Combating opiate dependence: a comparison among the available pharmacological options

Expert Opin Pharmacother. 2004 Apr;5(4):713-25. doi: 10.1517/14656566.5.4.713.


Pharmacotherapies for heroin addiction may target opiate withdrawal symptoms, facilitate initiation of abstinence and/or reduce relapse to heroin use either by maintenance on an agonist or antagonist agent. Available agents include opioid agonists, partial opioid agonists, opioid antagonists and alpha 2 -agonists for use during managed withdrawal and long-term maintenance. Experimental approaches combine alpha 2 -agonists with naltrexone to reduce the time of opiate withdrawal and to accelerate the transition to abstinence. Recently, buprenorphine has been introduced in the US for office-based maintenance, with the hope of replicating the success of this treatment in Europe and Australia. Naloxone has been added to buprenorphine in order to reduce its potential diversion to intravenous use, whilst facilitating the expansion of treatment. Although comprehensive substance abuse treatment is not limited to pharmacotherapy, this review will focus on the rationale, indications and limitations of the range of existing medications for detoxification and relapse prevention treatments. The two major goals of pharmacotherapy are to relieve the severity of opiate withdrawal symptoms during the managed withdrawal of the opioid and to prevent relapse to heroin use either after abstinence initiation or after being stabilised on a long-acting opiate agonist, such as methadone.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adrenergic alpha-2 Receptor Agonists
  • Heroin Dependence / drug therapy
  • Heroin Dependence / prevention & control
  • Heroin Dependence / rehabilitation
  • Humans
  • Narcotic Antagonists / therapeutic use
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / prevention & control
  • Opioid-Related Disorders / rehabilitation*
  • Receptors, Opioid, mu / agonists
  • Receptors, Opioid, mu / antagonists & inhibitors
  • Substance Withdrawal Syndrome / drug therapy


  • Adrenergic alpha-2 Receptor Agonists
  • Narcotic Antagonists
  • Receptors, Opioid, mu