Opioid dependence treatment: options in pharmacotherapy.
The development of effective treatments for opioid dependence is of great importance given the devastating consequences of the disease. Pharmacotherapies for opioid addiction include opioid agonists, partial agonists, opioid antagonists, and alpha-2-adrenergic agonists, which are targeted toward either detoxification or long-term agonist maintenance. Agonist maintenance therapy is currently the recommended treatment for opioid dependence due to its superior outcomes relative to detoxification. Detoxification protocols have limited long-term efficacy, and patient discomfort remains a significant therapy challenge. Buprenorphine's effectiveness relative to methadone remains a controversy and may be most appropriate for patients in need of low doses of agonist treatment. Buprenorphine appears superior to alpha-2 agonists, however, and office-based treatment with buprenorphine in the USA is gaining support. Studies of sustained-release formulations of naltrexone suggest improved effectiveness for retention and sustained abstinence; however, randomized clinical trials are needed.
Stotts
Angela L
AL
University of Texas Medical School at Houston, Department of Family and Community Medicine, 6431 Fannin, JJL 324, Houston, TX 77030, USA. Angela.L.Stotts@uth.tmc.edu
Dodrill
Carrie L
CL
Kosten
Thomas R
TR
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy
D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone