25 - Opiates and Prescription Drugs

Abstract

A dramatic change in the opiate misuse problem in the United States occurred in the mid-1990s. Opioid pharmaceuticals replaced heroin as the dominant drugs of abuse, and the number of users quadrupled. In both 2005 and 2006, pain relievers replaced marijuana as the most common new drug of abuse among first-time users aged 12 and older. The number of individuals meeting criteria for opioid use disorders has almost tripled and now exceeds 2 million adults and adolescents. There has also been a shift in demographics, with new users more likely to be white, employed, and better educated. Compared with heroin abusers, this group is less sociopathic, but more likely to have had prior treatment for other psychiatric disorders. Fortunately, the treatment options for these individuals are also more diverse and accessible. Traditionally, long-term therapeutic communities and methadone maintenance programs offered the only effective treatment for most opiate addicts. With the US Food and Drug Administration’s (FDA’s) approval of buprenorphine for use in office-based settings, a new and highly effective treatment became available and gained wide acceptance among clients. Treatment options were expanded further with the approval of extended-release naltrexone for opioid use disorder. The most effective treatments approach opiate dependence as a chronic, relapsing disease that requires long-term care and that integrates comprehensive medical and psychiatric services to address co-occurring conditions.