The implications of medication development in the treatment of substance use disorders in developing countries.
OBJECTIVE
To enquire as to how applicable are the latest developments in pharmacotherapy of substance use disorders (SUDs) to patients in developing countries. We review the latest literature regarding the magnitude of the problem in developing countries. We then present a review of recent developments in pharmacotherapy of SUDs, especially from developing countries. Finally, we discuss the barriers that prevent patients in developing countries from benefiting from these developments.


RESULTS
The problem of SUDs is increasing in developing countries and there is a severe shortage of manpower to manage it. Disulfiram, naltrexone and acamprosate are useful in treating alcohol dependence, and likewise methadone and buprenorphine in treating opioid dependence. Strategies of matching patients to medications and combining the medications have shown promise. There is a parallel benefit of reduction in the risk of HIV spread among injecting drug users. However, many barriers prevent an average patient with SUD from benefiting from these developments.


CONCLUSIONS
Medication treatment can improve the outcome of SUDs. Research in this field is catching up in developing countries. However, due to issues of availability, affordability, manpower and governmental policies, a large number of patients in these countries are unable to benefit from recent developments. Urgent efforts are required to fill this gap between research and practice.
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India. jaga@nimhans.kar.nic.in
Jagadisha
J
Thirthalli
Prabhat K
PK
Chand
D000077443:Acamprosate; D000427:Alcohol Deterrents / Q000627:therapeutic use; D000437:Alcoholism / Q000534:rehabilitation; D002047:Buprenorphine / Q000627:therapeutic use*; D015897:Comorbidity; D003906:Developing Countries / Q000706:statistics & numerical data*; D004221:Disulfiram / Q000627:therapeutic use; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D015995:Prevalence; D011640:Public Policy; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000534:rehabilitation; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D013654:Taurine; D002047:Buprenorphine; D000077443:Acamprosate; D004221:Disulfiram; D008691:Methadone