NIDA research-to-practice program assists people in overcoming addiction
In his 25 years at Maryhaven, a substance addiction and mental health treatment clinic in Columbus, Ohio, Psychologist Gregory Brigham, PhD, has seen hundreds of heroin addicts go through the physical agony of withdrawal. Brigham said at a February Capitol Hill briefing sponsored by the Friends of the National Institute on Drug Abuse and organized by APA science policy staff that nearly half of people who enter treatment for opioid dependence at the center drop out before completing the detoxification stage, and only about 30% of those who make it through go on to post withdrawal counseling and treatment.
Clonidine, the major medicine used for withdrawal from heroin and other opiates prior to the advent of methadone in highly regulated, licensed opioid treatment programs, has been part of the problem. According to Brigham, clonidine does not help many addicts with physical withdrawal symptoms.
"They're vomiting; they're cramping; they're simply very, very sick on the detox unit," he claimed.
However, a new drug called buprenorphine is giving Maryhaven fresh hope. 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—that 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 mentioned buprenorphine as one of the initiative's success stories at the briefing. Maryhaven took part in a research trial that found that 77 percent of buprenorphine-treated Maryhaven patients tested clean and remained in the program after 13 days, compared to only 22 percent of clonidine-treated Maryhaven patients. At Maryhaven, a publicly financed substance misuse treatment clinic that handles over 7,000 patients each year, the medication is now a common part of treatment.
Brigham stated, "Patient outcomes have improved, and lives have been saved."
This might not have been achievable without the NIDA Blending Initiative. According to Timothy P. Condon, PhD, NIDA's deputy director, the time gap between research findings and medical practice was estimated to be 17 years in a 1998 Institute of Medicine report.
"In order to enjoy any benefits from this scientific knowledge, it must be both useful and applied," he stated.
Condon noted that substance abuse therapy can surely reap those benefits, noting that an estimated 23 million people are addicted to alcohol or use illegal drugs, with just a small number obtaining treatment.
The Blending Initiative's main components are:
The Clinical Trials Network is an organization dedicated to conducting clinical trials. A network of 200 community-based substance misuse treatment clinics began testing novel techniques and medications in 1999, and is organized through 17 regional research and training "nodes." Patients serve as volunteers, while clinical care personnel serve as consultants. Putting Teams Together. Researchers collaborate with practitioners and employees from the SAMHSA Addiction Technology Transfer Centers to create training materials based on the clinical trial network's findings.
So far, the following training materials have been prepared for treatment approaches and drugs that have been evaluated through the network:
13-day taper of buprenorphine Patients who are addicted to opiates are begun on buprenorphine and gradually tapered off over the course of 13 days. Buprenorphine is an opiate, however it is a "partial agonist," meaning it does not cause the same euphoria as heroin. Motivational interviewing supervision. The training program promotes successful supervision of motivational interviewing. This therapy strategy helps patients develop goals and identify how their substance addiction has led to personal and financial devastation, such as losing a job or being arrested on drug charges. Incentives for motivation. When patients who are being monitored for drug usage test negative, they are given a prize. Awards could be cards complimenting progress or small, medium, or big prizes based on a lottery system.
According to Dennis McCarty, PhD, director of the Center for Substance Abuse Research and Policy at Oregon Health and Science University, once field-based research trials show that new treatment methods work, the goal is to develop and distribute training materials on how to use the treatment breakthroughs.
"When the research is published, having the tools available might have a huge impact on the area. It helps men and women who are in need of therapy "McCarty is also the chief investigator for the Clinical Trials Network's Oregon/Hawaii node.