INTRODUCTION The recent discoveries of the existence of opiate receptors and of endogenous opioid peptides in the central nervous system of animals and man have raised hopes that an understanding of the molecular mechanism of drug addiction may soon be achieved. It is clear from the title of this chapter that that day is not yet here. I will give a brief chronological review of the significant ...

This article provides an overview of central issues in chronic nonmalignant pain management with a focus on prescribing opioid analgesics. Definitions are provided for terminology regarding pain and addiction. Epidemiology of addiction among patients with chronic nonmalignant pain is reviewed. Benefits and complications of opioid therapy are discussed, along with recent regulatory issues for pr...

Conventional definitions of drug addiction are focused on characterizing the neurophysiological and behavioral responses of mammals. Although mammalian models have been invaluable in studying specific and complex aspects of addiction, invertebrate systems have proven advantageous in investigating how drugs of abuse corrupt the most basic motivational and neurochemical systems. It has recently b...

Opiate and cocaine addictions are major social and medical problems that impose a significant burden on society. Despite the size and scope of these problems, there are few effective treatments for these addictions. Methadone maintenance is an effective and most widely used treatment for opiate addiction, allowing normalization of many physiological abnormalities caused by chronic use of short-...

Opioid pain reliever addiction has increased among women of reproductive age over the last fifteen years. News media and public attention have focused on the implications of this trend for infants exposed to opioids prenatally, with state policy responses varying in the extent to which they are punitive or public health oriented. We fielded a six-group randomized experiment among a nationally r...

Pharmacotherapies for opioid addiction under active development in the US include lofexidine (primarily for managing withdrawal symptoms) and Probuphine®, a distinctive mode of delivering buprenorphine for six months, thus relieving patients, clinicians, and regulatory personnel from most concerns about diversion, misuse, and unintended exposure in children. In addition, two recently approved f...

TREATMENT of chronic pain in patients with a history of opioid addiction is difficult since tolerance to the opioid agonist effects may require extremely large opioid doses for pain control. Furthermore, insufficient pain control may be hard to discern from craving for more opioids. Although drug-free periods, also called “drug holiday,” can reestablish sensitivity to drugs used to treat Parkin...

Opioid misuse and addiction is an ongoing and rapidly evolving public health crisis, requiring innovative scientific solutions. In response, and because no existing medication is ideal for every patient, the National Institutes of Health (NIH) is joining with private partners to launch an initiative in three scientific areas: developing better overdose-reversal and prevention interventions to r...

This issue ofMolecular Pharmacology is dedicated to Dr. Avram Goldstein, the journal’s founding editor and one of the leaders in the development of modern pharmacology. This article focuses on his contributions to the discovery of the dynorphins and evidence that members of this family of opioid peptides are endogenous agonists for the kappa opioid receptor. In his original publication describi...

This issue ofMolecular Pharmacology is dedicated to Dr. Avram Goldstein, the journal’s founding editor and one of the leaders in the development of modern pharmacology. This article focuses on his contributions to the discovery of the dynorphins and evidence that members of this family of opioid peptides are endogenous agonists for the kappa opioid receptor. In his original publication describi...