SUBSTITUTION PHARMACOTHERAPIES FOR OPIOID ADDICTION - FROM METHADONE TO LAAM AND BUPRENORPHINE

The efficacy and cost-effectiveness of opioid substitution therapy for the treatment of opioid addiction has been well documented within the methadone maintenance model for over thirty years. However, methadone does not meet the specific treatment needs of all opioid-dependent pe rsons who might benefit from substitution therapy; consequently, a sig nificant proportion of heroin addicts remain untreated. The recent app roval of l-alpha-acetylmethadol (LAAM) as a maintenance treatment agen t represents the first opioid substitution alternative to methadone. L AAM is a fundamentally different medication than methadone, with uniqu e pharmacological characteristics. Its use requires a different approa ch to the clinical management of opioid substitution therapy and a dif ferent medication delivery strategy. The availability of LAAM has pote ntial important implications for patients, clinics, and the community at large. Full realization of its advantages could move opioid substit ution therapy into mainstream medical care and draw into treatment a s ubstantial number of new patients able to benefit from such treatment. Buprenorphine, the other new opioid substitution therapy under develo pment, shares some common advantages with LAAM. Its high safety profil e and low physical dependence liability make it uniquely suitable for a subset of addicts as well as an initial treatment of choice in the o pioid substitution treatment armamentarium.