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M9470127.TXT
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1994-07-02
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Document 0127
DOCN M9470127
TI Managing illicit drug use. A practical guide.
DT 9409
AU Wodak A; Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst,;
New South Wales, Australia.
SO Drugs. 1994 Mar;47(3):446-57. Unique Identifier : AIDSLINE MED/94252206
AB Illicit drug use is spreading, especially in the developing world, but
has begun to stabilise in most developed countries. The phenomenon of
illicit drug use is still poorly understood, with responses in most
countries influenced largely by cultural factors. A range of
psychosocial and pharmacotherapeutic treatments is available; of these,
methadone maintenance treatment for heroin dependence has the most
evidence of benefit. A large body of literature--including some well
designed studies--indicates that methadone reduces heroin use,
mortality, criminal activity and risk of human immunodeficiency virus
(HIV) infection. Methadone is more likely to be effective if higher
doses, longer durations of treatment and more realistic goals are set.
However, research findings which would improve outcomes considerably are
often not implemented. Methadone maintenance programmes, which attract
and retain more illicit drug users than other treatment modalities, are
now being made more available in many countries in recognition of their
therapeutic effectiveness and utility in reducing the spread of HIV
infection among people injecting heroin. HIV infection is now recognised
in many countries to be the most serious complication of illicit drug
use for both individual drug injectors and their communities.
Levo-alpha-acetylmethadol (LAAM) has similar properties to methadone but
a longer half-life. This suggests a number of clinical benefits which
would also reduce the cost of treatment. However, LAAM has not been
approved by regulatory authorities for routine use despite positive
findings in some studies. Buprenorphine has shown some promise in the
management of heroin dependence but is still undergoing evaluation. It
is, however, unlikely to ever be used widely for the management of
illicit drug users. Naltrexone may have some advantages for special
populations. Pharmacotherapeutic treatment for cocaine and amphetamine
users is still at a developmental stage.
DE Buprenorphine/THERAPEUTIC USE Counseling Disulfiram/THERAPEUTIC USE
Human Methadone/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE Methadyl
Acetate/PHARMACOKINETICS/THERAPEUTIC USE
Naltrexone/PHARMACOKINETICS/THERAPEUTIC USE Psychotherapy Self-Help
Groups Substance Abuse/EPIDEMIOLOGY/*REHABILITATION/*THERAPY Substance
Abuse Treatment Centers/ECONOMICS/*ORGANIZATION & ADMIN JOURNAL ARTICLE
REVIEW REVIEW, TUTORIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).