Response: Anticipating New Medications

Lawrence DeMarzo: My agency, House of the Crossroads, like other drug-free com­ munity-based agencies, has historically cho­ sen not to use medications in its treatment regimens. That is changing now, through our involvement in NIDA’s Clinical Trials Network and our acquaintance with litera­ ture like Dr. Kampman’s article (Kampman, 2008). Much has changed since we started Cross­ roads. We know a lot more about addiction and treatment than we did 40 years ago. Although the agency is not using any med­ ications yet, we are considering implementing a methadone-to-abstinence model for heroin abusers. Methadone appeals to us, because we have seen that it works, and because it seems to be a service line that produces sta­ ble utilization and retention, which a feefor-service structure needs to generate rev­ enue to cover the cost of care. I was impressed and encouraged by Dr. Kampman’s positive outlook on the potential for medications to treat stimulant abuse. The drugs in this class, particularly crack cocaine and metham­ phetamine, have had the most devastating effects on our community and present the greatest challenge to us in terms of provid­ ing effective treatment.