Pharmacotherapy for opioid dependence

Miotto K, McCann M, Basch J, Rawson R ling W (2002). Naltrexone and dysphoria fact or myth American Journal of Addictions, 11, 151-60 Mitchell TB, White JM, Somogyi AA Bodmer F (2003). Comparative pharmacodynamics and pharmacokinetics of methadone and slow-release oral morphine for maintenance treatment of opioid dependence. Drug and Alcohol Dependence, 11, 85-94 Mitchell TB, White JM, Somogyi AA Bochner F (2004). Slow-release oral morphine versus methadone a crossover comparison of patient outcomes and acceptability as maintenance pharmacotherapies for opioid dependence. Addiction, 99, 940-5 Mitka M (2003). Office-based primary care physicians called on to treat the new addict. Journal of the American Medical Association, 290, 735-6... 

Cornish, J. W., Metzger, D., Woody, G. E., Wilson, D., McLellan, A. T., Vandergrift, B., et al. (1997). Naltrexone pharmacotherapy for opioid dependent federal probationers. Journal of Substance Abuse Treatment, 14(6), 529-534. 

The other pharmacotherapies for opioid dependence listed in Table 15.5 also have fared well in clinical trials. LAAM s eftectiveness convinced the FDA in 1993 to approve it as a treatment for heroin dependence. Buprenorphine also has been shown to be effective in several clinical trials with heroin addicts (Litten Allen, 1999). Therefore, the data show that the clinician has the option of prescribing three opiate agonist or partial agonist drugs in the treatment of opioid dependence, according to the clinician s or the client s preferences. 

Several effective pharmacotherapies for opioid dependence have been developed. The best known of these is methadone. Attempts to develop effective... 

The picture for the pharmacotherapy of cocaine dependence is not nearly as good as it is for opioid dependence. You have seen that a number of drug treatments for cocaine dependence have been tried, but so far none has proved to be effective consistently across clinical trials (Litten Allen, 1999). T he treatment of choice for cocaine dependence is a structured behavioral program, as we discuss in the next section. 

In other substance use disorders, the use of 12-step interventions is also popular, and participation in 12-step groups is correlated with better outcomes in cocaine abusers (e.g., McKay et al. 1994). However, a smdy of 128 cocaine abusers found that cognitive-behavioral therapy was more efficacious than 12-step facilitation in engendering cocaine abstinence (Maude-Griffm et al. 1998). Thus, the relative efficacy of 12-step approaches for drug use disorders requires further investigation. No known studies have systematically evaluated the efficacy of 12-step treatments in opioid-dependent patients, either alone or in conjunction with pharmacotherapies. 

Lingford-Hughes et al. (2004), Litten and Allen (1999), McLellan, Lewis, O Brien, and Kleber (2000), and O Brien (1996) summarized the major pharmacotherapies available for the treatment of drug-use disorders other than alcohol. Pharmacotherapies have received the most evaluative activity in the treatment of opioid dependence, cocaine dependence, and nicotine dependence. We discussed nicotine replacement therapies in Chapter 7 and therefore do not review them again here. A list of the pharmacotherapies that O Brien (1996) reviewed is presented in Table 15.5. 

Anton RF, Oroszi G, O Malley S, Couper D, Swift R, Pettinati H, Goldman D (2008) An evaluation of mu-opioid receptor (OPRM1) as a predictor of naltrexone response in the treatment of alcohol dependence results from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study. Arch Gen Psychiatry 65 135-144... 

Mfller, D.K., J.R. Lever, K.R. Rodvelt, et al. 2007. LobeUne, a potential pharmacotherapy for drug addiction, binds to mu opioid receptors and diminishes the effects of opioid receptor agonists. Drug Alcohol Depend. 89(2-3) 282-291. 

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