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Opioids: Heroin and Prescription Drugs

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Addiction Medicine

Abstract

A number of approaches have been used in the treatment of opioid dependence. Methadone maintenance has been demonstrated to be efficacious and cost-effective in a number of clinical trials. There are also good guidelines on various aspects of its use, including doses during induction and maintenance, supervision of doses and potential adverse effects. Buprenorphine is a μ-opioid receptor partial agonist that has been proven effective for maintenance treatment in clinical trials. There appears little difference in outcomes between methadone and buprenorphine, although methadone maintenance may be associated with slightly higher retention rates. Conversely, buprenorphine is associated with lower risk of respiratory depression and may also be associated with lower risk of some of the adverse effects of chronic opioid administration such as hypogonadism and low bone mineral density. Both morphine in slow-release formulations and diacetyl morphine have been used in maintenance treatment, but do not have the evidence base of methadone or buprenorphine. Naltrexone has shown some evidence of efficacy in treatment of dependence, but is associated with very low retention rates. Newer implant and depot formulations may prove more successful. For treatment of withdrawal both opioid agonists such as buprenorphine and the α2 adrenergic agonists such as clonidine have shown efficacy, although the degree of withdrawal suppression is likely to be greater with the opioids. While psychosocial and ancillary treatment is widely regarded as important, there are as yet very few studies to indicate the optimal form of such treatment.

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  1. Division of Health Sciences, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia

    Jason M. White

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    Bankole A. Johnson

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White, J.M. (2010). Opioids: Heroin and Prescription Drugs. In: Johnson, B. (eds) Addiction Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0338-9_51

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