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Which medications are suitable for agonist drug maintenance?
Author(s) -
Darke Shane,
Farrell Michael
Publication year - 2016
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.13158
Subject(s) - nicotine , medicine , cannabis , drug , drug class , craving , pharmacology , neurocognitive , agonist , heroin , partial agonist , benzodiazepine , psychiatry , addiction , cognition , receptor
Background and aims We examine the feasibility of agonist maintenance treatment for the major psychoactive drug classes: opioids, nicotine, benzodiazepines, cannabis, psychostimulants and alcohol. Methods Eight clinical criteria for an agonist maintenance drug were assessed for each major drug class. These related to pharmacological aspects of the drug (agonist, pharmacological stability, dose–response, non‐toxic) and neurocognitive sequelae (psychiatric, cognitive, craving, salience). Results Opioids and nicotine met all eight criteria for a maintenance drug. While nicotine has not been promoted widely or used for maintenance, it has the potential to fulfil that role. Cannabis met five criteria and has potential, but long‐term data on cognitive impairment are required. Benzodiazepine maintenance would appear an option for the high‐dose chaotic abuser, also meeting five criteria, although clinic dosing appears the safest option. Psychostimulants (three of eight criteria) and alcohol (one of eight) appear poor propositions for maintenance, in terms of both their pharmacological and their neurocognitive characteristics. Conclusions Drug classes have properties that distinguish them in their suitability for maintenance treatment. Some classes not yet used for maintenance (notably nicotine and cannabis) have potential to fulfil such a role. Others, however, by their inherent nature, appear unsuitable for such a treatment regimen.