Addiction Therapy
Although opioids are generally safe and effective when used in carefully selected patient populations, they have the potential to be used for non-medical purposes. The non-medical use of opioids has existed throughout recorded human history and includes recreational drug users who may use such agents episodically and individuals with an addiction disorder who desire frequent use.
Nonmedical opioid users source their supply from non-pharmaceutical sources (e.g., heroin) or as pharmaceutical dosage forms through manipulation of the medical system. For instance, unsuspecting clinicians may prescribe opioids for pain to individuals with an addiction disorder or individuals with pain who divert a portion of their prescribed dose to other persons. There have also been documented cases of inappropriate prescribing or dispensing of opioids by physicians and pharmacists, with its eventual diversion into the non-medical marketplace. In addition, the non-medical supply of pharmaceutical-grade opioids is often achieved through prescription forgeries and theft from pharmacies.
According to the American Academy of Pain Medicine, the American Pain Society and the American Society of Addiction Medicine, addiction is a neurobiological disease characterized by behaviors with at least one of the following attributes: impaired control over drug use, compulsive use, use despite harm and craving for the drug.
In the past, a common approach to treatment of opioid dependence involved medically supervised detoxification or opioid withdrawal. However, the long term success rates for opioid detoxification were found to be quite low. Consequently, opioid maintenance therapy, where patients receive stable doses of opioids at regular intervals for extended periods has largely replaced opioid detoxification, particularly after several failed detoxification attempts. In opioid maintenance therapy, medically supervised pharmaceutical grade opioids are provided to the patient in place of non-medically sourced opioids. Opioid maintenance therapy attenuates the acute subjective effects of heroin and other illicit opioids and decreases the intoxication/withdrawal cycle that is seen in heroin dependent individuals. Opioid maintenance therapy has demonstrated a number of benefits, including reduction in heroin and other illicit drug use, crime, HIV risk and death.
Two commonly used treatments for opioid maintenance therapy are sublingual buprenorphine (Suboxone®/Subutex®) and methadone. The 2009 sales for sublingual buprenorphine for opioid dependence were $970 million.
Illicit Use of Prescription Pain Drugs
