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Date Posted: 09:55:40 05/02/02 Thu
Author: Susie
Author Host/IP: bgp425870bgs.union01.nj.comcast.net / 68.36.197.75
Subject: NIH Consensus Statement on Opiate Addiction (in part)

The Natural History of Opiate Dependence
Abstract – Effective Medical Treatment of Opiate Addiction, National Institute of Health Consensus Statement 1997

Scientific evidence reviewed for the NIH report indicates that opiate dependence stems from a physiological medical disorder in the human brain that causes the addicted individual to crave and continue to use the substance despite the risk of physical or psychological harm. There is consistent evidence that medical treatment can be utilized to effectively manage this disorder and that treatment can provide substantial positive benefits to the addicted patient and society.

Investigators that have examined the biological, psychological and social factors that contribute to opiate abuse argue that most individuals that become dependent on opiates begin their cycle of addictive behavior early, generally in their twenties, and continue to use illicit drugs intermittently throughout their lifetime. They argue that repeated exposure to drugs such as opiates causes substance use to increase despite the adverse effects and harmful consequences that the individual may experience. The majority of individuals that become addicted to opiates develop a physiological dependence that gradually escalates as the body concomitantly builds up tolerance to the physical effects of the drug. Once a pattern of physical dependence is firmly established the addicted patient enters repeated cycles of drug cessation and relapse that can continue throughout his or her lifespan. This pattern of dependence on opiates leads to what the experts call an addiction career that is usually accompanied by decades of legal problems and incarceration in public correctional facilities.

The Neurobiology, Pathology and Genetic Risk Factors Associated with Opioid Addiction and Dependence
Abstract – Effective Medical Treatment of Opiate Addiction, National Institute of Health Consensus Statement 1997

Decades of clinical research on the neurobiology and pathology of opiate dependence have revealed that individual vulnerability to drug abuse is partially inherited and the pattern and degree of severity of this disorder are strongly influenced by environmental factors. This conclusion is supported by evidence gathered in government-funded family, twin, and adoption studies that indicate that the children of opiate dependent parents have a higher predisposition and susceptibility to abuse and dependence after their initial use of opioids compared with children whose parents do not use drugs. Neurobiological studies suggest that there are a number of opioid receptor pathways in the human cerebral cortex that play an important role in the development of drug dependence and the intensity of symptoms of physical withdrawal experienced by opiate addicted patients.

Definition of Opioid Dependence as a Medical Disorder
Abstract – Effective Medical Treatment of Opiate Addiction, National Institute of Health Consensus Statement 1997

The Consensus panel at the National Institutes of Health defines opioid dependence as a cluster of cognitive, behavioral, and physiological symptoms in which an individual continues to use opiates despite significant physiological and psychological harm caused by the ingestion of the drugs. The condition is characterized by the patient’s repeated self-administration of an opiate drug over an extended period of time resulting in the development of opioid tolerance, compulsive drug taking behavior, and withdrawal symptoms upon cessation of use. Patients may develop a dependence on opioids with or without symptoms of physiological tolerance and withdrawal; these patients usually have a long history of opioid self-administration either through intravenous drug injection, intranasal ingestion or smoking.

Health care providers in the United States agree that although the factors that contribute to opiate dependency are poorly understood, one thing is certain: once physical dependence on opiates develops, it can constitute a medical disorder that requires treatment intervention. Methadone maintenance treatment in conjunction with medical attention and psychiatric counseling can do a great deal to alter the course of the natural history of opiate dependence and help prolong periods of abstinence from illicit drug use in addicted patients.

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