[Federal Register Volume 62, Number 180 (Wednesday, September 17, 1997)]
[Notices]
[Pages 48878-48879]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-24628]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health


Consensus Development Conference on Effective Medical Treatment 
of Heroin Addiction

    Notice is hereby given of the NIH Consensus Development Conference 
on ``Effective Medical Treatment of Heroin Addiction,'' which will be 
held November 17-19, 1997, in the Natcher Conference Center of the 
National Institutes of Health, 9000 Rockville Pike, Bethesda, Maryland 
20892. The conference begins at 8:30 a.m. on November 17, at 8:30 a.m. 
on November 18, and at 9 a.m. on November 19.
    In the United States alone, approximately one-half million people 
are addicted to heroin. Estimates of heroin incidence (122,000 new 
users) in recent years suggest an increased incidence and an emerging 
pattern of drug use among the young. For many years, heroin addiction 
has been associated with increased criminal activity and human 
suffering. In the past 10 years, there has been a dramatic increase in 
the prevalence of human immunodeficiency virus (HIV), hepatitis C virus 
(HCV), and tuberculosis among intravenous heroin users. From 1991 to 
1995 in major metropolitan areas, the annual number of heroin-related 
emergency room visits has increased from 36,000 to 76,000, and the 
annual number of heroin-related deaths has increased from 2,300 to 
4,000. The associated morbidity and mortality further underscore the 
human, economic, and societal cost of heroin addiction.
    Over the last 20 years, a significant body of evidence has 
accumulated on the neurobiology of heroin addiction and on the safety 
and efficacy of narcotic (methadone) maintenance treatment.
    Although there have been other medications (e.g., levo-alpha 
acetylmethadol [LAAM]) subsequently determined safe and effective in 
narcotic maintenance treatment, the focus of this consensus development 
conference will be on methadone, because methadone has been the 
medication used in most narcotic treatment research. Evaluation studies 
have consistently shown methadone treatment to be effective in reducing 
drug use and crime and in enhancing social productivity. More recent 
studies demonstrate that methadone treatment is an effective method for 
preventing the spread of HIV, HCV, and tuberculosis among intravenous 
drug users.
    Most heroin users are not receiving treatment. Most recent data 
indicate that there are approximately 112,000 patients in narcotic 
maintenance treatment. Barriers exist to both access to narcotic 
maintenance treatment and effective treatment, despite the science on 
the neurobiology of heroin addiction and the evidence demonstrating the 
effectiveness of treatment in reducing drug use and crime and 
preventing the spread of HIV and HCV. An important reason for some of 
these barriers is that narcotic maintenance treatment remains 
controversial. The science has not yet overcome the stigma of addiction 
and public perception about narcotic maintenance treatment.
    Many members of the medical community and the public conceive of 
opiate addiction as a self-inflicted disease of the will, methadone 
treatment as mere narcotic substitution and relapses likely to follow 
treatment, drug-free treatment as the only valid rehabilitative method, 
and total abstinence from all drugs, including methadone, as the only 
valid treatment goal. Other obstacles include Federal and state 
government regulations limiting treatment providers and patient access 
and concerns about methadone diversion by patients and its 
consequences.
    To address the most important and controversial issues surrounding 
narcotic maintenance treatment, the NIH has organized this 2\1/2\ day 
conference to present the available data on opiate agonist treatment 
for heroin addiction. The conference will bring together national and 
international experts in the fields of basic and clinical neuroscience, 
epidemiology, and natural history, prevention and treatment of heroin 
addiction, as well as representatives from the public.
    After 1\1/2\ days of presentations and audience discussion, an 
independent, non-Federal consensus panel chaired by Dr. Lewis Judd, 
chair of the Department

[[Page 48879]]

of Psychiatry at the University of California at San Diego School of 
Medicine, will weigh the scientific evidence and write a draft 
statement that will be presented to the audience on the third day. The 
consensus statement will address the following key questions:
    * What is the scientific evidence to support a conceptualization of 
opiate addiction as a medical disorder including natural history, 
genetics and risk factors, pathophysiology, and how is diagnosis 
established?
    * What are the consequences of untreated opiate addiction to 
individuals, families and society?
    * What is the efficacy of current treatment modalities in the 
management of opiate addiction including detoxification alone, non-
pharmacological/psychosocial treatment, treatment with opiate 
antagonists, and treatment with opiate agonists (short-term and long-
term)?
    * What is the (scientific evidence for the) most effective use of 
opiate agonists in the treatment of opiate addiction?
    * What are the important barriers to effective use of opiate 
agonists in the treatment of opiate addiction in the U.S., including 
perceptions and the adverse consequences of opiate agonist use, legal, 
regulatory, financial and programmatic barriers?
    * What are the future research areas and recommendations for 
improving opiate agonist treatment and improving access?
    The primary sponsors of this meeting are the National Institute on 
Drug Abuse and the NIH Office of Medical Applications Research. The 
conference is co-sponsored by the NIH Office of Research on Women's 
Health.
    Advance information on the conference program and conference 
registration materials may be obtained from Prospect Associates, 1801 
Rockville Pike, Suite 500, Rockville, Maryland 20852, (301) 468-MEET, 
by e-mail at [email protected], or by visiting http://
consensus.nih.gov on the World Wide Web.
    The consensus statement will be submitted for publication in 
professional journals and other publications. In addition, the 
statement will be available beginning November 19, 1997, from the NIH 
Consensus Program Information Center, P.O. Box 2577, Kensington, 
Maryland 20891, phone 1-888-NIH-CONSENSUS (1-888-644-2667) and from the 
NIH Consensus Development Program site on the World Wide Web at http://
consensus.nih.gov.

    Dated: September 4, 1997.
Ruth L. Kirschstein,
Deputy Director, NIH.
[FR Doc. 97-24628 Filed 9-16-97; 8:45 am]
BILLING CODE 4140-01-M