Long-Term Pharmacotherapy for Opiate (Primarily Heroin) Addiction: Opioid Agonists

Abstract

Opiate addiction, primarily addiction to the short-acting synthetic derivative of the natural product morphine, has been recognized as a major health problem in the United States since the mid-1960s (KREEK 1987). The problems of excessive use and addiction to opiate compounds may be traced back to the mid-1800s in the United States and, historically, the medicinal use and misuse of opiates has existed for hundreds and even thousands of years. Yet the recognition of the enormous impact of heroin addiction in the United States, and also of the need to approach this addiction as a medical problem with social and economic ramifications, was not generally embraced until the late 1960s or early 1970s (NYSWANDER 1956; DOLE and NYSWANDER 1965; DOLE et al. 1966a,b; KREEK 1972, 1973a,b, 1975, 1991a, 1992a,b,c; ZWEBEN and PAYTE 1990; GOLDSTEIN 1994). Until this time, fear of legal constraints or sanctions, because of ongoing punitive interpretations of earlier laws, caused most physicians and health care professionals to shun the responsibility of treating of addicts. Then, significant findings based on carefully conducted basic and applied clinical research studies showed the efficacy of a pharma-cotherapy for addiction specifically using methadone maintenance treatment (DOLE and NYSWANDER 1965, 1966; DOLE et al. 1966a,b; KREEK 1991a, 1992a,b,c). The research supporting this therapy had been planned with a rationale based on all available knowledge concerning both the pharmacology of specific opioid agents, natural and synthetic, and their effects, as well as clinical observations of their duration of action or kinetics (KREEK 1991a, 1992a,b,c,d,e,f).