Global Availability and Utilization of Medication Assisted Treatment of Drug Abuse and Dependence: An Update
Pp. 625-637 (13)
Thomas F. Kresina and Billy Pick
Clinical trials and clinical studies, using patented drugs and drugs off patent, provide data that impact the best treatment practices for substance abuse and dependence. In the United States, medications have been approved for use in the treatment of both alcohol and opioid dependence. Medications used in the detoxification from drug abuse and dependence provide symptomatic relief of drug and alcohol withdrawal. For long term treatment or medical maintenance treatment, medications eliminate the physiological effects of drug use by blocking drug-receptor binding in the brain. Patented drugs remain an important source of candidate pharmacotherapies comprising medication assistant treatment, part of a comprehensive treatment plan for drug dependence that addresses the medical, social, and psychological needs of the patient. Therefore, patented drugs characterized by demonstrable interactions with neurotransmitters in the brain, are attractive candidates for treatment efficacy trials. An effective long term treatment paradigm for reducing drug dependence is the concomitant use of medications that block the effects of drug use with behavior change counseling and psychotherapy. Medications which have demonstrated effectiveness for the long term treatment of opioid dependence are methadone, buprenorphine, and naltrexone. Pharmacotherapies used in the treatment of alcohol dependence include acamprosate, antabuse and naltrexone.
A reliable indicator for successful treatment of drug dependence is time in treatment. Patients remain in treatment for longer periods of time when they perceive that their health care environment is supportive and non-stigmatizing, with a good patient-provider relationship, and where they feel that their needs are identified and met. Additional medications may be needed for individual comprehensive substance abuse treatment plans, particularly for individuals who abuse stimulants or have co-occurring mental health disorders. Adapting a comprehensive drug treatment paradigm globally requires identifying and testing new drug candidates while building and changing programs to become more patient centered, adapting to local socio-cultural conditions to promote access to care and treatment and integrating medical, psychological, and social services.
Pharmacotherapy, addiction, methadone, buprenorphine, naltrexone, opioid dependence, alcoholism
Division of Pharmacological Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD, USA