Objective.— To provide clinicians, patients, and the
general public with a responsible assessment of the effective
approaches to treat opiate dependence.
Participants.— A nonfederal, nonadvocate, 12-member panel
representing the fields of psychology, psychiatry, behavioral medicine,
family medicine, drug abuse, epidemiology, and the public. In addition,
25 experts from these same fields presented data to the panel and a
conference audience of 600. Presentations and discussions were divided
into 3 phases over 212 days: (1) presentations by investigators
working in the areas relevant to the consensus questions during a 2-day
public session; (2) questions and statements from conference attendees
during open discussion periods that are part of the public session; and
(3) closed deliberations by the panel during the remainder of the
second day and morning of a third day. The conference was organized and
supported by the Office of Medical Applications of Research, National
Institutes of Health.
Evidence.— The literature was searched through MEDLINE and
other National Library of Medicine and online databases from January
1994 through September 1997 and an extensive bibliography of 941
references was provided to the panel and the conference audience.
Experts prepared abstracts for their presentations as speakers at the
conference with relevant citations from the literature. Scientific
evidence was given precedence over clinical anecdotal experience.
Consensus Process.— The panel, answering predefined
questions, developed its conclusions based on the scientific evidence
presented in open forum and the scientific literature. The panel
composed a draft statement that was read in its entirety and circulated
to the experts and the audience for comment. Thereafter, the panel
resolved conflicting recommendations and released a revised statement
at the end of the conference. The panel finalized the revisions within
a few weeks after the conference. The draft statement was made
available on the World Wide Web immediately following its release at
the conference and was updated with the panel's final revisions.
Conclusions.— Opiate dependence is a brain-related
medical disorder that can be effectively treated with significant
benefits for the patient and society, and society must make a
commitment to offer effective treatment for opiate dependence to all
who need it. All persons dependent on opiates should have access to
methadone hydrochloride maintenance therapy under legal supervision,
and the US Office of National Drug Control Policy and the US Department
of Justice should take the necessary steps to implement this
recommendation. There is a need for improved training for physicians
and other health care professionals. Training to determine diagnosis
and treatment of opiate dependence should also be improved in medical
schools. The unnecessary regulations of methadone maintenance therapy
and other long-acting opiate agonist treatment programs should be
reduced, and coverage for these programs should be a required benefit
in public and private insurance programs.