Both recent trends in illicit drug use in the United States and pharmacotherapies that clinicians can use to treat certain substance use disorders, such as opioid dependence, were the focus of a symposium at APA’s Institute on Psychiatric Services in San Francisco, which ended Sunday.
“For a while, until 2000, the United States was seeing a marked decrease in heroin use” that spanned a period of nearly 10 years, Petros Levounis, M.D., M.A. (shown in photo), chair of the Department of Psychiatry at Rutgers New Jersey Medical School, said at the session. “Then we had the explosion of prescription opioid use, which became an epidemic.” In an interview with Psychiatric News, Levounis said that because heroin has become less expensive, and sometimes easier to acquire, than prescription opiates, heroin has become the drug of choice for some addicts and accounts for the rapid spread of its use throughout the country in the last few years, along with more people showing up in emergency rooms suffering from heroin overdoses and needing addiction treatment.
Levounis explained that there are currently three FDA-approved pharmacotherapies to treat opiate dependence: methadone, buprenorphine, and naltrexone/naloxone. “There is no ‘one-size fits-all’ treatment… [and] efficacy of the treatments may vary from person to person,” he said. Levounis noted in a later interview with Psychiatric News that there are no “new” medications in the drug-development pipeline to treat opioid addiction, but there are newer formulations of FDA-approved drugs, such as probuphine, which is an implantable, long-injection version of buprenorphine that helps patients adhere to their addiction-treatment regimen.
For more information about opioid dependence, see the Psychiatric News article “Caution Urged for Clinicians Who Prescribe Opioids.” Levounis is co-author of The Addiction Casebook, available from American Psychiatric Publishing, which describes strategies for diagnosing and treating patients with various types of addictions.