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Pharmacological Treatment of Addiction: Normalization of Physiology and AIDS Risk Reduction

  • M. J. Kreek
Conference paper

Summary

In the United States, it is estimated that over 2 million persons have used heroin at some time and between 500.000 and 1 million are heroin addicts. It is estimated that over 23 million have used cocaine at some time and, of those, between 600.000 and 900.000 use cocaine regularly and are cocaine addicts. Parenteral drug abuse has become the leading risk for development of HIV infection in many regions. Illicit use of other drugs may also contribute to increase risk for HIV infection. The goals of treatment for any addiction must include prevention of abstinence or withdrawal symptoms, reduction or elimination of “drug hunger” or craving and relapse, and normalization of physiological functions which have been disrupted by abuse of the drug. Long-term studies of the physiological effects, in addiction to studies of the safety and efficacy of the long-acting opioid methadone as used in the maintenance treatment of addiction, have shown that this drug successfully addresses each of these three goals. It is assumed that future studies will show that another long-acting opioid, L-alpha-acethyl methadol (LAAM), will have similar desirable effects.

It has been shown that effective methadone maintenance treatment leads to a highly significant reduction in HIV-1 infection as long as patients remain in treatment. In our early study carried out in 1983–1984, we found that less than 10% of patients in effective methadone maintenance treatment has been infected with the HIV-1 virus at a time when over 50–60% of untreated addicts were infected with this AIDS virus. These studies now have been replicated in many parts of the world. Also, our studies have shown that chronic steady dose treatment with methadone allows normalization of many aspects of physiological function which may be profoundly disrupted during cycles of heroin addiction. This normalization includes restoration of function of the neuroendocrine axes which control stress response (the hypothalamic-pituitary-adrenal axis) as well as the reproductive biological responses (the hypothalamic-pituitary-gonadal axis). In addiction, our studies have shown that indices of immune function are disrupted cycles of heroin addiction become normalized during chronic steady dose methadone maintenance treatment, in part probably due to normalization of neuroendocrine function. On-going studies in our Laboratory have shown that the endogenous opioid system may play a physiological role in the modulation of specific indices of immune function such as natural killer cell activity. Therefore, it is essential to restore homeostasis of this endogenous opioid system which is disrupted during cycles of heroin and cocaine addiction. Other diseases now confound the problems of drug addiction and AIDS; they include Hepatitis B, C, and delta, and also tuberculosis. Compromised immune function may alter both the diagnosis and treatment of these disorders. Some drug interactions may occur between methadone as used in maintenance treatment and medications used to treat these other disorders, such as with the anti-tuberculosis agent rifampin. However, by knowledge of such interactions, it is possible to adjust the methadone maintenance treatment dose appropriately to allow appropriate maintenance treatment.

Keywords

Human Immunodeficiency Virus Human Immunodeficiency Virus Infection Natural Killer Cell Activity Methadone Maintenance Treatment Opioid Agonist 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Wien 1995

Authors and Affiliations

  • M. J. Kreek
    • 1
  1. 1.The Rockefeller UniversityNew YorkUSA

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