Problem with the term: Although this is a clinical diagnosis in the DSMIV and ICD10, this is a stigmatizing word because
Preferred terminology: Misuse, harmful use, inappropriate use, hazardous use, problem use, risky use, substance use disorder
The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definitions and recommend their use: see definitions
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Butrans® is a transdermal buprenorphine patch by Purdue Pharma FDA approved and indicated for the management of moderate to severe chronic pain in patients requiring a continuous, around-the-clock opioid analgesic for an extended period of time. Each Butrans patch is intended to be worn for 7 days. Comes in 3 doses; 5 mcg/hour, 10 mcg/hour, and 20 mcg/hour. Butrans is not indicated for the treatment of opioid dependence (addiction) and it is actually illegal for any US physician to prescribe Butrans off-label for the treatment of opioid dependence (addiction).
Craving (formerly called psychological dependence ) is an intense desire to reexperience the effects of a psychoactive substance. Craving is the cause of relapse after long periods of abstinence.(N Engl J Med 2003;349:975-86.)(see urges)
According to Harm Reduction International ‘Harm Reduction’ refers to policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community. Source: Harm Reduction International http://www.ihra.net/what-is-harm-reduction
Although harm reductionists recognize that some people need treatment for their addictions, the main focus of harm reduction is for those who are not experiencing consequences of drug use sufficient enough to outweigh the desire to continue to take drugs. Not everyone who takes drugs becomes addicted and the harm reductionists advocate for this population and try to minimize legal and health consequences making ongoing or occasional recreational drug use less risky.
It is wrong to characterize buprenorphine treatment for opioid addiction as “Harm Reduction” Buprenorphine treatment is not harm reduction in the sense of the harm reduction movement. Although buprenorphine treatment literally reduces harm, it is not meant as a means to enable ongoing recreational drug use. Instead it is a means of ending addictive behavior by suppressing cravings and withdrawal and allowing the patient to make substantial life changes that will in effect rewire the brain from an addicted brain to a non-addicted brain, then tapered off of when no longer needed.
Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.
Orphan status provides marketing protection and federal grant money for the development of certain drugs. The FDA grants companies orphan status for drugs and biologics which are defined as those intended for the treatment, diagnosis or prevention of rare diseases that affect fewer than 200,000 people in the U.S., or that affect more than 200,000 persons but are not expected to recover the costs of developing and marketing a treatment drug.
The FDA Office of Orphan Products Development mission is to advance the evaluation and development of products (drugs, biologics, devices, or medical foods) that demonstrate promise for the diagnosis and/or treatment of rare diseases or conditions. Suboxone® and Subutex® were granted orphan drug status and received marketing exclusivity protection for 7 years after FDA approval (Oct. 2002 – Oct. 2009)
Orphan Drug Act –Full Text.
The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definitions and recommend their use. see definitions
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Pending FDA approval, expected approval Q2 2013 -UPDATE- FDA DENIES approval 4/30/2013 - asks for more data
-UPDATE- FDA APPROVES PROBUPHINE IN MAY 2016 - AVAILABLE NOW
With SUBSTANCE ABUSE the user has a choice: he/she uses in spite of illegal, unsafe consequences, or inappropriateness of the drinking/drugging experience. Opioid Abuse is a specific type of Substance Abuse.
The use of buprenorphine has been approved for the diagnosis of Opioid Dependence NOT Opioid Abuse. An accurate diagnosis is essential in determining what treatment if any is appropriate.
Due to the resulting confusion between the terms "physical dependence" and "substance dependence" there is some talk within the industry of reintroducing the term "addiction" because it is better understood and may pose less chance of confusion.
The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definition see definition
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.
VIVITROL® is an opioid antagonist. VIVITROL is indicated for the prevention of relapse to opioid dependence, following opioid detoxification. VIVITROL is indicated for the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment with VIVITROL. Opioid-dependent patients, including those being treated for alcohol dependence, must be opioid-free at the time of initial VIVITROL administration. VIVITROL should be part of a comprehensive management program that includes psychosocial support. Patients should not be actively drinking at the time of initial VIVITROL administration.
Unlike Suboxone, which is a treatment for opioid dependence, Vivitrol is for the prevention of relapse. It is important to successfully treat the addiction disorder before initiating this type of relapse prevention protocol. If relapse prevention with naltrexone is begun before the underlying addiction condition is sufficiently in remission the patient may experience the unpleasant symptoms of a chronic addiction disorder.
To suppress the debilitating symptoms of cravings and withdrawal, enabling the patient to engage in therapy, counseling and support, so they can implement positive long-term changes in their lives which develops into the new healthy patterns of behavior necessary to achieve sustained addiction remission. - explain -