DNP Nurse Anesthesia
Project Category: Evidence Synthesis
Project Team: Courtney Ekhator, DNP, CRNA, Abduljabar Calfos, DNP, CRNA, Stephen Flaherty, CRNA, PhD, Pamela Chambers, DNP, EJD, MSN, CRNA, CPPS, FAANA (Advisors)
Background: Opioid addiction, or opioid use disorder (OUD), is a disease affecting people of all ages. Studies continue to show a significant increase in nonmedical prescription opioid use leading to OUD. Medication assisted therapy (MAT) is a comprehensive treatment that combines medications with counseling and behavioral therapies. The approved medications to treat OUD are methadone, naltrexone, and buprenorphine as a stand-alone medication and a combination of buprenorphine and naloxone (Suboxone). The purpose of this integrated review was to compare effectiveness of these medications in treating OUD.
Methods: A thorough and systematic search of the literature was conducted, identifying qualitative and quantitative studies across various databases (PubMed, CINAHL, and Embase) capturing a wide range of studies. The Joanna Briggs Institute (JBI) for evidence synthesis appraisal was utilized. Inclusion criteria consisted of studies that compared methadone and suboxone (and/or buprenorphine), adult subjects, and a urinalysis outcome measure of treatment success.
Results: This integrative review included nine quantitative studies, consisting of 4014 participants. Buprenorphine/naloxone demonstrated lower opioid-positive urine tests (0.2% to 68.32%) compared to methadone (1.5% to 76.62%) and naltrexone (9.0% to 50.5%). Extended-release naltrexone showed 54.6% opioid-negative urine tests at a 3-month follow-up.
Conclusion: Methadone and buprenorphine/naloxone effectively reduced opioid use amongst adults with OUD. Methadone generally showed lower attrition rates, while buprenorphine/naloxone often resulted in fewer opioid-positive urine analysis. Extended-release naltrexone and high-dose treatments of these medications demonstrated potential for effectively treating OUD.