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Current Bibliographies in Medicine 97­7

Effective Medical Treatment of Heroin Addiction

January 1994 through September 1997 plus selected earlier citations

941 Citations

Prepared by

Mary E. Conway, M.L.S., National Library of Medicine

James R. Cooper, M.D., National Institute on Drug Abuse

1997 November

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

National Institutes of Health

National Library of Medicine

Reference Section

8600 Rockville Pike

Bethesda, Maryland 20894

Series Note

Table of Contents for this bibliography

Introduction to this bibliography

Sample Citations

Series Note

Each bibliography in the Current Bibliographies in Medicine (CBM) series covers a distinct

subject area of biomedicine and is intended to fulfill a current awareness function. Citations

are usually derived from searching a variety of online databases. NLM databases utilized

include MEDLINE®, AVLINE®, BIOETHICSLINE®, CANCERLIT®, CATLINE®, HEALTHSTAR

tm,

POPLINE

tm, and TOXLINE®. The only criterion for the inclusion of a particular published work

is its relevance to the topic being presented; the format, ownership, or location of the material

is not considered.

Other publications in the Current Bibliographies in Medicine series are available at no cost to
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http://www.nlm.nih.gov/pubs/resources.html.

Comments and suggestions on this series may be addressed to:

Karen Patrias, Editor

Current Bibliographies in Medicine

Reference Section

National Library of Medicine

Bethesda, MD 20894

Phone: 301­496­6097

Fax: 301­402­1384

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Return to title page | Return to table of contents

Table of Contents

Series Note

Introduction

Sample Citations

Bibliography:

Overview and Natural History of Heroin Addiction and Opiate Agonist Treatment

History and Current Status of Opiate Agonist Treatment

The Natural History of Opiate Addiction

Molecular Neurobiology and Pathogenesis of Opiate Addiction

Genetic and Other Risk Factors

Neurobiological Substrates

PET Studies of Brain Function

Diagnosis of Heroin Abuse and Addiction

Consequences of Untreated Opiate Addiction

Narcotic Drugs and Crime

Societal Costs of Heroin Addiction

Economic Cost Offsets of Methadone Treatment

Transmission of Bloodborne Viruses Among Heroin Injectors

­ Overall

­ HIV/AIDS

­ Hepatitis

­ Other Viruses

Methadone Treatment of HIV­Infected Pregnant Women

Deaths Among Heroin Users In and Out of Methadone Treatment

Other Medical Complications

Current Opiate Addiction Treatment Modalities

Detoxification with or without Opiate Agonist Treatment
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Nonpharmacological/Psychosocial Treatment

Opiate Agonist Treatment, Molecular Pharmacology, and Physiology

Predictors of Treatment Outcome for Heroin Addiction

Differential Patient Characteristics

Patient Engagement and Duration of Treatment

Matching Treatment Services to Patient Problems

Methadone Dose and Outcome

Methadone SubstitutionTreatment in the United Kingdom

Barriers to the Effective Use and Availability of Opiate Agonist Treatment

Community, Staff, and Patient Perceptions and Attitudes

Access to Narcotic Addiction Treatment and Medical Care

Diversion and Trafficking of Methadone and Law Enforcement

Narcotic Agonist Treatment as a Benefit Under Managed Care

Legal, Regulatory, and Funding Barriers

Return to title page

Introduction

EFFECTIVE MEDICAL TREATMENT OF HEROIN ADDICTION

This bibliography was prepared in support of the National Institutes of Health Consensus

Development Conference on Effective Medical Treatment of Heroin Addiction held in Bethesda,

Maryland on November 17­19, 1997. The conference was sponsored by the National Institute

on Drug Abuse and the NIH Office of Medical Applications of Research; the NIH Office of

Research on Women's Health was cosponsor.

In the United States alone, approximately one­half million people are addicted to heroin.

Estimates of heroin incidence (122,000 new users) in recent years suggest an increased

incidence and an emerging pattern of drug use among the young. For many years, heroin

addiction has been associated with increased criminal activity and human suffering. In the past

10 years, there has been a dramatic increase in the prevalence of human immunodeficiency

virus (HIV), hepatitis C virus (HCV), and tuberculosis among intravenous heroin users. From

1991 to 1995 in major metropolitan areas, the annual number of heroin­related emergency

room visits has increased from 36,000 to 76,000, and the annual number of heroin­related

deaths has increased from 2,300 to 4,000. The associated morbidity and mortality further

underscore the human, economic, and societal cost of heroin addiction.

Over the last 20 years, a significant body of evidence has accumulated on the neurobiology of

heroin addiction and on the safety and efficacy of narcotic (methadone) maintenance

treatment. Although there have been other medications (e.g., levo­alpha acetylmethadol

[LAAM]) subsequently determined safe and effective in narcotic maintenance treatment, the

focus of this consensus development conference was on methadone, because methadone has

been the medication used in most narcotic treatment research. Evaluation studies have

consistently shown methadone treatment to be effective in reducing drug use and crime and in

enhancing social productivity. More recent studies demonstrate that methadone treatment is

an effective method for preventing the spread of HIV, HCV, and tuberculosis among

intravenous drug users.

Most heroin users are not receiving treatment. Most recent data indicate that there are

approximately 112,000 patients in narcotic maintenance treatment. Barriers exist to both

access to narcotic maintenance treatment and effective treatment, despite the science on the

neurobiology of heroin addiction and the evidence demonstrating the effectiveness of

treatment in reducing drug use and crime and preventing the spread of HIV and HCV. An

important reason for some of these barriers is that narcotic maintenance treatment remains

controversial. The science has not yet overcome the stigma of addiction and public perception

about narcotic maintenance treatment. Many members of the medical community and the

public conceive of opiate addiction as a self­inflicted disease of the will, methadone treatment
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as mere narcotic substitution with relapses likely to follow treatment, drug­free treatment as

the only valid rehabilitative method, and total abstinence from all drugs, including methadone,

as the only valid treatment goal. Other obstacles include Federal and state government

regulations limiting treatment providers and patient access and concerns about methadone

diversion by patients and its consequences.

The consensus development conference brought together national and international experts to

present and discuss the most important and controversial issues surrounding narcotic

maintenance treatment. An independent, non­Federal consensus panel addressed the following

key questions:

What is the scientific evidence to support conceptualization of opiate addiction as a

medical disorder including natural history, genetics and risk factors, and

pathophysiology, and how is diagnosis established?

What are the consequences of untreated opiate addiction to individuals, families, and

society?

What is the efficacy of current treatment modalities in the management of opiate

addiction including detoxification alone, non­pharmacological/psychosocial treatment,

treatment with opiate antagonists, and treatment with opiate agonists (short­term and

long­term)?

What is the scientific evidence for the most effective use of opiate agonists in the

treatment of opiate addiction?

What are the important barriers to effective use of opiate agonists in the treatment of

opiate addiction in the U.S. including perceptions and adverse consequences of opiate

agonist use, legal, regulatory, financial, and programmatic barriers?

What are the future research areas and recommendations for improving opiate agonist

treatment and improving access?

This bibliography is organized along the same lines as the conference agenda with additional

subsections for specific medical complications of opiate addiction. Citations include journal

articles, books and book chapters, conference proceedings, conference papers and posters,

hearings, and meeting abstracts. The majority of selected references are from January 1994 to

September 1997 and are in English with the focus on heroin addiction in the United States.

Older references were selected to provide background for the main topics of the conference.

References within each subject category are listed alphabetically by author; a reference may

be included in more than one category

Any reproductions of this bibliography, in whole or in part, must include all credits. If you wish

to cite this bibliography, the correct format is:

Conway, Mary E..; Cooper, James R., compilers. Effective medical treatment of heroin

addiction [bibliography online]. Bethesda (MD): National Library of Medicine; 1997 Nov [insert

cited year month day in brackets]. [insert no. of screens or lines in brackets]. (Current

bibliographies in medicine; no. 97­7). 941 citations from January 1994 through September

1997. Available from: URL http://www.nlm.nih.gov/pubs/resources.html

Return to title page | Return to table of contents

Sample Citations

Citations are formatted according to the rules established for Index Medicus ®. Sample journal

and monograph citations appear below. For journal articles written in a foreign language, the

English translation of the title is placed in brackets; for monographs, the title is given in the

original language. In both cases the language of publication is shown by a three letter

abbreviation appearing at the end of the citation.

Journal Article:

Example:
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Bakir AA, Dunea G. Drugs of abuse and renal disease. Curr Opin Nephrol Hypertens 1996

Mar;5(2):122­6.

Order, with separating punctuation:

Authors. Article Title. Abbreviated Journal Title Date;Volume(Issue):Pages.

Monograph:

Example:

Ball JC, Ross A. The effectiveness of methadone maintenance treatment: patients, programs,

services and outcome. New York: Springer­Verlag; c1991. 293 p.

Order, with separating punctuation:

Authors/Editors. Title. Place of Publication: Publisher; Date. Total No. of Pages.

Monograph Chapter:

Example:

Anglin MD, Hser YI. Treatment of drug abuse. In: Tonry M, Wilson JQ, eds. Drugs and crime.

Chicago: University of Chicago Press; 1990. p. 393­458.

Order, with separating punctuation:

Chapter Authors. Chapter Title. Connective Phrase. Monograph Editors. Monograph Title. Place

of Publication: Publisher; Date. Pages of Chapter.

For details of the formats used for references, see the following publication:

Patrias, Karen. National Library of Medicine recommended formats for bibliographic citation.

Bethesda (MD): The Library; 1991 Apr. Available from: NTIS, Springfield, VA; PB91­182030.

Return to title page | Return to table of contents

Overview and Natural History of Heroin Addiction and Opiate Agonist Treatment

History and Current Status of Opiate Agonist Treatment

Dole VP. Hazards of process regulations. The example of methadone maintenance. JAMA 1992

Apr 22­29;267(16):2234­5.

Dole VP, Nyswander M. Medical treatment for diacetylmorphine (heroin) addiction. A clinical

trial with methadone hydrochloride. JAMA 1965 Aug 23;193:646­50.

Dole VP, Nyswander ME, DesJarlais D, Joseph H. Sounding Board. Performance­based rating of

methadone maintenance programs. N Engl J Med 1982 Jan 21;306(3):169­71.

Gerstein DR, Harwood HJ, eds. Treating drug problems. Washington (DC): National Academy

Press; 1990­92. 2 vols.

Glasscote RM. The treatment of drug abuse: programs, problems, prospects. Washington (DC):

Joint Information Service of the American Psychiatric Association and the National Association

for Mental Health; 1972. 250 p.

Jaffe J. The maintenance option and the Special Action Office for Drug Abuse Prevention.

Psychiatr Ann 1975 Oct;5(10):12­39.

Jaffe JH, Schuster CR, Smith BB, Blachley PH. Comparison of acetylmethadol and methadone

in the treatment of long­term heroin users. A pilot study. JAMA 1970 Mar 16;211(11):1834­6.

McGlothlin WH, Anglin MD. The compulsory treatment of opiate dependence. New York:

Haworth Press; 1991.
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Molinari SP, Cooper JR, Czechowicz DJ. Federal regulation of clinical practice in narcotic

addiction treatment: purpose, status, and alternatives. J Law Med Ethics 1994 Fall;22(3):231­

9.

Musto DF. The American disease: origins of narcotic control. New Haven (CT): Yale University

Press; c1973.

Musto DF. The American disease: origins of narcotic control. New York: Oxford University

Press; c1987.

Payte JT. Methadone maintenance treatment: The first thirty years. J Psychoact Drugs 1997

Apr­Jun;29(2):149­53.

Rettig RA, Yarmolinsky A. Federal regulation of methadone treatment. Washington (DC):

National Academy Press; 1995. 248 p.

Robins LN. The sixth Thomas James Okey Memorial Lecture. Vietnam veterans' rapid recovery

from heroin addiction: a fluke or normal expectation? Addiction 1993 Aug;88(8):1041­54.

Smith AB, Pollack H. When working out drug policy, look backward. Natl Law J 1997 Mar

24;19(30):A25.

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1042 p.

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The Natural History of Opiate Addiction

Anglin MD, Hser YI. Treatment of drug abuse. In: Tonry M, Wilson JQ, eds. Drugs and crime.

Chicago: University of Chicago Press; 1990. p. 393­458. (Crime and justice: a review of

research; 13).

Anglin MD, Hser YI, Chou CP. Reliability and validity of retrospective behavioral self­report by

narcotics addicts. Eval Rev 1993 Feb;17(1):91­108.

Bailey RC, Hser YI, Hsieh SC, Anglin MD. Influences affecting maintenance and cessation of

narcotics addiction. J Drug Issues 1994 Winter­Spring;24(1­2):249­72.

Bremner JD, Southwick SM, Darnell A, Charney DS. Chronic PTSD in Vietnam combat

veterans: course of illness and substance abuse. Am J Psychiatry 1996 Mar;153(3):369­75.

Frykholm B, Anthony JC, Warner LA, Kessler RC. The drug career. Comparative epidemiology

of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from

the National Comorbidity Survey. J Drug Issues 1985 Summer;15(3):333­46.

Goldstein A, Herrera J. Heroin addicts and methadone treatment in Albuquerque: a 22­year

follow­up. Drug Alcohol Depend 1995 Dec;40(2):139­50.

Hser YI, Anglin MD, Powers K. A 24­year follow­up of California narcotics addicts. Arch Gen

Psychiatry 1993 Jul;50(7):577­84.

Hser YI, Yamaguchi K, Chen JK, Anglin MD. Effects of interventions on relapse to narcotics

addiction: an event­history analysis. Eval Rev 1995 Apr;19(2):123­40.

Maddux JF, Desmond DP. Careers of opioid users. New York: Praeger; 1981. 232 p.

Mariezcurrena R. Recovery from addictions without treatment: literature review. Scand J

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McGlothlin WH, Anglin MD, Wilson BD. Evaluation of the California civil addict program.

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McGlothlin WH, Anglin MD, Wilson BD. Narcotic addiction and crime. Criminology 1978

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Nurco DN, Balter MB, Kinlock T. Vulnerability to narcotic addiction: preliminary findings. J

Drug Issues 1994 Winter­Spring;24(1­2):293­314.

Nurco DN, Bonito AJ, Lerner M, Balter MB. Studying addicts over time: methodology and

preliminary findings. Am J Drug Alcohol Abuse 1975;2(2):183­96.

Senay EC. Clinical implications of drug abuse treatment outcome research. NIDA Res Monogr

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Simpson D, Sells SB, eds. Opioid addiction and treatment: a 12­year follow­up. Malabar (FL):

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Stephens RC. The street addict role: a theory of heroin addiction. Albany (NY): State

University of New York Press; c1991. 223 p.

Tims FM, Ludford JP, eds. Drug abuse treatment evaluation: strategies, progress, and

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Vaillant GE. A 12­year follow­up of New York narcotic addicts. 3. Some social and psychiatric

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Vaillant GE. Is there a natural history of addiction? Res Publ Assoc Res Nerv Ment Dis

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Vaillant GE. What can long­term follow­up teach us about relapse and prevention of relapse in

addiction? Br J Addict 1988 Oct;83(10):1147­57.

Woods G. Drug abuse in society: a reference handbook. Santa Barbara (CA): ABC CLIO; 1993.

269 p.

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Molecular Neurobiology and Pathogenesis of Opiate Addiction

Genetic and Other Risk Factors

Anthony JC, Warner LA, Kessler RC. Comparative epidemiology of dependence on tobacco,

alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity

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Cadoret RJ, Troughton E, O'Gorman TW, Heywood E. An adoption study of genetic and

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Castaneda R, Lifshutz H, Galanter M, Franco H. Empirical assessment of the self­medication

hypothesis among dually diagnosed inpatients. Compr Psychiatry 1994 May­Jun;35(3):180­4.

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Childress AR, Ehrman R, McLellan AT, MacRae J, Natale M, O'Brien CP. Can induced moods

trigger drug­related responses in opiate abuse patients? J Subst Abuse Treat 1994 JanFeb;11(1):17­23.

Comings DE, Muhleman D, Gade R, Johnson P, Verde R, Saucier G, MacMurray J. Cannabinoid

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Gainey RR, Catalano RF, Haggerty KP, Hoppe MJ. Deviance among the children of heroin

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Gerra G, Caccavari R, Marcato A, Zaimovic A, Avanzini P, Monica C, Mutti A, Fontanesi B,

Delsignore R, Brambilla F. Alpha­1­ and 2­adrenoceptor subsensitivity in siblings of opioid

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Neurobiological Substrates

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First published: 15 November 1997

Last updated: 15 November 1997

Date Archived: 29 August 2004

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U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894

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Last updated: 15 November 1997

Copyright, Privacy, Accessibility

U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894

National Institutes of Health, Health & Human Services