Cocaine dependence is common, involving 1 of every 3 drug-related emergency department visits, and has substantial social and economic effects.^1,2 In 2007, the United States had 2.5 million cocaine-dependent people and only 809 000 of them were treated.³

Background and Objectives: The opioid crisis has taken an immense toll in the United States. On average, five lives are lost to an opioid overdose every hour of the day; estimated costs associated with opioid misuse exceed $500 billion annually. Illicit opioid discontinuation is the first step in the treatment of opioid use disorder (OUD), and transition to an opioid agonist may initiate treatment. However, discontinuation to abstinence from either OUD directly or following agonist treatment results in severely distressing opioid withdrawal symptoms (OWS).Methods: This review evaluated studies on the etiology, burden, and management of OWS.Results: Noradrenergic hyperactivity generates many OWS. These OWS can cause patients to relapse during early opioid discontinuation. While agonist therapies are generally first‐line for moderate or severe OUD and reduce OWS, prescribing restrictions can limit their availability.Discussion and Conclusions: Non‐opioid medications to treat OWS provides a gateway into long‐term treatment with naltrexone or psychosocial therapies. For opioid dependent patients without OUD, non‐opioid treatments like α‐2 adrenergic agonists can facilitate opioid tapering.Scientific Significance: For the millions who are physically dependent on opioids, new treatments for OWS can enhance recovery from OUD and prevent relapse. (© 2019 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc.;XX:1–8)

Opioid use disorder (OUD) is a disorder that can lead to several negative outcomes, including overdose and death. A variety of opioids can be abused by individuals including both prescribed and non-prescribed opioids. Continued opioid use can be driven by negative affective states associated with opioid withdrawal. Several treatments exist in the field including medication assisted treatments such as methadone, buprenorphine, and naltrexone. Treatments such as clonidine and lofexidine can also be used to assist with decreasing withdrawal symptoms. Increasing adherence to treatment can further improve patient outcomes and promote continuation with treatment. A variety of methods to reduce relapse can also be utilized such as opioid agonists and maintenance therapy. According to the Centers for Disease Control, opioid overdoses contributed to 67.8% of overdose deaths in 2017.