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Chapter 14. Pharmacological Treatments for Opioid Addiction

Eric D. Collins, M.D.; Herbert D. Kleber, M.D.; Charles P. O'Brien, M.D., Ph.D.; Kyle M. Kampman, M.D.; Richard S. Schottenfeld, M.D.

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Opioid detoxification continues to be employed by the majority of heroin abusers as a pretreatment procedure prior to drug-free treatments, including opioid antagonist maintenance. Some individuals seek detoxification but do not seek long-term treatment, either because they expect to remain opioid-abstinent without additional help or because they do not seriously intend to remain abstinent. For those patients who do seek additional treatment, the prerequisite detoxification and withdrawal discomfort are often a barrier to entering and/or completing treatment. Thus, while detoxification is a necessary part of treatment for many patients, it has not achieved its full potential for the transition from opioid dependence to drug-free and/or antagonist maintenance treatments. The advent of buprenorphine for opioid detoxification may allow this transition to proceed safely, relatively quickly, and with a minimum of discomfort.

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