:shamrock: :shamrock:
Methadone History lesson, for noneya.
http://international.drugabuse.gov/coll ... tion4.html NIDA International Program, National Institute on Drug Abuse
6001 Executive Boulevard, Room 5274
Bethesda, Maryland 20892 USA
Phone: +1-301-443-6480
E-mail:
http://www.mssm.edu/msjournal/67/6756.shtml. [Accessed March 23, 2006.]
National Institute on Drug Abuse. Research Report Series: Heroin Abuse and Addiction. Bethesda, MD: NIDA, 2005a. Available online at:
http://www.drugabuse.gov/ResearchReport ... eroin.html. [Accessed March 26, 2006.]
National Institute on Drug Abuse. NIDA Info Facts: Heroin. Bethesda, MD: NIDA, 2005b. Available online at:
http://www.drugabuse.gov/infofacts/heroin.html. [Accessed March 26, 2006.]
Substance Abuse and Mental Health Services Administration. Table 4.4A Numbers (in Thousands) of Persons Who Initiated Heroin Use in the United States, Their Mean Age at First Use, and Rates of First Use (per 1,000 Person-Years of Exposure): 1965-2003, Based on 2002-2004 NSDUHs. Results From the 2004 National Survey on Drug Use and Health, Detailed Tables. Rockville, MD: SAMHSA Office of Applied Statistics, 2005. Available online at:
http://www.oas.samhsa.gov/nsduh/2k4nsdu ... s1to15.pdf. [Accessed March 26, 2006.]
United Nations Department of Social Affairs. History of heroin. Bulletin on Narcotics 1953;V(2):3-16. Available online at:
http://www.u[/quote]
Part A: Questions and Answers Regarding the History and Evolution of Methadone Treatment of Opioid Addiction in the United States
Question 3: What is the history of U.S. regulation of heroin?
Answer:U.S. regulations governing the manufacture, distribution, or use of heroin fall into four historical time periods:
* 1860-1909: Minimal Government Involvement
* 1909-1924: Increasing Federal Government Role
* 1924-1960: Criminalization of Narcotics Use
* 1960-Present: Combined Medical-Criminal Approach
1860-1909: Minimal Government Involvement
The Institute of Medicine documents U.S. narcotics policies from the 19th century through 1992 (Courtwright, 1992). In the first years following widespread use of heroin in the United States, there were no Federal regulations about the manufacture, distribution, or use of heroin, and the few State or municipal laws that existed were enforced sporadically. Physicians, pharmacists, and opportunists were free to prescribe opioids–and treat subsequent opioid addiction–in whatever manner they chose, which contributed to widespread addiction and sometimes unscrupulous practices. Inadvertent addiction to early over-the-counter medications prompted enactment of the 1906 Pure Food and Drug Act, which first authorized Federal regulations on any medication.
1909-1924: Increasing Federal Government Role
In the United States, heroin was first placed under Federal control by the 1914 Harrison Narcotic Act, which required anyone who sold or distributed narcotics–importers, manufacturers, wholesale and retail druggists, and physicians–to register with the Federal Government and pay an excise tax. The United Nations Bulletin on Narcotics documents early international efforts to address opioid addiction (United Nations Department of Social Affairs, 1953). The United States was among the organizers of the 1909 International Opium Commission in Shanghai, China, and a signatory of the 1912 Hague Opium Convention, the first international treaty to make heroin a controlled substance.
1924-1960: Criminalization of Narcotics Use
Between 1924 and 1960, the United States approved a series of progressively stiffer narcotics policies, first establishing mandatory sentences for possession and sale of opioids in 1951 (Courtwright, 1992). Internationally, the United States was a signatory to two more international treaties to limit the manufacture of narcotics: the Geneva Convention of 1925 and the Limitation Convention of 1931 (United Nations Department of Social Affairs, 1953).
1960-Present: Combined Medical-Criminal Approach
Scientific advances in the 20th century revolutionized our understanding of addiction and contributed to a medical approach to drug abuse treatment coupled with criminal sanctions for drug traffickers. The 1962 White House Conference on Narcotic Drug Abuse first recommended more flexible sentencing, wider latitude in medical treatment, and more emphasis on rehabilitation and research. By 1971, the Special Action Office of Drug Abuse Prevention (SAODAP), established within the White House, was responsible for drug treatment and rehabilitation, prevention, education, training, and research.
Currently, heroin is regulated under the Controlled Substances Act. Federal policies and regulations about heroin are coordinated by the following agencies:
* The Office of National Drug Control Policy (ONDCP) operates within the White House to establish policies, priorities, and objectives for the Nation's drug control program.
* The Substance Abuse and Mental Health Services Administration (SAMHSA) operates within the U.S. Department of Health and Human Services to promote and regulate addiction treatment services.
* The Drug Enforcement Administration (DEA) operates within the Department of Justice to prevent diversion and illicit use of controlled substances and administer criminal sanctions for drug traffickers.
References
Courtwright D. A century of American narcotic policy. In: Institute of Medicine. Treating Drug Problems: Volume 2. Washington, DC: IOM, 1992, pp. 1-62. Available online at: books.nap.edu/openbook.php?isbn=0309043964. [Accessed March 23, 2006.]
United Nations Department of Social Affairs. History of heroin. Bulletin on Narcotics 1953;V(2):3-16. Available online at: http://www.unodc.org/unodc/en/data-and- ... ge011.html. [Accessed March 22, 2006.]
Part A: Questions and Answers Regarding the History and Evolution of Methadone Treatment of Opioid Addiction in the United States
Question 4: How have U.S. regulations about treatment for heroin addiction evolved?
Answer: U.S. regulations about treatment for heroin addiction evolved through three time periods:
* 1914-1972
* 1972-2000
* 2000-Present
U.S. regulations about treatment for heroin addiction have evolved from strict prohibition of medical prescription of heroin to treat addiction, which began in 1914 and continued into the 1960s. Initial pilot studies testing methadone maintenance treatment for heroin addiction began in 1964, and methadone maintenance treatment was formally approved in 1972. Scientific advances prompted major reviews of Federal regulations by the Institute of Medicine in 1995 (Rettig and Yarmolinsky, 1995) and the National Institutes of Health in 1998. Both reports recommended reducing Federal regulations and improving patients’ access to treatment. The Drug Addiction Treatment Act of 2000 (Substance Abuse and Mental Health Services Administration, 2000b) made significant changes in U.S. regulations about treatment for heroin addiction, reducing Federal regulations and paving the way for new pharmacotherapies to treat heroin addiction.
1914-1972
Although heroin became a controlled substance under the Harrison Act of 1914, the law did not expressly prohibit the medical prescription of heroin to treat addiction. The U.S. Government concluded that the Harrison Act intended to prohibit such medical uses of controlled substances, prosecuting individual doctors who prescribed the drugs. In 1919, the U.S. Supreme Court upheld the Government’s position in Webb v. United States. In response, about 40 localities opened municipal narcotic clinics to treat addiction using a variety of methods, including medical prescription of narcotics, but by the mid-1920s, these clinics had all been closed by the Federal Government (Hentoff, 1965; Courtwright, 1992). A decade later, the U.S. Public Health Service established narcotics hospitals in Lexington, Kentucky, and Forth Worth, Texas, to treat heroin addiction. From 1935 through the 1960s, the Kentucky facility was the "single most important treatment and research facility in the country (Courtwright, 1992). In 1949, researchers at the Kentucky hospital first demonstrated that methadone could be effective in withdrawing patients from heroin, but relapse rates were as high as 90 percent in subsequent studies. A 1964 pilot study by Drs. Vincent P. Dole and Marie E. Nyswander first demonstrated that methadone maintenance could be an effective medical intervention for heroin addiction (Joseph, Stancliff, and Langrod, 2000).
1972-2000
Methadone maintenance treatment for heroin addiction was first approved by the U.S. Food and Drug Administration in 1972, subject to three levels of Federal regulation:
* Food and Drug Administration rules that pertained to all prescription drugs
* Drug Enforcement Administration rules that governed all controlled substances
* Unique Department of Health and Human Services rules limiting methadone maintenance treatment to strictly controlled opioid treatment programs, which also were subject to additional State or local rules
2000-Present
The Drug Addiction Treatment Act of 2000 (Substance Abuse and Mental Health Services Administration, 2000b) revised Federal regulations governing methadone maintenance treatment, making them both more rigorous and more practical. While treatment providers have more latitude in planning individualized treatment regimens and prescribing methadone dosages, they also must document and analyze outcomes and correct shortcomings (Marion, 2005). The law also authorized office-based dispensing of treatment medications providing physicians met specific licensing, certification, training, and best practices requirements. Buprenorphine, a new pharmacotherapy to treat heroin addiction (Substance Abuse and Mental Health Services Administration, 2000a), was approved for office-based dispensing by the Food and Drug Administration in 2002.
References
Courtwright D. A century of American narcotic policy. In: Institute of Medicine. Treating Drug Problems: Volume 2. Washington, DC: IOM, 1992, pp. 1-62. Available online at: books.nap.edu/openbook.php?isbn=0309043964. [Accessed March 23, 2006.]
Hentoff N. The treatment of patients - I. The New Yorker 1965;June 26:32-77.
Joseph H, Stancliff S, Langrod J. Methadone maintenance treatment (MMT): a review of historical and clinical issues. The Mount Sinai Journal of Medicine 2000;67(5 & 6):347-64. Available online at: http://www.mssm.edu/msjournal/67/6756.shtml. [Accessed March 23, 2006.]
Marion IJ. Methadone treatment at forty. NIDA Science & Practice Perspectives 2005;3(1):25-31. Available online at: http://drugabuse.gov/Perspectives/vol3no1.html. [Accessed March 23, 2006.]
National Institutes of Health. Effective Medical Treatment of Opiate Addiction: Consensus Development Conference Statement. Bethesda, MD: NIH, 1998. Available online at: http://consensus.nih.gov/1997/1998Treat ... 08html.htm. [Accessed March 22, 2006.]
Rettig R, Yarmolinsky A (eds.). Federal Regulation of Methadone Treatment. Washington, DC: Institute of Medicine, 1995, pp. 1-16. Available online at: books.nap.edu/catalog.php?record_id=4899. [Accessed March 22, 2006.]
Substance Abuse and Mental Health Services Administration. About Buprenorphine Therapy. Rockville, MD: SAMHSA, 2000a. Available online at: http://buprenorphine.samhsa.gov/about.html. [Accessed March 23, 2006.]
Substance Abuse and Mental Health Services Administration. Drug Addiction Treatment Act of 2000. Rockville, MD: SAMHSA, 2000b. Available online at: http://buprenorphine.samhsa.gov/data.html. [Accessed March 23, 2006.]
]Part A: Questions and Answers Regarding the History and Evolution of Methadone Treatment of Opioid Addiction in the United States
Question 5: What is methadone?
Answer: Methadone is a rigorously well-tested medication that has been safely used to treat opioid addiction in the United States for more than 40 years. Methadone
* Blocks the craving for opioids that is a major factor in relapse.
* Suppresses the symptoms of opioid withdrawal for 24 to 36 hours.
* Blocks the effects of administered heroin.
* Does not cause euphoria, intoxication, or sedation.
References
Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention. Methadone Maintenance Treatment. Atlanta, GA: CDC, 2000. Available online at: http://www.cdc.gov/idu/facts/MethadoneFin.pdf. [Accessed March 23, 2006.]
Joseph H, Stancliff S, Langrod J. Methadone maintenance treatment (MMT): a review of historical and clinical issues. The Mount Sinai Journal of Medicine 2000;67(5 & 6):347-64. Available online at: http://www.mssm.edu/msjournal/67/6756.shtml. [Accessed March 23, 2006.]
Office of National Drug Control Policy. Drug Policy Information Clearinghouse Fact Sheet: Methadone. Washington, DC: ONDCP, 2000. Available online at: http://www.whitehousedrugpolicy.gov/pub ... index.html. [Accessed March 23, 2006.]
Substance Abuse and Mental Health Services Administration. Medication Assisted Treatment. Rockville, MD: SAMHSA, 2005. Available online at: http://www.dpt.samhsa.gov/404error.aspx ... samhsa.gov /treatment.htm. [Accessed March 27, 2006
* Information / Resources
* E-news
* Publications
* Meetings
* International Forum
* NIH Resources
* International
* Program Link
[quotes
NIDA International Program, National Institute on Drug Abuse
6001 Executive Boulevard, Room 5274
Bethesda, Maryland 20892 USA
Phone: +1-301-443-6480
E-mail: http://www.drugabuse.gov/OtherResources.html
This list of Web links is not exhaustive, but is designed to introduce sites that may be of interest to the international community of drug abuse researchers.
U.S. Government Agencies
Department of Health and Human Services http://www.hhs.gov
* Centers for Disease Control and Prevention (CDC) http://www.cdc.gov
* National Institutes of Health http://www.nih.gov
o National Institute on Drug Abuse http://www.drugabuse.gov
+ NIDA Networking Project nnp.drugabuse.gov
+ NIDA’s Clinical Trials Network Dissemination Library http://www.ctndisseminationlibrary.org
+ NIDA Clinical Trials Network Data Share http://www.ctndatashare.org
o Fogarty International Center http://www.fic.nih.gov
o National Library of Medicine (PubMed, Medline) http://www..nlm.nih.gov
o RePORT (Research Portfolio Online Reporting Tool) report.nih.gov
o Links to all NIH Institutes, Centers, and Offices http://www.nih.gov/icd
* Substance Abuse and Mental Health Services Administration (SAMHSA) http://www.samhsa.gov
Office of National Drug Control Policy http://www.whitehousedrugpolicy.gov
Department of Justice http://www.usdoj.gov
* National Criminal Justice Reference Service http://www.ncjrs.org
Department of State http://www.state.gov
United Nations
http://www.un.org
* Joint United Nations Programme on HIV/AIDS http://www.unaids.org
* United Nations Office on Drugs and Crime http://www.unodc.org
o TreatNet http://www.unodc.org/treatment/index.html
* World Health Organization http://www.who.int
o WHO Substance Abuse http://www.who.int/substance_abuse
o WHO HIV/AIDS Programme http://www.who.int/hiv
* World Drug Report http://www.unodc.org/unodc/en/data-and- ... s/WDR.html
Non-U.S. Governmental Agencies
Australia
* Australian Drug Foundation http://www.adf.org.au
* New South Wales Mental Health and Drug and Alcohol Office http://www.druginfo.nsw.gov.au
Canada
* Canadian Centre on Substance Abuse http://www.ccsa.ca
* Centre for Addiction and Mental Health (Canada) http://www.camh.net
European Union
* European Monitoring Centre for Drugs and Drug Addiction http://www.emcdda.europa.eu
* Pompidou Group http://www.coe.int/T/DG3/Pompidou/Default_en.asp
United Kingdom
* Foresight Brain Science, Addiction and Drugs Project http://www.foresight.gov.uk/Previous_Pr ... index.html
U.S. Professional Organizations
* American Association for the Treatment of Opioid Dependence http://www.aatod.org
* American Psychiatric Association http://www.psych.org
* American Psychological Association http://www.apa.org
* American Public Health Association http://www.apha.org
* American Society of Addiction Medicine http://www.asam.org
* American Society for Clinical Pharmacology and Therapeutics http://www.ascpt.org
* American Sociological Association http://www.asanet.org
* Association for Psychological Science http://www.psycologicalscience.org
* College on Problems of Drug Dependence http://www.cpdd.vcu.edu
* National Inhalant Prevention Coalition http://www.inhalants.org
* Robert Wood Johnson Foundation http://www.rwjf.org
* Society for Neuroscience http://www.sfn.org
* Society for Prevention Research http://www.preverntionresearch.org
* Society of Behavioral Medicine http://www.sbm.org
* Society for Research on Nicotine and Tobacco http://www.srnt.org
International Professional Organizations
* Australian Drug Information Network http://www.adin.com.au
* Collegium Internationale Neuro-Psychopharmacologium http://www.cinp.org
* European Behavioural Pharmacology Society http://www.ebps.org
* European Opiate Addiction Treatment Association (Europad) http://www.europad.org
* Global Research Network on HIV Prevention in Drug-Using Populations grn-hiv-du.org/Default.aspx
* National Drug Prevention Alliance (UK) http://www.drugprevent.org.uk
* International AIDS Society http://www.iasociety.org
* International Society of Addiction Journal Editors www-users.york.ac.uk/~sjp22/isaje/isaje.htm
* International Brain Research Organization http://www.ibro.org
* International Cannabinoid Research Society http://www.cannabinoidsociety.org
* International Council on Alcohol and Addictions http://www.icaa.ch
* International Narcotics Research Conference http://www.inrcworld.org
* International Society for Neurochemistry – World’s Neurochemistry Portal http://www.neurochem.org
* International Society of Addiction Medicine http://www.isamweb.org
o International Certification in Addiction Medicine http://www.terveysportti.fi/kotisivut/s ... vusto=1534
* U.S. Civilian Research and Defense Foundation http://www.crdf.org
* World Federation of Therapeutic Communities http://www.wftc.org
NIDA International Program Research Partners
NIDA has signed letters of understanding to cooperate on biomedical and behavioral drug abuse research with the following institutions:
Latin America:
* Inter-American Drug Abuse Control Commission (CICAD) at the Organization of American States http://www.cicad.oas.org
Mexico:
* National Council Against Addictions (CONADIC), Mexico City http://www.conadic.gob.mx
Netherlands:
* Health Research and Development Council (ZonMw), The Hague http://www.zonmw.nl
* Netherlands Organisation for Scientific Research, The Hague http://www.nwo.nl
Russia:
* Pavlov Medical University, St. Petersburg http://www.spmu.runnet.ru/spmu/lbpharm/
Spain:
* National Plan on Drugs (PNSD), Madrid http://www.pnsd.msc.es/
* National Institute of Drug Research and Training, Madrid http://www.pnsd.msc.es//infid/index_infid3.htm
Taiwan:
* Taipei Medical University, Taipei eng.tmu.edu.tw
Research Resources
* International Society of Addiction Journal Editors http://www.PARINT.org
* Research Assistant http://www.theresearchassistant.com/index.asp
* Health InterNetwork Access to Research Initiative (HINARI) http://www.who.int/hinari/en/
* International Network for Availability of Scientific Publications (INASP) http://www.inasp.info
There you are noneya....
Danny