Current Bibliographies in Medicine 97-7

Effective Medical Treatment of Heroin Addiction

January 1994 through September 1997 plus selected earlier citations

941 Citations

Prepared by
Mary E. Conway, M.L.S., National Library of Medicine
James R. Cooper, M.D., National Institute on Drug Abuse

1997 November

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health

National Library of Medicine
Reference Section
8600 Rockville Pike
Bethesda, Maryland 20894

Series Note
Table of Contents for this bibliography
Introduction to this bibliography
Sample Citations

Series Note

Each bibliography in the Current Bibliographies in Medicine (CBM) series covers a distinct subject area of biomedicine and is intended to fulfill a current awareness function. Citations are usually derived from searching a variety of online databases. NLM databases utilized include MEDLINE®, AVLINE®, BIOETHICSLINE®, CANCERLIT®, CATLINE®, HEALTHSTAR^tm, POPLINE^tm, and TOXLINE®. The only criterion for the inclusion of a particular published work is its relevance to the topic being presented; the format, ownership, or location of the material is not considered.

Other publications in the Current Bibliographies in Medicine series are available at no cost to anyone with Internet access through the Library's World Wide Web site at http://www.nlm.nih.gov/pubs/resources.html.

Comments and suggestions on this series may be addressed to:

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Current Bibliographies in Medicine
Reference Section
National Library of Medicine
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Series Note

Introduction

Sample Citations

Bibliography:

Overview and Natural History of Heroin Addiction and Opiate Agonist Treatment

History and Current Status of Opiate Agonist Treatment

The Natural History of Opiate Addiction

Molecular Neurobiology and Pathogenesis of Opiate Addiction

Genetic and Other Risk Factors

Neurobiological Substrates

PET Studies of Brain Function

Diagnosis of Heroin Abuse and Addiction

Consequences of Untreated Opiate Addiction

Narcotic Drugs and Crime

Societal Costs of Heroin Addiction

Economic Cost Offsets of Methadone Treatment

Transmission of Bloodborne Viruses Among Heroin Injectors

- Overall

- HIV/AIDS

- Hepatitis

- Other Viruses

Methadone Treatment of HIV-Infected Pregnant Women

Deaths Among Heroin Users In and Out of Methadone Treatment

Other Medical Complications

Current Opiate Addiction Treatment Modalities

Detoxification with or without Opiate Agonist Treatment

Nonpharmacological/Psychosocial Treatment

Opiate Agonist Treatment, Molecular Pharmacology, and Physiology

Predictors of Treatment Outcome for Heroin Addiction

Differential Patient Characteristics

Patient Engagement and Duration of Treatment

Matching Treatment Services to Patient Problems

Methadone Dose and Outcome

Methadone SubstitutionTreatment in the United Kingdom

Barriers to the Effective Use and Availability of Opiate Agonist Treatment

Community, Staff, and Patient Perceptions and Attitudes

Access to Narcotic Addiction Treatment and Medical Care

Diversion and Trafficking of Methadone and Law Enforcement

Narcotic Agonist Treatment as a Benefit Under Managed Care

Legal, Regulatory, and Funding Barriers

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Introduction

EFFECTIVE MEDICAL TREATMENT OF HEROIN ADDICTION

This bibliography was prepared in support of the National Institutes of Health Consensus Development Conference on Effective Medical Treatment of Heroin Addiction held in Bethesda, Maryland on November 17-19, 1997. The conference was sponsored by the National Institute on Drug Abuse and the NIH Office of Medical Applications of Research; the NIH Office of Research on Women's Health was cosponsor.

In the United States alone, approximately one-half million people are addicted to heroin. Estimates of heroin incidence (122,000 new users) in recent years suggest an increased incidence and an emerging pattern of drug use among the young. For many years, heroin addiction has been associated with increased criminal activity and human suffering. In the past 10 years, there has been a dramatic increase in the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and tuberculosis among intravenous heroin users. From 1991 to 1995 in major metropolitan areas, the annual number of heroin-related emergency room visits has increased from 36,000 to 76,000, and the annual number of heroin-related deaths has increased from 2,300 to 4,000. The associated morbidity and mortality further underscore the human, economic, and societal cost of heroin addiction.

Over the last 20 years, a significant body of evidence has accumulated on the neurobiology of heroin addiction and on the safety and efficacy of narcotic (methadone) maintenance treatment. Although there have been other medications (e.g., levo-alpha acetylmethadol [LAAM]) subsequently determined safe and effective in narcotic maintenance treatment, the focus of this consensus development conference was on methadone, because methadone has been the medication used in most narcotic treatment research. Evaluation studies have consistently shown methadone treatment to be effective in reducing drug use and crime and in enhancing social productivity. More recent studies demonstrate that methadone treatment is an effective method for preventing the spread of HIV, HCV, and tuberculosis among intravenous drug users.

Most heroin users are not receiving treatment. Most recent data indicate that there are approximately 112,000 patients in narcotic maintenance treatment. Barriers exist to both access to narcotic maintenance treatment and effective treatment, despite the science on the neurobiology of heroin addiction and the evidence demonstrating the effectiveness of treatment in reducing drug use and crime and preventing the spread of HIV and HCV. An important reason for some of these barriers is that narcotic maintenance treatment remains controversial. The science has not yet overcome the stigma of addiction and public perception about narcotic maintenance treatment. Many members of the medical community and the public conceive of opiate addiction as a self-inflicted disease of the will, methadone treatment as mere narcotic substitution with relapses likely to follow treatment, drug-free treatment as the only valid rehabilitative method, and total abstinence from all drugs, including methadone, as the only valid treatment goal. Other obstacles include Federal and state government regulations limiting treatment providers and patient access and concerns about methadone diversion by patients and its consequences.

The consensus development conference brought together national and international experts to present and discuss the most important and controversial issues surrounding narcotic maintenance treatment. An independent, non-Federal consensus panel addressed the following key questions:

What is the scientific evidence to support conceptualization of opiate addiction as a medical disorder including natural history, genetics and risk factors, and pathophysiology, and how is diagnosis established?
What are the consequences of untreated opiate addiction to individuals, families, and society?
What is the efficacy of current treatment modalities in the management of opiate addiction including detoxification alone, non-pharmacological/psychosocial treatment, treatment with opiate antagonists, and treatment with opiate agonists (short-term and long-term)?
What is the scientific evidence for the most effective use of opiate agonists in the treatment of opiate addiction?
What are the important barriers to effective use of opiate agonists in the treatment of opiate addiction in the U.S. including perceptions and adverse consequences of opiate agonist use, legal, regulatory, financial, and programmatic barriers?
What are the future research areas and recommendations for improving opiate agonist treatment and improving access?

This bibliography is organized along the same lines as the conference agenda with additional subsections for specific medical complications of opiate addiction. Citations include journal articles, books and book chapters, conference proceedings, conference papers and posters, hearings, and meeting abstracts. The majority of selected references are from January 1994 to September 1997 and are in English with the focus on heroin addiction in the United States. Older references were selected to provide background for the main topics of the conference. References within each subject category are listed alphabetically by author; a reference may be included in more than one category

Any reproductions of this bibliography, in whole or in part, must include all credits. If you wish to cite this bibliography, the correct format is:
Conway, Mary E..; Cooper, James R., compilers. Effective medical treatment of heroin addiction [bibliography online]. Bethesda (MD): National Library of Medicine; 1997 Nov [insert cited year month day in brackets]. [insert no. of screens or lines in brackets]. (Current bibliographies in medicine; no. 97-7). 941 citations from January 1994 through September 1997. Available from: URL http://www.nlm.nih.gov/pubs/resources.html

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Sample Citations

Citations are formatted according to the rules established for Index Medicus ®. Sample journal and monograph citations appear below. For journal articles written in a foreign language, the English translation of the title is placed in brackets; for monographs, the title is given in the original language. In both cases the language of publication is shown by a three letter abbreviation appearing at the end of the citation.

Journal Article:

Example:
Bakir AA, Dunea G. Drugs of abuse and renal disease. Curr Opin Nephrol Hypertens 1996 Mar;5(2):122-6.

Order, with separating punctuation:
Authors. Article Title. Abbreviated Journal Title Date;Volume(Issue):Pages.

Monograph:

Example:
Ball JC, Ross A. The effectiveness of methadone maintenance treatment: patients, programs, services and outcome. New York: Springer-Verlag; c1991. 293 p.

Order, with separating punctuation:
Authors/Editors. Title. Place of Publication: Publisher; Date. Total No. of Pages.

Monograph Chapter:

Example:
Anglin MD, Hser YI. Treatment of drug abuse. In: Tonry M, Wilson JQ, eds. Drugs and crime. Chicago: University of Chicago Press; 1990. p. 393-458.

Order, with separating punctuation:
Chapter Authors. Chapter Title. Connective Phrase. Monograph Editors. Monograph Title. Place of Publication: Publisher; Date. Pages of Chapter.

For details of the formats used for references, see the following publication:
Patrias, Karen. National Library of Medicine recommended formats for bibliographic citation. Bethesda (MD): The Library; 1991 Apr. Available from: NTIS, Springfield, VA; PB91-182030.

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Overview and Natural History of Heroin Addiction and Opiate Agonist Treatment

History and Current Status of Opiate Agonist Treatment

Dole VP. Hazards of process regulations. The example of methadone maintenance. JAMA 1992 Apr 22-29;267(16):2234-5.

Dole VP, Nyswander M. Medical treatment for diacetylmorphine (heroin) addiction. A clinical trial with methadone hydrochloride. JAMA 1965 Aug 23;193:646-50.

Dole VP, Nyswander ME, DesJarlais D, Joseph H. Sounding Board. Performance-based rating of methadone maintenance programs. N Engl J Med 1982 Jan 21;306(3):169-71.

Gerstein DR, Harwood HJ, eds. Treating drug problems. Washington (DC): National Academy Press; 1990-92. 2 vols.

Glasscote RM. The treatment of drug abuse: programs, problems, prospects. Washington (DC): Joint Information Service of the American Psychiatric Association and the National Association for Mental Health; 1972. 250 p.

Jaffe J. The maintenance option and the Special Action Office for Drug Abuse Prevention. Psychiatr Ann 1975 Oct;5(10):12-39.

Jaffe JH, Schuster CR, Smith BB, Blachley PH. Comparison of acetylmethadol and methadone in the treatment of long-term heroin users. A pilot study. JAMA 1970 Mar 16;211(11):1834-6.

McGlothlin WH, Anglin MD. The compulsory treatment of opiate dependence. New York: Haworth Press; 1991.

Molinari SP, Cooper JR, Czechowicz DJ. Federal regulation of clinical practice in narcotic addiction treatment: purpose, status, and alternatives. J Law Med Ethics 1994 Fall;22(3):231-9.

Musto DF. The American disease: origins of narcotic control. New Haven (CT): Yale University Press; c1973.

Musto DF. The American disease: origins of narcotic control. New York: Oxford University Press; c1987.

Payte JT. Methadone maintenance treatment: The first thirty years. J Psychoact Drugs 1997 Apr-Jun;29(2):149-53.

Rettig RA, Yarmolinsky A. Federal regulation of methadone treatment. Washington (DC): National Academy Press; 1995. 248 p.

Robins LN. The sixth Thomas James Okey Memorial Lecture. Vietnam veterans' rapid recovery from heroin addiction: a fluke or normal expectation? Addiction 1993 Aug;88(8):1041-54.

Smith AB, Pollack H. When working out drug policy, look backward. Natl Law J 1997 Mar 24;19(30):A25.

Terry CE, Pellens M. The opium problem. New York: Bureau of Social Hygiene (NY); 1928. 1042 p.

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The Natural History of Opiate Addiction

Anglin MD, Hser YI. Treatment of drug abuse. In: Tonry M, Wilson JQ, eds. Drugs and crime. Chicago: University of Chicago Press; 1990. p. 393-458. (Crime and justice: a review of research; 13).

Anglin MD, Hser YI, Chou CP. Reliability and validity of retrospective behavioral self-report by narcotics addicts. Eval Rev 1993 Feb;17(1):91-108.

Bailey RC, Hser YI, Hsieh SC, Anglin MD. Influences affecting maintenance and cessation of narcotics addiction. J Drug Issues 1994 Winter-Spring;24(1-2):249-72.

Bremner JD, Southwick SM, Darnell A, Charney DS. Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse. Am J Psychiatry 1996 Mar;153(3):369-75.

Frykholm B, Anthony JC, Warner LA, Kessler RC. The drug career. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey. J Drug Issues 1985 Summer;15(3):333-46.

Goldstein A, Herrera J. Heroin addicts and methadone treatment in Albuquerque: a 22-year follow-up. Drug Alcohol Depend 1995 Dec;40(2):139-50.

Hser YI, Anglin MD, Powers K. A 24-year follow-up of California narcotics addicts. Arch Gen Psychiatry 1993 Jul;50(7):577-84.

Hser YI, Yamaguchi K, Chen JK, Anglin MD. Effects of interventions on relapse to narcotics addiction: an event-history analysis. Eval Rev 1995 Apr;19(2):123-40.

Maddux JF, Desmond DP. Careers of opioid users. New York: Praeger; 1981. 232 p.

Mariezcurrena R. Recovery from addictions without treatment: literature review. Scand J Behav Ther 1994;23(3-4):131-54.

McGlothlin WH, Anglin MD, Wilson BD. Evaluation of the California civil addict program. Rockville (MD): National Institute on Drug Abuse (US); 1977. 102 p. (DHEW publ.; no. (ADM) 78-558).

McGlothlin WH, Anglin MD, Wilson BD. Narcotic addiction and crime. Criminology 1978 Nov;16(3):293-315.

McGlothlin WH, Anglin MD, Wilson BD. Outcome of the California Civil Addict commitments: 1961-1972. Drug Alcohol Depend 1976 Feb;1(3):165-81.

Nurco DN, Balter MB, Kinlock T. Vulnerability to narcotic addiction: preliminary findings. J Drug Issues 1994 Winter-Spring;24(1-2):293-314.

Nurco DN, Bonito AJ, Lerner M, Balter MB. Studying addicts over time: methodology and preliminary findings. Am J Drug Alcohol Abuse 1975;2(2):183-96.

Senay EC. Clinical implications of drug abuse treatment outcome research. NIDA Res Monogr 1984;51:139-50.

Simpson DD, Sells SB. Effectiveness of treatment for drug abuse: an overview of the DARP research program. Adv Alcohol Subst Abuse 1982 Fall;2(1):7-29.

Simpson D, Sells SB, eds. Opioid addiction and treatment: a 12-year follow-up. Malabar (FL): Krieger; 1990. 274 p.

Stephens RC. The street addict role: a theory of heroin addiction. Albany (NY): State University of New York Press; c1991. 223 p.

Tims FM, Ludford JP, eds. Drug abuse treatment evaluation: strategies, progress, and prospects. Rockville (MD): National Institute on Drug Abuse (US); 1984. 180 p. (NIDA research monograph; 51).

Vaillant GE. A 12-year follow-up of New York narcotic addicts. 3. Some social and psychiatric characteristics. Arch Gen Psychiatry 1966 Dec;15(6):599-609.

Vaillant GE. Is there a natural history of addiction? Res Publ Assoc Res Nerv Ment Dis 1992;70:41-57.

Vaillant GE. What can long-term follow-up teach us about relapse and prevention of relapse in addiction? Br J Addict 1988 Oct;83(10):1147-57.

Woods G. Drug abuse in society: a reference handbook. Santa Barbara (CA): ABC CLIO; 1993. 269 p.

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Molecular Neurobiology and Pathogenesis of Opiate Addiction

Genetic and Other Risk Factors

Anthony JC, Warner LA, Kessler RC. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol 1994 Aug;2(3):244-68.

Cadoret RJ, Troughton E, O'Gorman TW, Heywood E. An adoption study of genetic and environmental factors in drug abuse. Arch Gen Psychiatry 1986 Dec;43(12):1131-6.

Cadoret RJ, Yates WR, Troughton E, Woodworth G, Stewart MA. Adoption study demonstrating two genetic pathways to drug abuse. Arch Gen Psychiatry 1995 Jan;52(1):42-52.

Castaneda R, Lifshutz H, Galanter M, Franco H. Empirical assessment of the self-medication hypothesis among dually diagnosed inpatients. Compr Psychiatry 1994 May-Jun;35(3):180-4. Published erratum appears in Comp Psychiatry 1994 Jul-Aug;35(4):328.

Childress AR, Ehrman R, McLellan AT, MacRae J, Natale M, O'Brien CP. Can induced moods trigger drug-related responses in opiate abuse patients? J Subst Abuse Treat 1994 Jan-Feb;11(1):17-23.

Comings DE, Muhleman D, Gade R, Johnson P, Verde R, Saucier G, MacMurray J. Cannabinoid receptor gene (CNR1): association with i.v. drug use. Mol Psychiatry 1997 Mar;2(2):161-8.

Ellinwood EH Jr, Smith WG, Vaillant GE. Narcotic addiction in males and females: a comparison. Int J Addict 1966 Jun;1(2):33-45.

Gainey RR, Catalano RF, Haggerty KP, Hoppe MJ. Deviance among the children of heroin addicts in treatment: impact of parents and peers. Deviant Behav 1997 Apr-Jun;18(2):143-59.

Gerra G, Caccavari R, Marcato A, Zaimovic A, Avanzini P, Monica C, Mutti A, Fontanesi B, Delsignore R, Brambilla F. Alpha-1- and 2-adrenoceptor subsensitivity in siblings of opioid addicts with personality disorders and depression. Acta Psychiatr Scand 1994 Oct;90(4):269-73.

Giros B, Pohl M, Rochelle JM, Seldin MF. Chromosomal localization of opioid peptide and receptor genes in the mouse. Life Sci 1995 Mar;56(18):PL369-75.

Gynther LM, Carey G, Gottesman II, Vogler GP. A twin study of non-alcohol substance abuse. Psychiatry Res 1995 Apr 28;56(3):213-20.

Johnson EO, Van den Bree M. Drug abuse: toward a refined phenotype. Paper presented at: Problems of drug dependence, 1997. The 59th Annual Scientific Meeting, The College of Drug Dependence, Inc.; 1997 Jun 14-19; Nashville, TN.

Kosten TA, Ball SA, Rounsaville BJ. A sibling study of sensation seeking and opiate addiction. J Nerv Mental Dis 1994 May;182(5):284-9.

Kosten TR, Rounsaville BJ, Kleber HD. Parental alcoholism in opioid addicts. J Nerv Ment Dis 1985 Aug;173(8):461-9.

Luthar SS, Anton SF, Merikangas KR, Rounsaville BJ. Vulnerability to substance abuse and psychopathology among siblings of opioid abusers. J Nerv Ment Dis 1992 Mar;180(3):153-61.

Maddux JF, Desmond DP. Family and environment in the choice of opioid dependence or alcoholism. Am J Drug Alcohol Abuse 1989;15(2):117-34.

Maldonado R, Blendy JA, Tzavara E, Gass P, Roques BP, Hanoune J, Schutz G. Reduction of morphine abstinence in mice with a mutation in the gene encoding CREB. Science 1996 Aug 2;273(5275):657-9. Comment in: Science 1996 Aug 2;273(5275):611-2.

Matthes HW, Maldonado R, Simonin F, Valverde O, Slowe S, Kitchen I, Befort K, Dierich A, Le Meur M, Dolle P, Tzavara E, Hanoune J, Roques BP, Kieffer BL. Loss of morphine-induced analgesia, reward effect and withdrawal symptoms in mice lacking the mu-opioid-receptor gene. Nature 1996 Oct 31;383(6603):819-23. Comment in: Nature 1996 Oct 31;383(6603):759-60.

Merikangas DR, Rounsaville BJ, Prusoff BA. Familial factors in vulnerability to substance abuse. In: Glantz MD, Pickens RW, eds. Vulnerability to drug abuse. Washington (DC): American Psychological Association; c1992. p. 75-97.

Mirrin SM, Weiss RD, Sollogub A, Michael J. Psychopathology in the families of drug abusers. In: Mirin SM, ed. Substance abuse and psychopathology. Washington (DC): American Psychiatric Press; 1984. p. 79-106.

Moss HB, Yao JK. Associations of beta-endorphin with HVA and MHPG in the plasma of prepubertal boys: effects of familial drug abuse and antisocial personality disorder liability. Psychiatry Res 1996 Jun 1;62(3):203-11.

Nurco DN, Balter MB, Kinlock T. Vulnerability to narcotic addiction: preliminary findings. J Drug Issues 1994 Winter-Spring;24(1-2):293-314.

Nurco DN, Kinlock TW, O'Grady KE, Hanlon TE. Early family adversity as a precursor to narcotic addiction. Drug Alcohol Depend 1996 Dec;43(1-2):103-13.

Nylander I, Vlaskovska M, Terenius L. Brain dynorphin and enkephalin systems in Fischer and Lewis rats: effects of morphine tolerance and withdrawal. Brain Res 1995 Jun 12;683(1):25-35.

O'Brien CP, Jaffe JH, eds. Addictive states. New York: Raven; c1992. 291 p. (Association for Research in Nervous and Mental Disease research publications; vol.70).

Ornoy A, Michailevskaya V, Lukashov I, Bar-Hamburger R, Harel S. The developmental outcome of children born to heroin-dependent mothers, raised at home or adopted. Child Abuse Negl 1996 May;20(5):385-96.

Persico AM, Bird G, Gabbay FH, Uhl GR. D2 dopamine receptor gene TaqI A1 and B1 restriction fragment length polymorphisms: enhanced frequencies in psychostimulant-preferring polysubstance abusers. Biol Psychiatry 1996 Oct 15;40(8):776-84.

Pickens RW, Svikis DS, McGue M, Lykken DT, Heston LL, Clayton PJ. Heterogeneity in the inheritance of alcoholism. A study of male and female twins. Arch Gen Psychiatry 1991 Jan;48(1):19-28.

Reisine T, Bell GI. Molecular biology of opioid receptors. Trends Neurosci 1993 Dec;16(12):506-10.

Robins LN. A follow-up of Vietnam drug users. Washington (DC): Executive Office of the President (US), Special Action Office for Drug Abuse Prevention; 1973. (Special Action Office monograph; ser. A, no.1).

Rounsaville BJ, Kosten TR, Weissman MM, Prusoff B, Pauls D, Anton SF, Merikangas K. Psychiatric disorders in relatives of probands with opiate addiction. Arch Gen Psychiatry 1991 Jan;48(1):33-42.

Tsuang MT, Lyons MJ, Eisen SA, Goldberg J, True W, Lin N, Meyer JM, Toomey R, Faraone SV, Eaves L. Genetic influences on DSM-III-R drug abuse and dependence: a study of 3,372 twin pairs. Am J Med Genet 1996 Sep 20;67(5):473-7.

Vaillant GE. A 12-year follow-up of New York narcotic addicts. 3. Some social and psychiatric characteristics. Arch Gen Psychiatry 1966 Dec;15(6):599-609.

Vaillant GE. Is there a natural history of addiction? Res Publ Assoc Res Nerv Ment Dis 1992;70:41-57.

Wang GJ, Volkow ND, Fowler JS, Logan J, Abumrad NN, Hitzemann RJ, Pappas NS, Pascani K. Dopamine D2 receptor availability in opiate-dependent subjects before and after naloxone-precipitated withdrawal. Neuropsychopharmacology 1997 Feb;16(2):174-82.

Wilens TE, Biederman J, Kiely K, Bredin E, et al. Pilot study of behavioral and emotional disturbances in the high-risk children of parents with opioid dependence. J Am Acad Child Adolesc Psychiatry 1995 Jun;34(6):779-85.

Wollemann M. Discrepancies between identical amino acid sequences of cloned opioid-receptor subtypes and their binding data [letter]. Trends Neurosci 1994 Aug;17(8):337-8. Comment on: Trends Neurosci 1993 Dec;16(12):506-10.

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Neurobiological Substrates

Adams RE, Wooten GF. Regional cerebral glucose utilization in withdrawal following systemic and intracerebroventricular sufentanil administration. Neurochem Res 1994 Oct;19(10):1243-8.

Aghajanian GK, Kogan JH, Moghaddam B. Opiate withdrawal increases glutamate and aspartate efflux in the locus coeruleus: an in vivo microdialysis study. Brain Res 1994 Feb 4;636(1):126-30.

Alcaraz C, Vargas ML, Milanes MV. Chronic naloxone-induced supersensitivity affects neither tolerance to nor physical dependence on morphine at hypothalamus-pituitary-adrenocortical axis. Neuropeptides 1996 Feb;30(1):29-36.

Ammer H, Schulz R. Chronic morphine treatment increases stimulatory beta-2 adrenoceptor signaling in A431 cells stably expressing the mu opioid receptor. J Pharmacol Exp Ther 1997 Jan;280(1):512-20.

Ammer H, Schulz R. Morphine dependence in human neuroblastoma SH-SY5Y cells is associated with adaptive changes in both the quantity and functional interaction of PGE1 receptors and stimulatory G proteins. Brain Res 1996 Jan 29;707(2):235-44.

Archer S, Glick SD, Bidlack JM. Cyclazocine revisited. Neurochem Res 1996 Nov;21(11):1369-73.

Azarov AV, Szabo G, Czako L, Telegdy G. Effects of calcitonin gene-related peptide on acute and chronic effects of morphine. Pharmacol Biochem Behav 1995 Nov;52(3):595-9.

Azolosa JL, Stitzer ML, Greenwald MK. Opioid physical dependence development: effects of single versus repeated morphine pretreatments and of subjects' opioid exposure history. Psychopharmacology (Berl) 1994 Feb;114(1):71-80.

Baraban SC, Stornetta RL, Guyenet PG. Effects of morphine and morphine withdrawal on adrenergic neurons of the rat rostral ventrolateral medulla. Brain Res 1995 Apr 10;676(2):245-57.

Bassareo V, Tanda G, Di Chiara G. Increase of extracellular dopamine in the medial prefrontal cortex during spontaneous and naloxone-precipitated opiate abstinence. Psychopharmacology (Berl) 1995 Nov;122(2):202-5.

Beckmann AM, Matsumoto I, Wilce PA. Immediate early gene expression during morphine withdrawal. Neuropharmacology 1995 Sep;34(9):1183-9.

Belozertseva I, Zvartau E, Bespalov A. Behavioral effects of MK-801 in morphine-dependent and non-dependent mice. Life Sci 1995;58(4):PL55-61.

Bhargava HN. Diversity of agents that modify opioid tolerance, physical dependence, abstinence syndrome, and self-administrative behavior. Pharmacol Rev 1994 Sep;46(3):293-324.

Bhargava HN. Drugs that modify opioid tolerance, physical dependence, and abstinence symptoms: preclinical and clinical studies. NIDA Res Monogr 1995;147:53-83.

Bhargava HN, Thorat SN. Evidence for a role of nitric oxide of the central nervous system in morphine abstinence syndrome. Pharmacology 1996 Feb;52(2):86-91.

Bozarth MA. Opiate reinforcement processes: re-assembling multiple mechanisms. Addiction 1994 Nov;89(11):1425-34.

Busquets X, Escriba PV, Sastre M, Garcia-Sevilla JA. Loss of protein kinase C-alpha beta in brain of heroin addicts and morphine-dependent rats. J Neurochem 1995 Jan;64(1):247-52.

Cameron DL, Wessendorf MW, Williams JT. A subset of ventral tegmental area neurons is inhibited by dopamine, 5-hydroxytryptamine and opioids. Neuroscience 1997 Mar;77(1):155-66.

Capasso A, Di Giannuario A, Loizzo A, Pieretti S, Sagratella S, Sorrentino L. Dexamethasone selective inhibition of acute opioid physical dependence in isolated tissues. J Pharmacol Exp Ther 1996 Feb;276(2):743-51.

Cappendijk SL, Duval SY, de Vries R, Dzoljic MR. Comparative study of normotensive and hypertensive nitric oxide synthase inhibitors on morphine withdrawal syndrome in rats. Neurosci Lett 1995 Jan 2;183(1-2):67-70.

Cappendijk SL, Fekkes D, Dzoljic MR. The inhibitory effect of norharman on morphine withdrawal syndrome in rats: comparison with ibogaine. Behav Brain Res 1994 Nov 16;65(1):117-9.

Carr KD. Feeding, drug abuse, and the sensitization of reward by metabolic need. Neurochem Res 1996 Nov;21(11):1455-67.

Casas M, Guardia J, Prat G, Trujols J. The apomorphine test in heroin addicts. Addiction 1995 Jun;90(6):831-5.

Chahl LA, Leah J, Herdegen T, Trueman L, Lynch-Frame AM. Distribution of c-Fos in guinea-pig brain following morphine withdrawal. Brain Res 1996 Apr 22;717(1-2):127-34.

Chieng B, Christie MD. Local opioid withdrawal in rat single periaqueductal gray neurons in vitro. J Neurosci 1996 Nov 15;16(22):7128-36.

Chieng B, Keay KA, Christie MJ. Increased fos-like immunoreactivity in the periaqueductal gray of anaesthetised rats during opiate withdrawal. Neurosci Lett 1995 Jan 2;183(1-2):79-82.

Christensen JD, Kaufman MJ, Levin JM, Mendelson JH, Holman BL, Cohen BM, Renshaw PF. Abnormal cerebral metabolism in polydrug abusers during early withdrawal: a 31P MR spectroscopy study. Magn Reson Med 1996 May;35(5):658-63.

Christie MJ, Williams JT, Osborne PB, Bellchambers CE. Where is the locus in opioid withdrawal? Trends Pharmacol Sci 1997 Apr;18(4):134-40.

Couceyro P, Douglass J. Precipitated morphine withdrawal stimulates multiple activator protein-1 signaling pathways in rat brain. Mol Pharmacol 1995 Jan;47(1):29-39.

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- Hepatitis

Brooks K, Orr S, Fenaughty A, Fisher D. ALT as a marker for hepatitis B and C in drug users. Int Conf AIDS 1994 Aug 7-12;10(1):161 (abstract no. PB0072).

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Gossop M, Powis B, Griffiths P, Strang J. Multiple risks for HIV and hepatitis B infection among heroin users. Drug Alcohol Rev 1994;13(3):293-300.

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Woodall DW, Godenick M, Valainis GT. Hepatitis C experience at a community teaching hospital. J Fam Pract 1994 Sep;39(3):257-61.

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- Other Viruses

Schwebke J, Calsyn D, Shriver K, Saxon A, Kleyn J, Oluoch-Mitchell E, Olmstead L, Fisher LD, Krone M, Ashley R, et al. Prevalence and epidemiologic correlates of human T cell lymphotropic virus infection among intravenous drug users. J Infect Dis 1994 May;169(5):962-7.

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Methadone Treatment of HIV-Infected Pregnant Women

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Deaths Among Heroin Users In and Out of Methadone Treatment

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Other Medical Complications

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Emergency rooms report huge increase in heroin sniffing. Subst Abuse Rep 1995 Feb 15;26(4):4.

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Current Opiate Addiction Treatment Modalities

Detoxification with or without Opiate Agonist Treatment

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Nonpharmacological/Psychosocial Treatment

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Opiate Agonist Treatment, Molecular Pharmacology, and Physiology

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Predictors of Treatment Outcome for Heroin Addiction

Differential Patient Characteristics

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Patient Engagement and Duration of Treatment

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Matching Treatment Services to Patient Problems

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Methadone Dose and Outcome

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Ling W, Charuvastra C, Kaim SC, Klett CJ. Methadyl acetate and methadone as maintenance treatments for heroin addicts. A veterans administration cooperative study. Arch Gen Psychiatry 1976 Jun;33(6):709-20.

Loimer N, Schmid R. The use of plasma levels to optimize methadone maintenance treatment. Drug Alcohol Depend 1992 Aug;30(3):241-6.

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Maddux JF, Desmond DP, Vogtsberger KN. Patient-regulated methadone dose and optional counseling in methadone maintenance. Am J Addict 1995 Winter;4(1):18-32.

Maddux JF, Prihoda TJ, Vogtsberger KN. The relationship of methadone dose and other variables to outcomes of methadone maintenance. Am J Addict 1997 Summer;6(3):246-55.

Maremmani I, Nardini R, Zolesi O, Castrogiovanni P. Methadone dosages and therapeutic compliance during a methadone maintenance program. Drug Alcohol Depend 1994 Jan;34(2):163-6.

Payte JT, Khuri ET. Principles of methadone dose determination. In: Parrino MW. State methadone treatment guidelines. Rockville (MD): Substance and Mental Health Services Administration (US), Center for Substance Abuse Treatment; 1993. p. 47-58 . (DHHS publication; no. (SMA) 93-1991); (Treatment improvement protocol (TIP) series;1).

Spiga R, Grabowski J, Silverman PB, Meisch RA. Human methadone self-administration: effects of dose and ratio requirement. Behav Pharmacol 1996 Mar;7(2):130-7.

Stine SM, Kosten TR. Reduction of opiate withdrawal-like symptoms by cocaine abuse during methadone and buprenorphine maintenance. Am J Drug Alcohol Abuse 1994 Nov;20(4):445-58.

Strain EC, Stitzer ML, Liebson IA, Bigelow GE. Methadone dose and treatment outcome. Drug Alcohol Depend 1993 Sep;33(2):105-17.

Tennant F, Shannon J. Cocaine abuse in methadone maintenance patients is associated with low serum methadone concentrations. J Addict Dis 1995;14(1):67-74.

Tennant FS Jr, Rawson RA, Cohen A, Tarver A, Clabough D. Methadone plasma levels and persistent drug abuse in high dose maintenance patients. Subst Alcohol Actions Misuse 1983;4(5):369-74.

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Methadone Substitution Treatment in the United Kingdom

Farrell M. Methadone treatment programmes in the United Kingdom. Ann Med Interne (Paris) 1994 Nov;145 Suppl 3:34-5.

Fleming PM. Prescribing policy in the UK: a swing away from harm reduction? Int J Drug Policy 1995;6(3):173-7.

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Strang J, Gossop M. Heroin addiction and drug policy: the British system. Oxford (England): Oxford University Press; 1994. 374 p.

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Barriers to the Effective Use and Availability of Opiate Agonist Treatment

Community, Staff, and Patient Perceptions and Attitudes

Anglin MD, Speckart GR, Booth MW, Ryan TM. Consequences and costs of shutting off methadone. Addict Behav 1989;14(3):307-26.

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Blansfield HN. Inadequate treatment of opioid dependence due to society's attitudes and beliefs. Conn Med 1996 Jul;60(7):423-8.

Caplehorn JR, Hartel DM, Irwig L. Measuring and comparing the attitudes and beliefs of staff working in New York methadone maintenance clinics. Subst Use Misuse 1997 Mar;32(4):399-413.

Caplehorn JR, Irwig L, Saunders JB. Attitudes and beliefs of staff working in methadone maintenance clinics. Subst Use Misuse 1996 Mar;31(4):437-52.

Caplehorn JR, Irwig L, Saunders JB. Physicians' attitudes and retention of patients in their methadone maintenance programs. Subst Use Misuse 1996 May;31(6):663-77.

Clinic move blocked. Narc Demand Reduct Dig 1994 Jan;6(1):8.

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Hunt DE, Lipton DS, Goldsmith DS, Strug DL, Spunt B. "It takes your heart": the image of methadone maintenance in the addict world and its effect on recruitment into treatment. Int J Addict 1985 Nov-Dec;20(11-12):1751-71.

McGlothlin WH, Anglin MD. Effects of closing the Bakersfield Methadone Clinic. NIDA Res Monogr 1979;27:135-41.

Murphy S, Irwin J. "Living with the dirty secret": problems of disclosure for methadone maintenance clients. J Psychoact Drugs 1992 Jul-Sep;24(3):257-64.

Murphy S, Rosenbaum M. Money for methadone. II: Unintended consequences of limited-duration methadone maintenance. J Psychoact Drugs 1988 Oct-Dec;20(4):397-402.

Rosenbaum M, Murphy S, Beck J. Money for methadone: preliminary findings from a study of Alameda County's new maintenance policy. J Psychoact Drugs 1987 Jan-Mar;19(1):13-9.

Rosenbaum M, Washburn A, Knight K, Kelley M, Irwin J. Treatment as harm reduction, defunding as harm maximization: the case of methadone maintenance. J Psychoact Drugs 1996 Jul-Sep;28(3):241-9.

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Zweben JE, Sorensen JL. Misunderstandings about methadone. J Psychoact Drugs 1988 Jul-Sep;20(3):275-81.

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Access to Narcotic Addiction Treatment and Medical Care

Bell J, Chan J, Kuk A. Investigating the influence of treatment philosophy on outcome of methadone maintenance. Addiction 1995 Jun;90(6):823-30.

Blansfield HN. Medical mismanagement in public methadone programs. Conn Med 1994 Mar;58(3):161-4. Comment in: Conn Med 1994 Mar;58(3):173-4.

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Greenfield L, Brady JV, Besteman KJ, De Smet A. Patient retention in mobile and fixed-site methadone maintenance treatment. Drug Alcohol Depend 1996 Oct;42(2):125-31.

Grella CE, Anglin MD, Rawson R, Crowley R, Hasson A. What happens when a demonstration project ends. Consequences for a clinic and its clients. J Subst Abuse Treat 1996 May-Jun;13(3):249-56.

Groves P, Heuston J, Durand MA, Albery I, et al. The identification and management of substance misuse problems by general practitioners. J Mental Health 1996;5(2):183-93.

Herman M, Gourevitch MN. Integrating primary care and methadone maintenance treatment: implementation issues. J Addict Dis 1997;16(1):91-102.

Kahan M, Sutton N. Opiate-dependent patients receiving methadone. How physicians should manage therapy. Can Fam Physician 1996 Sep;42:1769-78.

Klingemann HK. Drug treatment in Switzerland: harm reduction, decentralization and community response. Addiction 1996 May;91(5):723-36.

Lewis DC. Medical and health perspectives on a failing US drug policy. Daedalus 1992 Summer;121(3):165-94.

Lewis E Jr, Lenck WM. Medical practice under the law. Drug Enforc 1977 Dec;4:318-31.

Molinari SP, Cooper JR, Czechowicz DJ. Federal regulation of clinical practice in narcotic addiction treatment: purpose, status, and alternatives. J Law Med Ethics 1994 Fall;22(3):231-9.

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Policy group calls for easier access to methadone. Subst Abuse Rep 1996 Jun 1;27(11):3.

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Rosenbaum M. The demedicalization of methadone maintenance. J Psychoact Drugs 1995 Apr-Jun;27(2):145-9.

Rosenbaum M, Murphy S, Beck J. Money for methadone: preliminary findings from a study of Alameda County's new maintenance policy. J Psychoact Drugs 1987 Jan-Mar;19(1):13-9.

Rosenbaum M, Washburn A, Knight K, Kelley M, Irwin J. Treatment as harm reduction, defunding as harm maximization: the case of methadone maintenance. J Psychoact Drugs 1996 Jul-Sep;28(3):241-9.

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Senay E, Lewis DC. The history and current status of drug substitution therapy for narcotic addiction in the United States. In: Rihs-Middel M, et al. The medical prescription of narcotics: scientific foundations and practical experiences. Toronto: Hogrefe & Huber; c1997. [pages unknown].

Senay EC, Barthwell A, Marks R, Bokos PJ. Medical maintenance: an interim report. J Addict Dis 1994;13(3):65-9.

Senay EC, Barthwell AG, Marks R, Bokos P, Gillman D, White R. Medical maintenance: a pilot study. J Addict Dis 1993;12(4):59-76.

Sirica CM, ed. Training about alcohol and substance abuse for all primary care physicians: a conference; 1994 Oct 2-5; Phoenix. New York: Josiah Macy, Jr. Foundation; 1995. 290 p.

Spunt B, Hunt DE, Lipton DS, Goldsmith DS. Methadone diversion: a new look. J Drug Issues 1986 Fall;16(4):569-83.

Swiss Narcotic Substances Commission, Sub-Commission on Drug Issues, Methadone Working Group. Swiss methadone report: narcotic substitution in the treatment of heroin addicts in Switzerland. 3rd Eng. ed. Toronto: Addiction Research Foundation; [1996?].

Treatment made easier. Narc Demand Reduct Dig 1994 Apr;6(4):6.

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Diversion and Trafficking of Methadone and Law Enforcement

Blackmore J. Use and abuse of methadone. Police Mag 1980 Jan;3:144-51.

Dope sales & mismanagement charged to Chicago drug clinics. Narc Control Dig 1975 Sep 10;5(37):4-5.

FDA revokes methadone program's approval. Subst Abuse Rep 1994 Mar 1;25(5):3.

How to file a complaint about a methadone program. Subst Abuse Rep 1994 Feb 15;25(4):6-7.

Methadone diversion : a report of the House Select Committee on Narcotics Abuse and Control, 95th Cong., 2nd Sess. Washington (DC): U.S. Government Printing Office; 1978. 31 p. (SCNAC-95-2-17).

Pulse check: national trends in drug abuse. NarcOfficer 1996 Nov-Dec:18

Registered physicians can be prosecuted for drug 'pushing' under Controlled Substances Act (21 U.S.C. 841)--methadone maintenance program exceeded bounds of professional practice. Crim Law Bull 1976 May-Jun;12(3):335-6.

Rettig RA, Yarmolinsky A. Federal regulation of methadone treatment. Washington (DC): National Academy Press; 1995. 248 p.

Spunt B, Hunt DE, Lipton DS, Goldsmith DS. Methadone diversion: a new look. J Drug Issues 1986 Fall;16(4):569-83.

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Narcotic Agonist Treatment as a Benefit Under Managed Care

Boyle PJ, Callahan D. Managed care in mental health: the ethical issues. Health Aff (Millwood) 1995 Fall;14(3):7-22.

Callahan JJ, Shepard DS, Beinecke RH, Larson MJ, Cavanaugh D. Mental health/substance abuse treatment in managed care: the Massachusetts Medicaid experience. Health Aff (Millwood) 1995 Fall;14(3):173-84.

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Frank RG, McGuire TG, Notman EH, Woodward RM. Developments in Medicaid managed behavioral health care. In: Manderscheid RW, Sonnenschein MA, eds. Mental health, United States. Rockville (MD): Substance Abuse and Mental Health Administration, Center for Mental Health Services; 1996. p.138-53. (DHHS publ; (SMA) 96-3098).

Kassirer JP. Managed care and the morality of the marketplace [editorial]. N Engl J Med 1995 Jul 6;333(1):50-2. Comments in: N Engl J Med 1995 Nov 2;333(18):1219-21; discussion 1221.

Langenbucher J. Offsets are not add-ons: the place of addictions treatment in American health care reform. J Subst Abuse 1994;6(1):117-22.

Mechanic D, Schlesinger M, McAlpine DD. Management of mental health and substance abuse services: state of the art and early results. Milbank Q 1995;73(1):19-55.

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Schlesinger M, Dorwart RA, Epstein SS. Managed care constraints on psychiatrists' hospital practices: bargaining power and professional autonomy. Am J Psychiatry 1996 Feb;153(2):256-60. Comment in: Am J Psychiatry 1997 Mar;154(3):443.

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Woolhandler S, Himmelstein DU. Annotation: patients on the auction block. Am J Public Health 1996 Dec;86(12):1699-700.

Woolhandler S, Himmelstein DU. Extreme risk--the new corporate proposition for physicians [editorial]. N Engl J Med 1995 Dec 21;333(25):1706-8. Comments on: N Engl J Med 1995 Dec 21;333(25):1678-83; N Engl J Med 1995 Dec 21;333(25):1684-7.

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Legal, Regulatory, and Funding Barriers

Court okays terminating take-home methadone for unemployed. Subst Abuse Rep 1992 Nov 15;23(22):1-3.

Dole VP. On federal regulation of methadone treatment. JAMA 1995 Oct 25;274(16):1307. Comment in: JAMA 1996 Feb 21;275(7):519.

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General Accounting Office (US). Methadone maintenance: some treatment programs are not effective: greater federal oversight needed: report to the chairman, Select Committee on Narcotics Abuse and Control, House of Representatives. Washington (DC): The Office; [1990]. 38 p.

IOM recommends easing methadone regulations. Subst Abuse Rep 1995 Jan 15;26(2):1-2.

Methadone program's approval in jeopardy. Subst Abuse Rep 1995 Sep 1;26(17):5.

Methadone treatment center said to lose Medicaid funding. Narc Enforc Prev Dig 1996 Mar 28;2(13):8.

Molinari SP, Cooper JR, Czechowicz DJ. Federal regulation of clinical practice in narcotic addiction treatment: purpose, status, and alternatives. J Law Med Ethics 1994 Fall;22(3):231-9.

Moline M. State's methadone program held to violate federal law. Los Angeles Daily Journal 1994 Jun15;107(114):3. 4 col. in.

Moline M. State told to weigh methadone options. Los Angeles Daily Journal 1993 Nov 2;106(220):3. 16 col. in.

Newman RG. Methadone: prescribing maintenance, pursuing abstinence. Int J Addict 1995 Aug;30(10):1303-9.

Pani PP, Pirastu R, Ricci A, Gessa GL. Prohibition of take-home dosages: negative consequences on methadone maintenance treatment. Drug Alcohol Depend 1996 May;41(1):81-4.

Rettig RA, Yarmolinsky A. Federal regulation of methadone treatment. Washington (DC): National Academy Press; 1995. 248 p.

Strang J. Opiates: are there under-utilized and unexplored areas of prevention? Addiction 1994 Nov;89(11):1511-6.

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Last updated: 15 November 1997
First published: 15 November 1997
Metadata| Permanence level: Permanent: Dynamic Content