial outcome measures. We discuss theses inconsistencies and make recommendations to incorporate these outcomes to achieve patient-centered and personalized treatment strategies.
KW - Clinical trials
KW - Opioid
KW - Outcomes
KW - Patient important
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U2 - 10.1590/1516-4446-2019-0734
DO - 10.1590/1516-4446-2019-0734
M3 - Article
C2 - 32556002
AN - SCOPUS:85099335490
SN - 1516-4446
VL - 43
SP - 138
EP - 146
JO - Revista Brasileira de Psiquiatria
JF - Revista Brasileira de Psiquiatria
IS - 2
ER -
