Melissa Cyders

The impact of medication assisted treatment on long-term opioid use disorder recovery focus of IU research

Recovery from opioid use disorder is a life-long process, but we know surprisingly little about how best to support people in such long-term recovery. The process of recovery is not the same for everyone, but there may be patterns that can help us understand what factors help people succeed on distinct paths to recovery.

Led by Melissa Cyders, associate professor at the School of Science at IUPUI, a team of researchers including Cyders; Wei Wu, associate professor of psychology at the School of Science at IUPUI; Melissa Fry, director of the applied research and education center at IU Southeast and Kevin Ladd, professor of psychology at IU South Bend, is working on a project for IU's Responding to the Addictions Crisis Grand Challenge that will search for these patterns. The goal is to document different pathways in long-term opioid use disorder recovery and to develop best practices to support these varied paths to wellness.

Although some previous studies have examined long-term recovery from heroin, an illegal opioid, the relatively recent rise of prescription opioid use has created an addiction epidemic whose recovery patterns are not well understood.

Recently, medication assisted treatment, including medications such as methadone, buprenorphine and naltrexone, has shown remarkable promise in reducing relapse and overdose risk, although much of the research is based on relatively short follow-up periods. Despite its effectiveness, medication assisted treatment is sometimes viewed as “replacing one drug for another,” leading to stigma (negative perception of individuals associated with a particular attribute) and other barriers to treatment, recovery, and support.

Relapse (recurrence of drug use) is a common occurrence for those in recovery but is often viewed as a recovery failure rather than a step in the recovery process. Most studies define recovery "successes" as the absence of relapse. These studies, Cyders said, often fail to document other pathways in recovery that can involve struggles or relapse. This omission limits understanding of what leads to relapse and how it can be critical in recovery. Defining relapse as failure may actually deter long-term recovery among those caught in the relapse struggle due to feelings of defeat or loss of support.

The project, "Characterizing the course of long-term opioid use disorder recovery and the impact of medication-assisted treatment on opioid use disorder recovery," includes gathering information from Hoosiers whose lives are affected by opioid use disorder. The researchers are leading focus groups to learn what people think, believe and do about opioid use and recovery. Half of these discussions bring together people from the Indianapolis-metro area, while the other half represent rural southern Indiana communities.

The groups include a variety of viewpoints from people with different relationships to opioid use disorder. In each region, the team has separate focus groups for people in recovery (one short-term and one long-term), friends and family of people in recovery, healthcare providers who treat people with opioid use disorder, and community members who do not (to their knowledge) have a close relationship with anyone with an opioid use disorder. The researchers hope the study will help guide appropriate recovery expectations that will reduce stigma and barriers to treatment and successful recovery.

The study will also follow the progress of approximately 150 people in recovery from opioid use disorder for three years, conducting check-ins every three months. These participants will be recruited from both the urban and rural communities and will range from those who recently embarked on recovery to those who have been in recovery for many years.

By tracking their progress in real time, the researchers will build a more representative picture of what long-term recovery looks like in Indiana, helping to identify patterns, set expectations, and assess what works best in helping people achieve lasting health and stability.