Methadone opiate substitution therapies

While there are extensive data on the use of methadone substitution therapy in adult opiate-dependent patients, there are only two published studies on opiate substitution therapy in adolescents and most of these subjects were 18 years of age or older (Hopfer et al., 2000). This lack of research is particularly concerning, given the recent increase in heroin use among adolescents (Hopfer et ah, 2000). Two newer substitution agents, L-oc acetylmethadol (LAAM) and buprenor-phine, offer alternatives to methadone, but remain untested in youth with SUD (Kranzler et al., 1999). 

There are few empirical data on the use of substitution agents in youth with SUD. However, there is significant evidence supporting the efficacy of opiate substitution therapy for adults with opiate addiction with agents such as methadone, buprenorphine, and LAAM. While... 

Slow-Onset, Long-Acting DA Substitution Strategy An Analogy to Methadone and LAAM for Opiate Substitution Therapy and to Slow-Onset Long-Acting Electrical Brain Stimulation Reward... 

Substitution therapy with methadone or buprenorphine has been veiy successfiil in terms of harm reduction. Some opiate addicts might also benefit from naltrexone treatment. One idea is that patients should undergo rapid opiate detoxification with naltrexone under anaesthesia, which then allows fiuther naltrexone treatment to reduce the likelihood of relapse. However, the mode of action of rapid opiate detoxification is obscure. Moreover, it can be a dangerous procedure and some studies now indicate that this procedure can induce even more severe and long-lasting withdrawal symptoms as well as no improvement in relapse rates than a regular detoxification and psychosocial relapse prevention program. 

Cross-tolerance occurs between all opiates that act primarily via the mu receptors. This is the basis of the methadone substitution therapy which is commonly used to withdraw people who are dependent on heroin or morphine methadone is used because of its relatively long half-life (about 12 hours) and its ease of administration in an oral form. Cross-tolerance does not occur between the opiates and other classes of dependence-producing drugs such as the barbiturates, alcohol or the amphetamines, which act through different mechanisms. 

A common strategy for treating chronic opiate addiction iavolves the substitution of methadone which can either be provided as maintenance therapy or tapered until abstinence is achieved. Naltrexone and buprenorphine [52485-79-7] have also been used ia this manner. The a2 adrenergic agonist clonidine [4205-90-7] provides some rehef from the symptoms of opiate withdrawal, probably the result of its mimicking the inhibitory effect of opiates on the activity of locus coerukus neurons. 

Methadone maintenance therapy is effective against heroin and other opiate dependence. Methadone, a synthetic analgesic, is pharmacologically equivalent to opiates and gradually substitutes for the abused drug. It saturates the opiate receptors. This substance is addictive too the addictive potential, however, is lesser and milder than that associated... 

---