Which medications are suitable for agonist drug maintenance?
OBJECTIVE
We examine the feasibility of agonist maintenance treatment for the major psychoactive drug classes: opioids, nicotine, benzodiazepines, cannabis, psychostimulants and alcohol.


METHODS
Eight clinical criteria for an agonist maintenance drug were assessed for each major drug class. These related to pharmacological aspects of the drug (agonist, pharmacological stability, dose-response, non-toxic) and neurocognitive sequelae (psychiatric, cognitive, craving, salience).


RESULTS
Opioids and nicotine met all eight criteria for a maintenance drug. While nicotine has not been promoted widely or used for maintenance, it has the potential to fulfil that role. Cannabis met five criteria and has potential, but long-term data on cognitive impairment are required. Benzodiazepine maintenance would appear an option for the high-dose chaotic abuser, also meeting five criteria, although clinic dosing appears the safest option. Psychostimulants (three of eight criteria) and alcohol (one of eight) appear poor propositions for maintenance, in terms of both their pharmacological and their neurocognitive characteristics.


CONCLUSIONS
Drug classes have properties that distinguish them in their suitability for maintenance treatment. Some classes not yet used for maintenance (notably nicotine and cannabis) have potential to fulfil such a role. Others, however, by their inherent nature, appear unsuitable for such a treatment regimen.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Shane
S
Darke
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Michael
M
Farrell
D000427:Alcohol Deterrents / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D002188:Cannabis; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D054313:Drug Agonism; D000431:Ethanol / Q000627:therapeutic use; D005240:Feasibility Studies; D006801:Humans; D009538:Nicotine / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000534:rehabilitation*
D000427:Alcohol Deterrents; D000701:Analgesics, Opioid; D000697:Central Nervous System Stimulants; D001569:Benzodiazepines; D000431:Ethanol; D009538:Nicotine
Alcohol; benzodiazepines; cannabis; maintenance; nicotine; opioids; psychostimulants