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20 - Treatment of opioid dependence

from Part III - Specific treatments

Published online by Cambridge University Press:  12 May 2010

By
Leslie L. Buckley ,
Nicholas Seivewright ,
Mark Parry ,
Abhijeetha Salvaji  and
Richard Schottenfeld
Edited by
Peter Tyrer  and
Kenneth R. Silk
Leslie L. Buckley
Affiliation:
University Health Network Toronto, ON Canada
Nicholas Seivewright
Affiliation:
Substance Misuse Service Fitzwilliam Centre Sheffield UK
Mark Parry
Affiliation:
Bowman House Reading Berkshire UK
Abhijeetha Salvaji
Affiliation:
Doncaster Drug Team Doncaster UK
Richard Schottenfeld
Affiliation:
Yale University School of Medicine Connecticut Mental Health Center New Haven, CT USA
Peter Tyrer
Affiliation:
Imperial College of Science, Technology and Medicine, London
Kenneth R. Silk
Affiliation:
University of Michigan, Ann Arbor
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Summary

Editor's note

Opiate addiction is one misuse and dependence disorder for which we have good pharmacological treatments. Both methadone and buprenorphine are effective in withdrawing individuals from opiates via substitution, and their use in maintenance treatment has an excellent track record. Naltrexone may also be efficacious for selected patients. Psychosocial and behavioral treatments play a role too, most often in combination with pharmacological treatments or for patients who do not want pharmacological treatments. This is one subject in which practice varies enormously in different parts of the world. Readers who look at the text closely will notice considerable geographical variation in treatment polices, and it is a tribute to our authors that they have kept this to a minimum in this combined chapter.

Introduction

Opioid dependence is a chronic disorder characterized by relapse, increased mortality, significant medical morbidity, psychiatric sequelae and impaired social function in the individual. Accompanying these detrimental effects to the dependent individual are costs to their families and society secondary to impaired social and occupational functioning and increased criminal behavior or violence. In recent years there have been considerable gains in our understanding of the neurobiology of opioid dependence and in the development of new pharmacological and behavioral treatments for opioid dependence.

Epidemiology

In 1999 there were estimated to be 1 million chronic users of heroin in the United States, or 0.4% (4 per 1000) of the population (Rhodes et al., 2000).

Type
Chapter
Information
Cambridge Textbook of Effective Treatments in Psychiatry , pp. 381 - 401
Publisher: Cambridge University Press
Print publication year: 2008

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