Pharmacotherapy, as a means of treating drug addiction in combination with other treatment modalities, has received too little attention from the research community, the pharmaceutical industry, public health officials, and the federal government. Medications to combat drug addiction could have an enormous impact on the medical consequences and socioeconomic problems associated with drug abuse, both for drug-dependent individuals and for American society as a whole. This book examines the current environment for and obstacles to the development of anti-addiction medications, specifically those for treating opiate and cocaine addictions, and proposes incentives for the pharmaceutical industry that would help overcome those obstacles and accelerate the development of anti-addiction medications.

Contents

• COMMITTEE TO STUDY MEDICATION DEVELOPMENT AND RESEARCH AT THE NATIONAL INSTITUTE ON DRUG ABUSE
• Acknowledgments
• Preface
• Note to the Reader
• Executive Summary
• 1. Introduction
  • Public-Health Repercussions Of Illicit Drug Use
  • Economic Costs Of Illicit Drug Use To Society
  • Extent Of Illicit Drug Use
  • Role Of Pharmacotherapy
  • References
• 2. Overview of the State of Scientific Knowledge Concerning Drug Addiction
  • Concepts Of Drug Addiction
  • Biological Correlates And Psychopharmacology Of Addiction
  • MDD And Strategies For The Discovery Of A Cocaine Medication: Description And Critical Analysis
  • Conclusions And Recommendations
  • References
• 3. Assessment of the Medications Development Division
  • Structure And Functions Of The Medications Development Division
  • Relationships With Other Federal Agencies And The Private Sector
  • Assessment Of The Medications Development Division
  • Summary
  • Conclusions And Recommendations
  • References
• 4. Treatment Setting and Effectiveness
  • Treatment Setting
  • Demographic And Financial Profile
  • Treatment Effectiveness And Cost-Effectiveness
  • Conclusions And Recommendation
  • References
• 5. Treatment Financing and Trends in Health Insurance
  • Financing Of Treatment
  • Financing Of Laam For The Treatment Of Opiate Addiction
  • Impact Of Health Insurance Trends On Medications Development
  • References
• 6. Training and Education
  • Expanding The Core Of Researchers And Clinicians
  • Increasing Knowledge And Skills Among Primary Care Physicians
  • Comprehensive Drug Abuse Centers
  • Summary
  • References
• 7. Federal Laws and Regulations
  • Creation Of A Drug By The Pharmaceutical Industry
  • Food And Drug Administration
  • Drug Enforcement Administration
  • Conclusions
  • References
• 8. State Laws and Regulations
  • State Regulatory Landscape
  • Laam: A Case Study
  • Conclusions
  • Recommendations
  • References
• 9. Market Obstacles and Creating Incentives
  • Market Obstacles To Private-Sector Investment
  • Need For Federal Leadership
  • Conclusions
  • Options For Further Consideration
  • References
• Appendix A Acknowledgements
• Appendix B Organization and Mission Statements of NIDA's Medications Development Division and Its Branches
• Appendix C Diagnostic Criteria for Psychoactive Substance Dependence
• Appendix D Survey of Pharmaceutical Companies
• Appendix E Model Federal Programs in Pharmaceutical R&D
• Appendix F Workshop Agenda and Participants
• Appendix G Health Care Reform Legislation
• Appendix H Acronyms

Support for this study was provided by the National Institute on Drug Abuse (contract no. N01DA-3-8000).

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.