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• W1566011100 abstract "Clinicians treating people with opioid dependence are fortunate to have three medications that can provide substantial reductions in illicit opioid use and addiction-related problems: methadone, buprenorphine and naltrexone (NIH Consensus Conference 1998; Johnson et al. 2004; Krupitsky et al. 2004). LAAM was a fourth, but it is no longer unavailable as a result of its association with cardiac conduction delays. In this regard, treating opioid addiction is easier than treating amphetamine, cocaine or many other addictions where no effective medications are available, although a few promising leads have emerged recently (Dackis 2005; Dackis et al. 2005). However, in the case of opioid addiction, as pointed out by Eder et al. (2005), there is a large gap between those who might benefit from pharmaceutical treatment and those who actually receive it. This gap is seen even in western societies where all three medications are approved for use, although under varying levels of clinical and regulatory involvement, which influence their availability. The need for effective treatment of opioid dependence is arguably greatest in areas such as China, Russia, the former Soviet States and South-east Asia, where heroin addiction has increased in parallel with HIV, and agonist treatments are either illegal or have only recently become available. Compare this situation to the treatment of asthma, cardiovascular disease, cancer, depression, diabetes or a host of other illnesses where a wide range of medications is available, and their approval seems to largely follow studies showing they are safe and effective. Because patients with similar disorders do not always respond equally to the same medication, having more options is a good thing because it provides more chances to balance side effects and efficacy. In this regard, the study by Eder et al. (2005) is important, as it provides strong data that long-acting morphine may be equally effective to methadone and, at least for some patients, has fewer side-effects. If replicated, long-acting morphine could be approved for general use as an additional treatment option that might close the gap between treatment need and utilization. However, such a development would depend on a number of steps including regulatory approval, getting the medication into hospital and insurance formularies, reimbursement policies and having clinicians use it. The regulatory aspect will vary across different settings. The formulary and reimbursement aspects are likely to depend on the price for the drug compared to its alternatives. The clinical aspect depends on the degree to which it is actually used. Each of these steps can present barriers, especially for a long-acting agonist that, like methadone, may be subject to ‘ideological battles that persist and controversy that is impervious to considerable scientific evidence’ (Lowinson et al. 1997). However, the journey toward clinical use begins with data—and the paper by Eder et al. (2005) is an excellent starting-point. Additional studies are needed to replicate their findings; to quantify the degree to which long-acting morphine reduces illicit heroin use, perhaps by testing urine for contaminants typically present in illicit heroin, as is being undertaken in the German heroin maintenance study; and to see if addicts will ‘outsmart’ the long-acting formulation to release morphine that can be injected like heroin. The findings by Eder et al. (2005) could lead to a new indication for long-acting morphine, and a useful addition to the limited number of pharmacotherapies currently available for treating opioid dependence, which could help to close the gap between those receiving treatment and those who need it. Reckitt-Benckiser provides Suboxone that is being used in a NIDA study on which Dr Woody is the Lead Investigator. Dr Woody is consultant to Ortho-McNeill Pharmaceutical and Purdue Pharma Inc." @default.
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• W1566011100 date "2005-12-01" @default.
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• W1566011100 title "New horizons: sustained release morphine as agonist treatment" @default.
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• W1566011100 doi "https://doi.org/10.1111/j.1360-0443.2005.01286.x" @default.
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