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Review

Illicit Opiate Abuse

Wayne Hall, Chris Doran, Louisa Degenhardt, Donald Shepard
Dean T Jamison, Joel G Breman, Anthony R Measham, George Alleyne, Mariam Claeson, David B Evans, Prabhat Jha, Anne Mills, Philip Musgrove
, editors.
In: Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 48.
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Review

Illicit Opiate Abuse

Wayne Hall et al.
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Excerpt

Illicit opioid use, especially injecting use, contributes to premature mortality and morbidity in many developed and developing societies. Fatal overdoses and HIV/AIDS resulting from the sharing of dirty injecting equipment are major contributors to mortality and morbidity, and the economic costs of illicit opioid dependence are substantial. Illicit opioid dependence generates substantial externalities that are not included in burden-of-disease estimates, principally law enforcement costs incurred in handling drug dealing and property crime.

The most popular interventions for illicit opioid dependence in many developed societies have been law enforcement efforts to interdict the drug supply and enforce legal sanctions against the use of opioid drugs. One consequence of this strategy has been that most illicit opioid users have been exposed to the least effective intervention: imprisonment for drug or property offenses. Prisons rarely take the opportunity to treat dependence using opioid maintenance or to reduce the harm caused by illicit opioid use by providing access to clean injecting equipment.

In treatment settings, the most popular interventions have been detoxification (which is not a treatment but a prelude to treatment) and drug-free treatment (which is the least attractive and the least effective in retaining opioid-dependent people in treatment). Opioid agonist maintenance treatment has been ambivalently supported in many developed societies despite its being the treatment for which there is the best evidence of effectiveness, safety, and cost-effectiveness. The range of opioid agonists available for maintenance treatment is increasing. A number of developed countries have approved the use of BMT, which the limited data suggest may be approximately equivalent to MMT in efficacy and cost-effectiveness. Opioid antagonists have a niche role in the treatment of opioid dependence because of poor compliance and an increased risk of overdose on return to heroin use. Their efficacy may improve with the development of long-acting injectable forms of the drug.

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References

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