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Medical Treatment of Opiate Addiction

Gerald M. Aronoff, MD
JAMA. 2000;283(22):2931. doi:10.1001/jama.283.22.2931.
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To the Editor: The article on the treatment of opiate addiction based on a National Institutes of Health (NIH) Consensus Conference1 is inaccurate, misleading, and misguided in its attempt to "provide clinicians, patients, and the general public with a responsible assessment of the effective approaches to treat opiate dependence."

One of the major flaws of this article is a failure to define the terms dependence and addiction. Throughout this article these terms are used interchangeably. The basic flaw in the consensus panel's assumption is that opiate dependence is a medical disorder that needs treatment and that individuals and society will benefit from providing this treatment. Beginning with this flawed premise, the consensus panel goes on to the flawed conclusion that opiate dependence (what they mean to say is opiate addiction) is a medical disorder with biological, psychological, sociological, and economic factors. They indicate that when certain persons begin to use opiates, their use escalates to a state of abuse and then to a state of dependence. Unfortunately in its discussion of dependence, the consensus panel includes compulsive drug-taking, which is not a part of the concept of physical dependence. They go on to discuss ways in which treatment can alter the natural history of opiate dependence. Research emanating from the pain medicine discipline (research that has also included reviews of multiple studies of persons prescribed opiates for legitimate medical purposes) indicates that physical dependence is a physiologic not a pathologic process.2


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