Bridging the Gap Between Practice and Research Forging Partnerships with Community-Based Drug and Alcohol Treatment (1998) / Chapter Skim
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Appendix F: National Institute of Health Consensus Development Statement on Effective Medical Treatment of Heroin Addiction
Appendix F: National Institute of Health Consensus Development Statement on Effective Medical Treatment of Heroin Addiction
Pages 198-225
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From page 198... ...
1997. NIH Consensus Development Statement: Effective Medical Treatment of Heroin Addiction.
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There is a need for improved training for physicians and other health care professionals and in medical schools in the diagnosis and treatment of opiate dependence. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance programs.
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This search resulted in the emergence of drug-free therapeutic communities and the use of the opiate agonist, methadone, to maintain those with opiate dependence. Furthermore, a multimodality treatment strategy was designed to meet the needs of the individual addict patient.
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To address the most important issues surrounding effective medical treatment of opiate dependence, the NIH organized this 2 1/2-day conference to present data on opiate agonist treatment for opiate dependence. The conference brought together national and international experts in the fields of the basic and clinical medical sciences, epidemiology, natural history, prevention and treatment of opiate dependence, and broad representation from the public.
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· What are the future research areas and recommendations for improving opiate agonist treatment and improving access? The primary sponsors of this meeting were the National Institute on Drug Abuse and the NIH Office of Medical Applications of Research.
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The second pathway is an indirect effect from antisocial personality disorder in a biologic parent, leading to both antisocial personality disorder and drug abuse/dependence in the adoptee. Family studies report significantly increased relative risk for substance abuse (6.7-fold increased risk)
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Regional Cerebral Glucose Metabolism in Opiate Abusers Two independent human studies (using positron emission tomography) suggest that opiates reduce cerebral glucose metabolism in a global manner, with no regions showing increased glucose utilization.
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Of the estimated total opiate-dependent population of 600,000, only 115,000 are known to be in methadone maintenance treatment (MMT) programs.
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Over the past two decades, clear and convincing evidence has been collected from multiple studies that effective treatment of opiate dependence markedly reduces the rates of criminal activity. Therefore, it is clear that significant amounts of crime perpetrated by opiatedependent persons is a direct consequence of untreated opiate dependence.
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3. What Is the Efficacy of Current Treatment Modalities in the Management of Opiate Dependence Including Detoxification Alone, Nonpharmacological/Psychosocial Treatment, Treatment with Opiate Antagonists, and Treatment with Opiate Agonists (Short Term and Long Term)
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Comorbid psychiatric disorders require treatment. Other behavioral strategies have been successfully used in substance abuse treatment.
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A single dose of LAAM can prevent withdrawal symptoms and drug craving for 2 to 4 days. Buprenorphine, a recently developed partial opiate agonist, has the advantage over methadone that its discontinuation leads to much less severe withdrawal symptoms.
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Many people believe that dependence is self-induced or a failure of willpower and also believe that efforts to treat it will inevitably fail. Vigorous and effective leadership is needed to inform the public that dependence is a medical disorder that can be effectively treated with significant benefits for the patient and society.
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The U.S. Department of Health and Human Services can more effectively, less coercively, and much more inexpensively discharge its statutory obligation to provide treatment guidance to MMT programs, physicians, and staff by means of publications, seminars, Web sites, continuing medical education, and the like.
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5. What Are the Future Research Areas and Recommendations for Improving Opiate Agonist Treatment and Improving Access?
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Research on prevention methods is necessary. Research on efficacy of other opiate agonists/antagonists should be compared to methadone.
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We recommend expanding the availability of opiate agonist treatment in those States and programs where this treatment option is currently unavailable. CONSENSUS DEVELOPMENT PANEL Lewis L
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"Deaths Among Heroin Users In and Out of Methadone Maintenance" Instructor Department of Psychiatry University of Texas Health Science Center San Antonio, Texas Rose Etheridge, Ph.D. "Factors Related to Retention and Posttreatment Outcomes in Methadone Treatment: Replicated Findings Across Two Eras of Treatment" Senior Research Psychologist National Development and Research Institutes, Inc.
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"Methadone Maintenance and Regional Cerebral Glucose Metabolism in Opiate Abusers: A Positron Emission Tomographic Study" Physician-in-Charge Division of Psychiatric Functional Brain Imaging Department of Psychiatry Beth Israel Medical Center New York, New York G Thomas Gitche!
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"Problem-Service Matching in Methadone Maintenance Treatment: Policy Suggestions From Two Prospective Studies" Scientific Director DeltaMetrics in Association with Treatment Research Institute Philadelphia, Pennsylvania 217 Jeffrey Merrill, Ph.D. "Impact of Methadone Maintenance on HIV Seroconversion and Related Costs" Director Economic and Policy Research Treatment Research Institute University of Pennsylvania Philadelphia, Pennsylvania Eric }.
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"Genetic and Other Risk Factors in Opiate Addiction" Senior Scientist Division of Intramural Research Addiction Research Center National Institute on Drug Abuse National Institutes of Health Baltimore, Maryland D Dwayne Simpson, Ph.D.
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Planning Committee Chair Associate Director for Medical Affairs Division of Clinical and Services Research National Institute on Drug Abuse National Institutes of Health Rockville, Maryland Elsa A Bray Program Analyst Office of Medical Applications of Research National Institutes of Health Bethesda, Maryland Mona Brown Press Officer National Institute on Drug Abuse National Institutes of Health Rockville, Maryland Kendall Bryant, Ph.D.
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Jaffe, M.D. Director, Office for Scientific Analysis and Evaluation Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration Rockville, Maryland Lewis L
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Zukin, M.D. Director Division of Clinical and Services Research National Institute on Drug Abuse National Institutes of Health Rockville, Maryland CONFERENCE SPONSORS Office of Medical Applications of Research, NIH John H
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Washington: National Academy Press; 1997. National evaluations of drug abuse treatment outcomes.
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Treatment services in two national studies of community-based drug abuse treatment programs. J Subst Abuse Treat 1995;7:9-26.
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Salsitz EA, Kalin MF, Keefe JB, Miller EL, et al. Outcomes of treatment of socially rehabilitated methadone maintenance patients in physicians' offices (medical maintenance)
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Walsh SL, Gilson SF, Jasinski DR, Stapleton JM, Phillips RL, Dannals RF, et al. Buprenorphine reduces cerebral glucose metabolism in polydrug abusers.
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