New Treatments for Addiction

New and improved therapies to treat and protect against drug dependence and
abuse are urgently needed. In the United States alone about 50 million people regularly
smoke tobacco and another 5 million are addicted to other drugs. In a given
year, millions of these individuals attempt—with or without medical assistance—to
quit using drugs, though relapse remains the norm. Furthermore, each year several
million teenagers start smoking and nearly as many take illicit drugs for the first
time. Research is advancing on promising new means of treating drug addiction
using immunotherapies and sustained-release (depot) medications. The aim of this
research is to develop medications that can block or significantly attenuate the psychoactive
effects of such drugs as cocaine, nicotine, heroin, phencyclidine, and
methamphetamine for weeks or months at a time. This represents a fundamentally
new therapeutic approach that shows promise for treating drug addiction problems
that were difficult to treat in the past. Despite their potential benefits, however, several
characteristics of these new methods pose distinct behavioral, ethical, legal, and
social challenges that require careful scrutiny. Such issues can be considered unique
aspects of safety and efficacy that are fundamentally related to the distinct nature
and properties of these new types of medications.



Table of Contents


Front Matter
Executive Summary
1 Introduction and Background
2 Clinical Trials
3 Treatment, Financing, and Costs
4 Behavioral Responses and Consent
References
Appendix A: Vaccines and Depot Medications for Drug Addiction: Rationale, Mechanisms of Action, and Treatment Implications
Appendix B: What Will We Learn from the FDA Clinical Trials Process and What Will We Still Want to Know About Immunotherapies and Depot Medications to Treat Drug Dependence?
Appendix C: Putting Addiction Treatment Medications to Use: Lessons Learned
Appendix D: Adoption of Drug Abuse Treatment Technology in Speciality and Primary Care Settings
Appendix E: The Use of Immunotherapies and Sustained-Release Formulations in the Treatment of Drug Addiction: Will Current Law Support Coercion?
Appendix F: Ethical Issues in Immunotherapies and Depot Mechanisms for Substance Abuse
Appendix G: Costs and Benefits of Immunotherapies or Depot Medications for the Treatment of Drug Abuse
Appendix H: Anticipating Unintended Consequences of Vaccine-Like Immunotherapies for Addictive Drug Use
Appendix I: Vaccines and Immunotherapies to Control Addiction in Minors: The Legal Framework
Appendix J: Biographical Sketches of Committee Members and Staff