Drugs Of Abuse, Drugs Of Assistance

On a daily basis, Christiane Farentinos sees many examples of how pharmaceuticals can work in opposite but equally life-altering ways. Pharmaceuticals can be objects of addiction and abuse or tools in the fight to treat those conditions. Recent news reports about thefts of oxycodone, a potent pain-killing but addictive opiate, from pharmacies exemplify an increased abuse of prescription drugs. Yet naltrexone, an opiate antagonist approved by the Food & Drug Administration, has helped people seeking treatment for alcohol addiction.

Addiction is complex, encompassing both physiological and psychological dimensions. Roughly 55% of addictions can be traced to genetic predisposition and 45%, to environmental influences, says Farentinos, who is the research and clinical director of ChangePoint Inc., a group of six substance abuse treatment centers located around Portland, Ore., and Vancouver, Wash. Before coming to the U.S., she practiced clinical psychiatry in Rio de Janeiro while serving as the medical director for a residential alcohol and drug treatment center there.

"I see a slow but bright future" for pharmaceuticals to treat some addiction, says Farentinos, who is also a member of the National Institute on Drug Abuse and the National Center on Addiction & Substance Abuse protocol development team for research on motivational interviewing and patient retention. Scientists are uncovering how the addicted brain works, but the process of collecting multitudes of brain scans, analyzing them, and then developing drugs with that information takes a lot of time, she says.

Pharmaceutical advances can help patients deal with the social stigma of addiction, Farentinos says. For example, some recovering heroin users hold daily jobs but must visit a clinic daily to receive treatment with methadone. Employees who do not want to tell their employers about their situation may lose their jobs over unexplained and frequent time off for those visits. A newer treatment called buprenorphine has longer lasting effects compared with methadone and thus requires fewer clinic visits and results in better patient compliance.

Unfortunately, Farentinos says, a lack of doctors willing to write prescriptions poses the largest roadblock in getting pharmaceutical aids to patients. Most substance abuse clinics do not have a doctor on staff who can write prescriptions, so counselors often try to work with a patient's primary care doctor. Doctors get very little training in medical school about how to deal with substance abuse, let alone how to use drugs in treatments, Farentinos says. And, she adds, doctors can have many of the same prejudices about addiction that the general public does.

She says the situation is improving but only slowly because of uninformed or unwilling doctors. For example, she had a small grant program to give patients free therapeutic drugs to treat addiction provided that the drugs were prescribed. Many of the patients' doctors, however, either didn't understand the program or just refused to be involved, she says.