A Research Update from the National Institute on Drug Abuse —
August 2006
Drug abuse is a significant risk factor for HIV/AIDS in the U.S.
Opiate Addiction in the United States
Heroin, morphine, and some prescription painkillers (e.g., OxyContin, Vicodin, and Fentanyl) belong to the class of
drugs known as opiates. They act on specific (opiate) receptors in the brain, which also interact with naturally
produced substances known as endorphins or enkephalins– important in regulating pain and emotion. And while
prescription painkillers are highly beneficial medications when used as prescribed, opiates as a general class of
drugs have significant abuse liability.
Currently, approximately 1 million people in the United States are addicted to heroin (Office of National Drug
Control Policy, 2000), and more than 3 million people over the age of 12 have used heroin at least once [National
Survey on Drug Use and Health (NSDUH), 2004]. What's more, an estimated 1.4 million people are dependent on
or abusing other opiate drugs, including prescription painkillers [NSDUH (Ibid)].
Scientific research has led to effective treatments for opiate addiction:
- In the 1960's, methadone gained recognition as an effective treatment for heroin addiction. Administered
daily, methadone treatment is currently regulated so that only specialized clinics can provide it.
- Naltrexone, an opioid receptor blocker, joined the medications inventory in 1984. It proved to be highly
effective in reversing the effects of opiate overdose, but poor treatment adherence has hampered its utility
to promote abstinence.
- Buprenorphine, the newest medication in our toolkit, is a long-acting partial agonist that acts on the same
receptors as heroin and morphine, relieving drug cravings without producing the same intense "high" or
dangerous side effects.
These medications, along with effective behavioral treatments and outreach efforts, have not only reduced
injection drug use in this country, but have also helped reduce the spread of HIV/AIDS– from a peak of more than
25,000 new cases in 1993 to fewer than 10,000 cases in 2003.
The Buprenorphine Success Story
NIDA-supported basic and clinical research led to the development of
buprenorphine, which culminated in a large NIDA-sponsored, multisite clinical trial
demonstrating its effectiveness. The trial showed that, alone or in combination with
naloxone, buprenorphine significantly reduced opiate drug abuse and cravings and
was a safe and acceptable addiction treatment (figure).
While these products were being developed in concert with industry partners,
Congress passed the Drug Addiction Treatment Act (DATA 2000) permitting
qualified physicians to prescribe narcotic medications (Schedules III to V) for the
treatment of opioid addiction. This legislation created a major paradigm shift by
allowing access to opiate treatment in a medical setting rather than limiting it to
federally approved Opioid Treatment Programs.
The FDA approved Subutex® (buprenorphine) and Suboxone® tablets (buprenorphine/naloxone) in October 2002,
making them the first medications to be eligible for prescribing under the DATA 2000. To date, nearly 10,000
physicians have taken the training needed to prescribe these two medications, and nearly 7,000 have registered
as potential providers.
Buprenorphine's Pioneering Contributions to Addiction Treatment
- Buprenorphine's novel formulation with naloxone, an opioid antagonist, limits abuse and diversion
potential. Scientific breakthroughs led to this formulation, which produces severe withdrawal symptoms in
those who inject it to get "high" but no adverse effects when taken orally, as prescribed.
- Buprenorphine represents a health services delivery innovation. The development of buprenorphine and
its authorized use in physicians' offices gives opiate-addicted patients more medical options and extends
the reach of addiction medication to remote populations. Its accessibility may even prompt earlier attempts
to obtain treatment.
Reaching Into the Community
Through our unique "blending" partnership with SAMHSA, NIDA is developing and
disseminating protocols to educate multidisciplinary treatment professionals about
buprenorphine (http://www.ctndisseminationlibrary.org/display/85.htm). Blending
Teams of NIDA researchers, treatment practitioners, and trainers have completed
two buprenorphine training packets:
- To increase overall awareness of buprenorphine therapy, and
- To instruct physicians and treatment practitioners in implementing a 13-day
detoxification intervention for opiate-dependent patients.
Through these efforts, buprenorphine has helped change the mindset of many
community treatment providers previously unwilling to consider the use of medications to treat drug addiction.
Some of these programs now regularly use buprenorphine to assist in opiate detoxification and treatment
maintenance.
Where We Are Going Next
- We will continue to test the safety and efficacy of buprenorphine in other affected populations, including
pregnant women, adolescents, and patients addicted to opiate analgesics.
- Working with SAMHSA's Addiction Technology Transfer Centers (ATTCs), State Directors, and other
stakeholders, we are continuing to spread the word about buprenorphine to more proactively address the
urgent needs of drug addiction.
- We are striving to increase the use of this and other addiction medications in different settings and locales,
including in the U.S. criminal justice system and in countries where injection drug use is still a primary
mode of HIV transmission.