Effective Treatment for Prescription Opioid Abuse

描述（由申请人提供）： 近年来，处方类阿片滥用情况令人震惊地增加。例如，2002年全国药物使用和健康调查的数据表明，1990年至2000年期间，处方类阿片的滥用增加了400%以上。处方类阿片滥用的增加与毒品相关犯罪的增加、许多不良健康后果和治疗需求有关。尽管有这些统计数据，我们知道没有发表的研究评估处方阿片类药物滥用的治疗。该提案是为了响应NIDA的PA 04-110“处方药滥用”而提交的，并概述了两项旨在以编程方式评估处方阿片类药物滥用的行为-药理学联合治疗的实验研究。在这两项研究中，向患者提供的平台行为治疗是社区强化方法（CRA），这是一种促进合法和非法药物滥用者改变健康生活方式的有效疗法。药物治疗将是丁丙诺啡解毒，然后是纳洛酮治疗方案。在研究1中，我们提出了一个参数调查，以确定一个有效的丁丙诺啡剂量递减时间表，防止不良的保留和高复发率，往往破坏戒毒计划。在研究2中，我们提出了一个参数调查，以确定一个有效的纳洛酮治疗方案，可以维持阿片类药物戒断后丁丙诺啡解毒。该提案的总体目标是为处方阿片类药物滥用开发一种手动有效的治疗方法。本申请中提出的两项随机临床试验有可能为处方阿片类药物滥用的有效干预措施的开发提供重要的新科学和临床知识。该项目的目标也直接关系到NIDA的使命，即开发有效的药物依赖治疗方法。最后，拟议的研究具有影响公共卫生状况的重大潜力。为这一新兴人群开发有效的治疗方法将有助于减少与处方阿片类药物滥用相关的巨大经济和社会成本。

DESCRIPTION (provided by applicant): There has been an alarming increase in abuse of prescription opioids in recent years. Data from the 2002 National Survey on Drug Use and Health, for example, indicate that abuse of prescription opioids increased by more than 400% between 1990 and 2000. This increase in prescription opioid abuse has been associated with increases in drug-related crime, numerous adverse health consequences and treatment demand. Despite these statistics, we know of no published studies evaluating treatments for prescription opioid abuse. This proposal is submitted in response to NIDA's PA 04-110 "Prescription Drug Abuse" and outlines two experimental studies designed to programmatically evaluate a combined behavioral-pharmacological treatment for prescription opioid abuse. The platform behavioral treatment delivered to patients in both studies is the Community Reinforcement Approach (CRA), an efficacious therapy for promoting healthy lifestyle changes in licit and illicit drug abusers. The pharmacological treatments will be a buprenorphine detoxification followed by a regimen of naltrexone therapy. In Study 1 we propose a parametric investigation to determine an effective buprenorphine dose-tapering schedule that prevents the poor retention and high relapse rates that often undermine detoxification programs. In Study 2 we propose a parametric investigation to determine an effective regimen of naltrexone therapy that can sustain opioid abstinence following the buprenorphine detoxification. The overarching goal of this proposal is to develop a manualized, efficacious treatment for prescription opioid abuse. The two randomized clinical trials proposed in this application have the potential to contribute important new scientific and clinical knowledge critical to the development of effective interventions for prescription opioid abuse. The aims of the project are also directly relevant to NIDA's mission of developing effective, empirically-based treatments for drug dependence. Finally, the proposed research holds significant potential for impacting the status of public health in general. Development of efficacious treatments for this emerging population will help to reduce the vast economic and societal costs associated with prescription opioid abuse.