Similar to treatment resistant depression, there is a subpopulation of those addicted to opioids who do not respond to standard opioid use disorder (OUD) treatments. In a new paper, an addiction expert at the Brown School at Washington University in St. Louis suggests a new category for these types of patients: treatment-resistant opioid use disorder (TROUD).
The field has suggested that if a treatment does not work, it is either the patient's fault, they have not hit bottom, or simply we need to try the same treatment again. This paper challenges the addiction research and treatment providers to change focus from individuals being resistant to the unique conditions associated with this brain disorder as being resistant to treatment as usual." David Patterson Silver Wolf, associate professor and an expert on substance use disorder treatment
Patterson Silver Wolf is co-author of "Treatment Resistant Opioid Use Disorder (TROUD): Definition, Rationale, and Recommendations," recently published online in the Journal of the Neurological Sciences. His co-author is Mark Gold, adjunct professor in the Department of Psychiatry at Washington University School of Medicine in St. Louis.
Patterson Silver Wolf was reading about treatment resistant depression and thought some of the same mechanisms might apply to opioid addiction.
"I found out that it is unethical to recommend the same depression treatment that has already failed," Patterson Silver Wolf said. "In substance use disorder treatment, this is exactly what we do, over and over again.
"In this article, we discovered that patients being admitted to outpatient treatment and diagnosed with an opioid use disorder had upwards of 30 past treatment attempts. And the unfortunate fact was that they would most likely be receiving the same treatment as before. In substance use disorder treatment, the treatment does not change, we expect the individual to change."
Patterson Silver Wolf defines TROUD in stages. "For example, Stage 1 TROUD would be failure of three standard OUD medications or behavioral treatments, either in combination or succession, with Stage 2 TROUD being five or more failures," he said. Related Stories
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