Opiates and Addiction

Abstract Abuse of and dependence on opiates is associated with significant morbidity and mortality. It is a worldwide problem, with millions of people directly involved. In addition to the risks posed with the abusc of opiates, the common practice of injection drug use (and to a lesser extent, sexual relationships with injection drug users), results in significant risk of contracting Acquired Immune Deficiency Syndrome and Hepatitis C infections. l the past 10 years, the abuse pattern of opiates in the United States has changed in two ways: the heroin purity has increasing, facilitating use by the intranasal and pulmonary routes, and abuse of prescription opiates has increased. More adolescents are abusing opiates, resulting in a greater need for treatment. Prescription opiate abusers primarily use the oral route of administration but about one in eight moves onto injection practices. The geographic distribution of abuse suggests that the greatest problem with abuse of prescription opiates is in nonmetropolitan areas, forming a new challenge for the treatment system. Responses to increased treatment demands in the United States can be met by the newest pharmacotherapies, buprenorphine (SUBUTEX) and buprenorphinelnaloxone (SUBOXONE), which can be prescribed by qualified physicians. Additionally, the increased use of methadone in “office‐based practice” would be a second approach to increase treatment capacity. Finally, non‐opiate medications are the current focus ofresearch in the management of opiate abuse and dependence disorders. These medications could be used as both adjuncts to agonist pharmacothcorapy or as “stand alone” therapies.