The pharmacological treatment of opioid addiction--a clinical perspective.
This article reviews the main pharmacotherapies that are currently being used to treat opioid addiction. Treatments include detoxification using tapered methadone, buprenorphine, adrenergic agonists such as clonidine and lofexidine, and forms of rapid detoxification. In opioid maintenance treatment (OMT), methadone is most widely used. OMT with buprenorphine, buprenorphine-naloxone combination, or other opioid agonists is also discussed. The use of the opioid antagonists naloxone (for the treatment of intoxication and overdose) and oral and sustained-release formulations of naltrexone (for relapse prevention) is also considered. Although recent advances in the neurobiology of addictions may lead to the development of new pharmacotherapies for the treatment of addictive disorders, a major challenge lies in delivering existing treatments more effectively. Pharmacotherapy of opioid addiction alone is usually insufficient, and a complete treatment should also include effective psychosocial support or other interventions. Combining pharmacotherapies with psychosocial support strategies that are tailored to meet the patients' needs represents the best way to treat opioid addiction effectively.
Lobmaier
Philipp
P
Department of Addiction Medicine, Oslo University Hospital, Aker, Oslo, Norway. p.p.lobmaier@medisin.uio.no
Gossop
Michael
M
Waal
Helge
H
Bramness
Jorgen
J
D000322:Adrenergic Agonists / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D002047:Buprenorphine / Q000008:administration & dosage; D003000:Clonidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004359:Drug Therapy, Combination; D006801:Humans; D008658:Inactivation, Metabolic; D008691:Methadone / Q000008:administration & dosage; D009270:Naloxone / Q000008:administration & dosage; D009271:Naltrexone / Q000008:administration & dosage; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000523:psychology; D012944:Social Support; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control
D000322:Adrenergic Agonists; D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine; D009271:Naltrexone; D003000:Clonidine; D008691:Methadone; C025655:lofexidine