Treatment of heroin (diamorphine) addiction - Current approaches and future prospects

New pharmacological treatments for heroin (diamorphine) addiction include drugs that reduce opiate withdrawal symptoms and agents that are given during the maintenance phase of treatment. A variety of different types of pharmacological agents (opioid agonists, partial opioid agonists, opioid antagonists and alpha(2)-adrenoreceptor agonists) are reviewed and the evidence of their use during managed withdrawal and maintenance are presented. Experimental approaches attempting to reduce the time of opiate withdrawal and to accelerate the transition to abstinence are being developed. The combination tablet of buprenorphine and naloxone that is to be introduced for office-based maintenance is currently undergoing intense evaluation in the US. This new approach may facilitate the expansion of treatment while reducing the potential for medication diversion and intravenous use. The use of heroin continues to increase and is estimated that eight million people in the world (0.14%) abuse opiates. The regions with the highest annual prevalence (2%) are South East and South West Asia,([1]) and based on the National Household Survey.([2]) the annual prevalence of heroin use in the US is 0.3% with a rising trend of heroin use in the last 2 years.[3] Comprehensive treatments for heroin dependence include environmental changes. psychosocial interventions and pharmacotherapy. Recent advances in pharmacotherapy are aimed at reducing problems associated with persistent heroin use and expanding the accessibility of long-term treatment. For example, the introduction of the combination tablet of buprenorphine and naloxone into drug abuse treatment in an office-based setting should expand available treatment slots and facilitate general medical care of individuals who are addicted.([4,5]) This review focuses on the rationale, indications and limitations of medications that either facilitate the reduction of withdrawal symptoms during detoxification or improve the overall psychosocial stabilisation during maintenance, and briefly discusses potential future directions for opiate dependence treatments.