In Brief

Psychologist Gregory Brigham, PhD, has seen hundreds of heroin addicts suffer through the physical misery of withdrawal in his 25 years at Maryhaven, a substance abuse and mental health treatment center in Columbus, Ohio.

Historically, nearly half the people who enter treatment for opioid dependence at the center have dropped out before they finish the detoxification stage, and of the ones who've made it through, only about 30 percent have gone on to postwithdrawal counseling and treatment, said Brigham at a February Capitol Hill briefing sponsored by the Friends of the National Institute on Drug Abuse and organized by APA science policy staff.

Part of the problem has been clonidine, historically the primary medication used for withdrawal from heroin and other opiates-outside of the methadone administered in highly regulated, licensed opioid treatment programs. Clonidine doesn't ease many of addicts' physical withdrawal symptoms, said Brigham.

"On the detox unit, they're vomiting; they're cramped up; they're just very, very sick," he said.

But now a new medication, buprenorphine, is offering new hope at Maryhaven. The center tested it through the National Institute on Drug Abuse's (NIDA's) Clinical Trials Network, and found that patients are more likely to complete withdrawal and continue with counseling when they take it, Brigham said at the briefing, which highlighted medication and treatment developments through NIDA's Research and Practice Blending Initiative-which seeks to more quickly put research breakthroughs into practice.

At the briefing, Brigham described buprenorphine as one of the initiative's success stories. Maryhaven participated in a clinical trial that showed that 77 percent of Maryhaven patients given buprenorphine tested clean and were still in the program at 13 days, compared with 22 percent of the patients given clonidine.

The medication is now a standard part of treatment at Maryhaven, a publicly funded substance abuse treatment center that sees more than 7,000 patients annually.

"Patient outcomes have improved, and lives have been saved," Brigham said.

Without the NIDA Blending Initiative, this may not have been possible. In 1998, an Institute of Medicine report estimated the time gap from research findings to medical practice at an average of 17 years, said Timothy P. Condon, PhD, NIDA's deputy director, at the briefing.

"To reap any benefits from this scientific knowledge, it needs to be useful, but it also needs to be used," he said.

Substance abuse treatment can certainly reap those benefits, Condon said, noting that an estimated 23 million people are dependent on alcohol or abuse illicit drugs, with only a small percentage receiving treatment.

The key components of the Blending Initiative include:

  • The Clinical Trials Network. Started in 1999 and organized through 17 regional research and training "nodes," a network of 200 community-based substance abuse treatment centers try new techniques and medications, using patients as volunteers and clinical treatment staff as consultants.

  • Blending Teams. Researchers work with practitioners and staff from the SAMHSA Addiction Technology Transfer Centers to develop training materials based on results from the clinical trials network.

So far, training materials developed for treatment techniques and medications tested through the network include:

  • Buprenorphine 13-day taper. During withdrawal, patients addicted to opiates are started on buprenorphine, on a dosage stepped down over 13 days. Although it's an opiate, buprenorphine is a "partial agonist" and does not produce the euphoria of heroin.

  • Supervision for motivational interviewing. This counseling technique helps patients set goals and recognize how their substance abuse has led to personal and financial disaster, such as losing a job or getting arrested on drug charges; the training product supports effective supervision of motivational interviewing.

  • Motivational incentives. Patients monitored for drug use get a prize when they test clean. Based on a lottery system, prizes could be cards praising progress or small, medium or large prizes.

Once field-based research trials demonstrate that new treatment methods work, the goal is developing and distributing training materials on how to use the treatment breakthroughs, said Dennis McCarty, PhD, director of the Center for Substance Abuse Research and Policy at Oregon Health and Science University.

"Having the tools available when the research is published can have tremendous impact on the field. It benefits the men and women needing treatment," said McCarty, also principal investigator for the Oregon/Hawaii node of the Clinical Trials Network.

--C. Munsey

Further Reading

For more information on the NIDA Blending Initiative, go to www.drugabuse.gov/blending.