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).