Approximately one million Americans are dependent on heroin, prescription painkillers and other opioids, but the vast majority of them--as many as 800,000--aren't receiving any treatment.
Opiate substitutes that prevent withdrawal are among the most effective treatments for such addictions, when combined with psychological counseling, researchers say. But until recently, only two such drugs--methadone and levo-alpha-acetyl methadol (LAAM)--were available, and only licensed treatment clinics were authorized to dispense them. Many addicts avoid opiate treatment programs (OTPs) because of their inconvenience or perceived stigma, and even those who would like to enroll sometimes can't because of limited treatment slots.
The approval of a new medication by the Food and Drug Administration (FDA) last fall, however, could reshape the landscape of opiate addiction treatment in the United States, making pharmacotherapy available and attractive to patients who previously shunned it, say researchers.
Psychologists have played a key role in developing the medication--buprenorphine--by conducting the basic and clinical research that defined its unusual pharmacology. They are continuing to shape its use by influencing training programs for physicians. And they are developing the behavioral and psychosocial treatments that are a critical part of any effective substance abuse treatment program.
And as the network of physicians who are certified to prescribe buprenorphine grows, it should also provide new opportunities for psychologists to get involved in pharmacotherapy-based substance abuse treatment by making such treatments available in a wide variety of settings and increasing the number of patients who use pharmacotherapies--and who therefore need the counseling and behavioral treatments that psychologists can provide.
"It's a very, very exciting time to be involved with buprenorphine work," says psychologist Leslie Amass, PhD, of the Friends Research Institute in Santa Monica, Calif., who has been studying the use of buprenorphine as a treatment for opiate addiction since the early 1990s. "For those of us who have been involved with the medication from very early on, it's rewarding to see it get to this point and be offered to patients.