A newly published monograph “addresses the challenges of achieving long-term stable (OUD) remission and recovery, and, more specifically, the related challenges involved in adherence and retention within the pharmacotherapeutic treatment of OUD.”
This document is a critical step toward understanding what medication can and cannot achieve for which patients under what circumstances. This right-sizing of expectations helps clarify the work needed to develop and implement better models to improve outcomes for patients with OUD.
The monograph was written by William L. White, MA, Marc Galanter, MD, George Kolodner, MD, Wayne Kepner, PhD, MPH, Casey Sarapas, PhD, and Candace L. Mouton, MS.
It’s well worth your time.
Opioid use disorder (OUD) and opioid addiction (the most severe and complex form of OUD) exist within the larger continua of opioid use and opioid-related problems.1 The global prevalence of nonmedical opioid use is estimated at more than 60 million individuals,2 OUD prevalence exceeds 26 million, and worldwide opioid overdose deaths exceed 100,000 annually,3 more than 80,000 of which occur in the United States.4
Opioid addiction is a chronic (remitting and relapsing), potentially lifelong condition that profoundly affects physical health, life expectancy, psychosocial functioning, quality of personal and family life, and community health and safety.5 Though a centuries-old problem, OUD severity, complexity, and mortality have been amplified by the recent infusion of illicitly manufactured fentanyl and related analogues into international drug markets.6 OUD is a severe and complex substance use disorder as evidenced by its related mortality risks, debilitating effects on global health and psychosocial functioning, and the average number of treatment attempts required before achievement of remission and recovery stability.7 Long-term OUD recurrence rates are high following assisted and unassisted abstinence attempts and may be accompanied by increased alcohol and other drug use.8 Adolescents and young adults experiencing high severity OUD are at particular risk for prolonged addiction careers and related morbidity and mortality risks.9
The personal resolution of OUD encompasses qualitatively different achievements commonly referred to as remission and recovery. Remission involves the elimination or reduction of OUD-related pathology below the OUD diagnostic threshold, while recovery conveys achievement of remission plus enhancement of global health, social functioning, and the potential to flourish, i.e., to get “better than well.” 10 Put simply, OUD remission is about finding a way to survive; OUD recovery is about then finding a way to thrive.11
White, W. L., Galanter, M., Kolodner, G., Kepner, W. E., Sarapas, C. & Mouton, C. L. (2025).
Medications for opioid use disorder: Enhancing retention to achieve long-term remission and recovery.
Chestnut Health Systems, Lighthouse Institute.
Shared below with permission.
Recovery Review 