Expert opinion on pharmacotherapy · 2026
Do we need to improve pharmacological approaches to treat insomnia in patients with opioid use disorder?
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Wolinsky David, Huhn Andrew S
Аннотация
INTRODUCTION: Insomnia is very common among individuals with Opioid Use Disorder [OUD] and can interfere with successful treatment. However, no pharmacotherapies with consistent efficacy for treating insomnia in this population have been identified.
AREAS COVERED: A selection of medications, including trazodone and mirtazapine, have been studied as treatments for insomnia among individuals with OUD. Results have been mixed and require interpretation in the context of small sample sizes and/or clinical trial design. Dual orexin-receptor antagonists [DORAs] have shown some promise as treatments for insomnia that could also attenuate drug seeking behaviors. Future pharmacotherapies will need to address the underlying mechanisms driving insomnia among individuals with OUD, including dysregulated hypothalamic - pituitary - adrenal [HPA] axis activity in which excessive and/or aberrant cortisol release in early treatment drives hypervigilance and wakefulness, as well as potential sleep disturbances mediated by mu-opioid agonist therapies.
EXPERT OPINION: There is an absence of clear guidance on how to address insomnia among individuals with OUD. Improved pharmacotherapies targeting this pathology are critical not only for enhancing quality of life but also the success of OUD treatment outcomes. Large, rigorous clinical trials are sorely needed to improve sleep medication prescribing guidelines in this population.
AREAS COVERED: A selection of medications, including trazodone and mirtazapine, have been studied as treatments for insomnia among individuals with OUD. Results have been mixed and require interpretation in the context of small sample sizes and/or clinical trial design. Dual orexin-receptor antagonists [DORAs] have shown some promise as treatments for insomnia that could also attenuate drug seeking behaviors. Future pharmacotherapies will need to address the underlying mechanisms driving insomnia among individuals with OUD, including dysregulated hypothalamic - pituitary - adrenal [HPA] axis activity in which excessive and/or aberrant cortisol release in early treatment drives hypervigilance and wakefulness, as well as potential sleep disturbances mediated by mu-opioid agonist therapies.
EXPERT OPINION: There is an absence of clear guidance on how to address insomnia among individuals with OUD. Improved pharmacotherapies targeting this pathology are critical not only for enhancing quality of life but also the success of OUD treatment outcomes. Large, rigorous clinical trials are sorely needed to improve sleep medication prescribing guidelines in this population.