Effective medical treatment of opiate addiction

Objective.-To provide clinicians, patients, and the general public with a r esponsible assessment of the effective approaches to treat opiate dependenc e. Participants.-A nonfederal, nonadvocate, 12-member panel representing the f ields of psychology, psychiatry, behavioral medicine, family medicine, drug abuse, epidemiology, and the public. In addition, 25 experts from these sa me fields presented data to the panel and a conference audience of 600, Pre sentations and discussions were divided into 3 phases over 2 1/2 days: (1) presentations by investigators working in the areas relevant to the consens us questions during a 2-day public session; (2) questions and statements fr om conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remai nder of the second day and morning of a third day. The conference was organ ized and supported by the Office of Medical Applications of Research, Natio nal Institutes of Health. Evidence.-The literature was searched through MEDLINE and other National Li brary of Medicine and online databases from January 1994 through September 1997 and an extensive bibliography of 941 references was provided to the pa nel and the conference audience. Experts prepared abstracts for their prese ntations as speakers at the conference with relevant citations from the lit erature. Scientific evidence was given precedence over clinical anecdotal e xperience. Consensus Process.-The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and t he scientific literature. The panel composed a draft statement that was rea d in its entirety and circulated to the experts and the audience for commen t. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the r evisions within a few weeks af; ter the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions. Conclusions-Opiate dependence is a brain-related medical disorder that can be effectively treated with significant benefits for the patient and societ y, and so ciety must make a commitment to offer effective treatment for opi ate dependence to all who need it. All persons dependent on opiates should have access to methadone hydrochloride maintenance therapy under legal supe rvision, and the US Office of National Drug Control Policy and the US Depar tment of Justice should take the necessary steps to implement this recommen dation. There is a need for improved training for physicians and other heal th care professionals. Training to determine diagnosis and treatment of opi ate dependence should also be improved in medical schools. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate a gonist treatment programs should be reduced, and coverage for these program s should be a required benefit in public and private insurance programs.