"Virtually all drug courts (98%) reported that at least some of their participants were opioid-dependent in 2010. Prescription opioids were more frequently cited as the primary opioid problem than heroin (66% vs. 26%). This trend is particularly apparent in less densely populated areas: prescription versus heroin rates across the three population areas were: rural (76% vs. 12%), suburban (67% vs. 33%), and urban (prescription opioids less likely to be selected than heroin as the primary opioid; 38% vs. 50%); p < .01.
Methadone & Buprenorphine
Methadone Maintenance & Buprenorphine Therapy
(Risk of Death and Other Adverse Events from Anesthesia-Assisted Rapid Opioid Detoxification (AAROD)) "Government agencies and professional societies,* including the American Society of Addiction Medicine, have recommended against using AAROD in clinical settings (9). There is insufficient knowledge regarding how widely AAROD is used in the United States and the frequency of AAROD-associated adverse events in community practice settings. At least seven deaths occurred following AAROD among 2,350 procedures performed in one practice during 1995–1999.†
(Trends in Treatment Admissions for Heroin Addiction and in Opioid Substitution Treatment in the US, 2003-2013) "General measures of heroin abuse among treatment admissions aged 12 and older were relatively consistent from 2003 through 2011, accounting for 13 to 15 percent of TEDS admissions in those years, but rose to 16 percent in 2012 and 19 percent in 2013 [Table 1.1b]. In 2013, injection was the preferred route of administration for 71 percent of primary heroin admissions, inhalation for 23 percent, and smoking for 4 percent [Table 2.4].
(Methadone vs. Buprenorphine Treatment) "Opioid dependence and addiction, whether to heroin or prescription pain relievers, is a serious, life-threatening medical condition. Methadone and buprenorphine are medications that permit addicted individuals to function normally within their families, jobs, and communities. While treatment with methadone is more established, it requires daily visits to an OTP. Not all individuals who could benefit from methadone treatment live within easy travelling distance of an OTP.
(Efficacy of Naltrexone Treatment) "Studies conducted in St. Petersburg, Russia, for more than a decade have demonstrated the efficacy and safety of different naltrexone formulations (oral, implantable, injectable) for relapse prevention and maintenance of abstinence in detoxified opioid addicts. The positive results from different formulations seem related to two cultural factors. One is that relatives can be recruited to supervise daily dosing of the oral formulation. However, this advantage is decreasing as the addicted population ages.
(Improving Naltrexone Treatment Outcomes) "However, one problem markedly reduces naltrexone’s efficacy and has limited its use for treating heroin and other forms of opioid dependence worldwide: patients often do not like it and do not take it on a daily basis.
(Efficacy of Extended-Release Injectable Naltrexone) "Findings from a 24-week randomized controlled trial comparing extended-release injectable naltrexone (Vivitrol, Alkermes) to placebo in individuals with current opioid dependence have been considered in the recent indication for extended-release injectable naltrexone for the treatment of opioid dependence.
(Efficacy of Long-Acting Injectable Naltrexone) "A randomized, double-blind, placebo-controlled trial examined the treatment efficacy of long-acting injectable naltrexone (Naltrel, DrugAbuse Sciences) for relapse prevention in 60 heroin-dependent individuals. Patients were stratified by sex and years of heroin use and randomized to receive placebo, 192 mg, or 384 mg of long-acting naltrexone intramuscular injections dosed on weeks 1 and 5. In addition to medication, patients received relapse prevention therapy and had urine monitored for drug relapse.
(Sustained Release Naltrexone Implants) "In order to overcome the issues of poor treatment adherence with oral naltrexone, a number of sustained-release implants have been developed internationally for use in alcohol and opioid dependence. A non-randomized retrospective review examined two types of sustained-release naltrexone implants, oral naltrexone, and historical controls revealed a significant difference between immediate and sustained-release injectable naltrexone in individuals opioid-free 12 months after initiating treatment.
(Compliance Problems with Naltrexone) "Despite the ease of outpatient dosing and its ability to effectively block the euphoric effects of ?-opioid agonists, naltrexone has had limited success for relapse prevention when compared with maintenance therapy with methadone or buprenorphine.