commentary from the British Columbia Centre on Substance Use is
‘SROM-based oral opioid agonist therapy is effective and has a lower risk for drug-drug interactions. But, further research is needed to include SROM in the U.S.’
With more Americans dying from accidental opioid-related overdoses
than from motor vehicle accidents and homicides combined, it is clear
that evidence-based solutions are urgently needed.
Despite the proven
benefits of opioid agonist therapy with buprenorphine or methadone,
several health system and regulatory barriers to this treatment persist
throughout North America.
In addition, buprenorphine and methadone may
not be effective for all patients. These barriers have resulted in a
large unmet treatment need, leaving an estimated gap of up to one
million persons with untreated opioid use disorder, who continue to be
at risk for overdose death and other negative health and social
Existing studies suggest that SROM has comparable efficacy to
methadone and is well-tolerated by patients, with a lower risk for
SROM-based oral opioid agonist therapy is
increasingly and successfully used in several European countries and
Canada, but more research is needed before it can be determined how SROM
could be used in the United States.
The authors suggest that the U.S. must also address the regulatory
burdens that create barriers to treatment.
The Canadian model, in which
methadone is dispensed through daily witnessed ingestion in
community-based pharmacies could be adapted in this country, which could
help to overcome current treatment gaps.