This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (35)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Substance Abuse/ Alcoholism  • Alert me on articles by topic  Social Bookmarking   What's this?

Growing Implications for Primary Care

Mori J. Krantz, MD; Philip S. Mehler, MD

Arch Intern Med. 2004;164:277-288.

Almost 3 million Americans have abused heroin. The most effective treatment for this concerning epidemic is opioid replacement therapy. Although, from a historical perspective, acceptance of this therapy has been slow, growing evidence supports its efficacy. There are 3 approved medications for opioid maintenance therapy: methadone hydrochloride, levomethadyl acetate, and buprenorphine hydrochloride. Each has unique characteristics that determine its suitability for an individual patient. Cardiac arrhythmias have been reported with methadone and levomethadyl, but not with buprenorphine. Due to concerns about cardiac risk, levomethadyl use has declined and the product may ultimately be discontinued. These recent safety concerns, specifics about opioid detoxification and maintenance, and new federal initiatives were studied. Opioid detoxification has a role in both preventing acute withdrawal and maintaining long-term abstinence. Although only a minority of eligible patients are engaged in treatment, opioid maintenance therapy appears to offer the greatest public health benefits. There is growing interest in expanding treatment into primary care, allowing opioid addiction to be managed like other chronic illnesses. This model has gained wide acceptance in Europe and is now being implemented in the United States. The recent Drug Addiction Treatment Act enables qualified physicians to treat opioid-dependent patients with buprenorphine in an office-based setting. Mainstreaming opioid addiction treatment has many advantages; its success will depend on resolution of ethical and delivery system issues as well as improved and expanded training of physicians in addiction medicine.

From the Department of Medicine, University of Colorado Health Sciences Center, and Denver Health, Denver. The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

QTc Prolongation Among Hospitalized Patients Receiving Methadone
John Schmittner and Mori J. Krantz
Arch Intern Med. 2006;166(20):2289.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study
McCowan et al.
BMJ 2009;338:b2225-b2225.
ABSTRACT | FULL TEXT  

Sublingual Buprenorphine for Treatment of Neonatal Abstinence Syndrome: A Randomized Trial
Kraft et al.
Pediatrics 2008;122:e601-e607.
ABSTRACT | FULL TEXT  

Methadone, Commonly Used as Maintenance Medication for Outpatient Treatment of Opioid Dependence, Kills Leukemia Cells and Overcomes Chemoresistance
Friesen et al.
Cancer Res. 2008;68:6059-6064.
ABSTRACT | FULL TEXT  

Dopamine in Drug Abuse and Addiction: Results of Imaging Studies and Treatment Implications
Volkow et al.
Arch Neurol 2007;64:1575-1579.
ABSTRACT | FULL TEXT  

End-of-Life Care for Homeless Patients: "She Says She Is There to Help Me in Any Situation"
Kushel and Miaskowski
JAMA 2006;296:2959-2966.
ABSTRACT | FULL TEXT  

QTc Prolongation Among Hospitalized Patients Receiving Methadone.
Schmittner and Krantz
Arch Intern Med 2006;166:2289-2289.
FULL TEXT  

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy
Alford et al.
ANN INTERN MED 2006;144:127-134.
ABSTRACT | FULL TEXT