Chapter

Addiction Medicine

pp 463-493

Date:

Opiates and Prescription Drugs

  • John A. RennerAffiliated withVeterans Administration Outpatient Clinic, Boston University School of Medicine Email author 
  • , Joji SuzukiAffiliated withDepartment of Psychiatry, Brigham and Women’s HospitalDepartment of Psychiatry, Harvard Medical School

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Abstract

There has been a dramatic change in the opiate abuse problem in the United States during the last decade. Opiate pharmaceuticals have replaced heroin as the dominant drugs of abuse, and the number of users has quadrupled. In both 2005 and 2006, pain relievers replaced marijuana as the most common new drug of abuse among first-time users aged 12 and older. The number of individuals meeting criteria for opiate use disorders has almost tripled and now approaches 2 million adults and adolescents. There has also been a shift in demographics, with new users more likely to be White, employed, and better educated. Compared with heroin abusers, this group is less sociopathic, but more likely to have had prior treatment for other psychiatric disorders. Fortunately, the treatment options for these individuals are also more diverse and accessible. Traditionally, long-term therapeutic communities and methadone maintenance programs offered the only effective treatment for most opiate addicts. With the Food and Drug Administration’s approval of buprenorphine for use in office-based settings, a new and highly effective treatment has become available and has gained wide acceptance among clients. The most effective treatments approach opiate dependence as a chronic, relapsing disease that requires long-term care and that integrates comprehensive medical and psychiatric services to address co-occurring conditions.

Keywords

Behavioral couples therapy Buprenorphine Cognitive behavior therapy Contingency management Detoxification Drug Addiction Treatment Act of 2000 Drug courts Epidemiology Etiology Iatrogenic addiction Levo-alpha acetyl methadol Methadone Methadone maintenance Motivational enhancement therapy Naloxone Naltrexone Neurobiology Office-based treatment Opioid overdose Opioid receptors OxyContin® Partial opioid agonist Primary prevention Psychiatric comorbidity Psychosocial treatment Substance-induced disorders Therapeutic communities Tolerance Twelve-step facilitation Withdrawal