TY - JOUR
KW - Analgesics, Opioid/pharmacokinetics/pharmacology/therapeutic use
KW - Buprenorphine/pharmacokinetics/pharmacology/therapeutic use
KW - Humans
KW - Long-Term Care
KW - Methadone/pharmacokinetics/pharmacology/therapeutic use
KW - Naltrexone/pharmacokinetics/pharmacology/therapeutic use
KW - Narcotic Antagonists/pharmacokinetics/pharmacology/therapeutic use
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/drug therapy/epidemiology/rehabilitation
KW - Substance Withdrawal Syndrome/drug therapy
KW - Treatment Outcome
AU - G. Bart
A1 - 
AB - Illicit use of opiates is the fastest growing substance use problem in the United States, and the main reason for seeking addiction treatment services for illicit drug use throughout the world. It is associated with significant morbidity and mortality related to human immunodeficiency virus, hepatitis C, and overdose. Treatment for opiate addiction requires long-term management. Behavioral interventions alone have extremely poor outcomes, with more than 80% of patients returning to drug use. Similarly poor results are seen with medication-assisted detoxification. This article provides a topical review of the three medications approved by the Food and Drug Administration for long-term treatment of opiate dependence: the opioid-agonist methadone, the partial opioid-agonist buprenorphine, and the opioid-antagonist naltrexone. Basic mechanisms of action and treatment outcomes are described for each medication. Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function. Oral naltrexone is ineffective in treating opiate addiction, but recent studies using extended-release naltrexone injections have shown promise. Although no direct comparisons between extended-release naltrexone injections and either methadone or buprenorphine exist, indirect comparison of retention shows inferior outcome compared with methadone and buprenorphine. Further work is needed to directly compare each medication and determine individual factors that can assist in medication selection. Until such time, selection of medication should be based on informed choice following a discussion of outcomes, risks, and benefits of each medication.
BT - Journal of addictive diseases
C5 - Opioids & Substance Use; Healthcare Policy
CP - 3
CY - England
DO - 10.1080/10550887.2012.694598
IS - 3
JF - Journal of addictive diseases
N2 - Illicit use of opiates is the fastest growing substance use problem in the United States, and the main reason for seeking addiction treatment services for illicit drug use throughout the world. It is associated with significant morbidity and mortality related to human immunodeficiency virus, hepatitis C, and overdose. Treatment for opiate addiction requires long-term management. Behavioral interventions alone have extremely poor outcomes, with more than 80% of patients returning to drug use. Similarly poor results are seen with medication-assisted detoxification. This article provides a topical review of the three medications approved by the Food and Drug Administration for long-term treatment of opiate dependence: the opioid-agonist methadone, the partial opioid-agonist buprenorphine, and the opioid-antagonist naltrexone. Basic mechanisms of action and treatment outcomes are described for each medication. Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function. Oral naltrexone is ineffective in treating opiate addiction, but recent studies using extended-release naltrexone injections have shown promise. Although no direct comparisons between extended-release naltrexone injections and either methadone or buprenorphine exist, indirect comparison of retention shows inferior outcome compared with methadone and buprenorphine. Further work is needed to directly compare each medication and determine individual factors that can assist in medication selection. Until such time, selection of medication should be based on informed choice following a discussion of outcomes, risks, and benefits of each medication.
PP - England
PY - 2012
SN - 1545-0848; 1055-0887
SP - 207
EP - 225
EP - 
T1 - Maintenance medication for opiate addiction: The foundation of recovery
T2 - Journal of addictive diseases
TI - Maintenance medication for opiate addiction: The foundation of recovery
U1 - Opioids & Substance Use; Healthcare Policy
U2 - 22873183
U3 - 10.1080/10550887.2012.694598
VL - 31
VO - 1545-0848; 1055-0887
Y1 - 2012
ER -