EFFECTIVE MEDICAL TREATMENT OF OPIATE ADDICTION

National Consensus Development Panel on Effective Medical Treatment of
Opiate Addiction

Objective.--To provide clinicians, patients, and the general public with a
responsible assessment of the effective approaches to treat opiate
dependence.

Participants.--A nonfederal, nonadvocate, 12-member panel representing the
fields of psychology, psychiatry, behavioral medicine, family medicine, drug
abuse, epidemiology, and the public. In addition, 25 experts from these same
fields presented data to the panel and a conference audience of 600.
Presentations and discussions were divided into 3 phases over 2BD days: (1)
presentations by investigators working in the areas relevant to the
consensus questions during a 2-day public session; (2) questions and
statements from conference attendees during open discussion periods that are
part of the public session; and (3) closed deliberations by the panel during
the remainder of the second day and morning of a third day. The conference
was organized and supported by the Office of Medical Applications of
Research, National Institutes of Health.

Evidence.--The literature was searched through MEDLINE and other National
Library of Medicine and online databases from January 1994 through September
1997 and an extensive bibliography of 941 references was provided to the
panel and the conference audience. Experts prepared abstracts for their
presentations as speakers at the conference with relevant citations from the
literature. Scientific evidence was given precedence over clinical anecdotal
experience.

Consensus Process.--The panel, answering predefined questions, developed its
conclusions based on the scientific evidence presented in open forum and the
scientific literature. The panel composed a draft statement that was read in
its entirety and circulated to the experts and the audience for comment.
Thereafter, the panel resolved conflicting recommendations and released a
revised statement at the end of the conference. The panel finalized the
revisions within a few weeks after the conference. The draft statement was
made available on the World Wide Web immediately following its release at
the conference and was updated with the panel's final revisions.

Conclusions.-- Opiate dependence is a brain-related medical disorder that
can be effectively treated with significant benefits for the patient and
society, and society must make a commitment to offer effective treatment for
opiate dependence to all who need it. All persons dependent on opiates
should have access to methadone hydrochloride maintenance therapy under
legal supervision, and the US Office of National Drug Control Policy and the
US Department of Justice should take the necessary steps to implement this
recommendation. There is a need for improved training for physicians and
other health care professionals. Training to determine diagnosis and
treatment of opiate dependence should also be improved in medical schools.
The unnecessary regulations of methadone maintenance therapy and other
long-acting opiate agonist treatment programs should be reduced, and
coverage for these programs should be a required benefit in public and
private insurance programs.

JAMA. 1998;280:1936-1943

Checked-by: Don Beck