Current and Experimental Therapeutics for the Treatment of Opioid Addiction

Currently, numerous effective pharmacologic and behavioral therapies are available for the treatment of opioid addiction, and these two types of therapies often are combined to optimize patient management. Newer therapeutic options may take various forms. For example, methadone maintenance is an established treatment modality, whereas the use of buprenorphine and naloxone in an office-based setting represents a new variation on that theme. Clonidine has been used extensively to ameliorate opioid withdrawal signs, whereas lofexidine is a structural analogue that appears to have less hypotensive and sedating effects. The depot dosage form of naltrexone, currently under development, may increase compliance with a medication that has been an effective opioid antagonist but that has been underused secondary to patient nonacceptance. In almost every treatment episode using pharmacotherapy, it is combined with some type of psychosocial or behavioral treatment. Recent research has documented the value of these additional treatments and has provided insight into the ones that are the most effective. This chapter reviews current and experimental treatments for opioid addiction with an emphasis on some of the newer, more promising, and interesting therapies.