ABSTRACT
Illicit drug use is responsible for more than 25,000 deaths and $100 billion in total economic costs annually in the United States (Harwood, Fountain, & Livermore, 1998). Recently, heroin has emerged as the major contributor to these societal problems and costs. Persons suffering from heroin abuse and dependence are an important patient population for general internists. Although patients may present with medical problems that relate directly to heroin or its route of administration (for example, injection), physicians are often unaware of the underlying drug abuse problems (Schorling & Buchsbaum, 1997) and thus may miss the opportunity to offer drug treatment services. Over the past decade, research on heroin dependence has demonstrated that treatment is effective, and new pharmacologically based treatments show promise for the expansion of treatment options (Kosten & McCance, 1996). Most recently, research has suggested that internists may have a direct role in the provision of drug treatment services for heroin-dependent persons in their offices (O'Connor et al., 1998). In this chapter, we review the treatment of heroin dependence and emphasize recent developments in pharmacologically based treatment approaches.
