09159nam 2200685 a 450 991082885220332120240416233512.00-309-17652-21-280-19299-297866101929910-309-58791-30-585-02541-X(CKB)110986584751598(SSID)ssj0000137964(PQKBManifestationID)11146785(PQKBTitleCode)TC0000137964(PQKBWorkID)10096668(PQKB)10945348(Au-PeEL)EBL3376237(CaPaEBR)ebr10055260(OCoLC)923262252(MiAaPQ)EBC3376237(EXLCZ)9911098658475159819950206d1995 uy 0engurcn|||||||||txtccrDevelopment of medications for the treatment of opiate and cocaine addictions issues for the government and private sector /Carolyn E. Fulco, Catharyn T. Liverman, and Laurence E. Earley, editors ; Committee to Study Medication Development and Research at the National Institute on Drug Abuse, Division of Biobehavioral Sciences and Mental Disorders, Institute of Medicine1st ed.Washington, DC National Academy Press1995xvii, 250 p. illCommittee chairman: Laurence E. Earley.Support for this study was provided by the National Institute on Drug Abuse.0-309-05244-0 Includes bibliographical references.Development of Medications for the Treatment of Opiate and Cocaine Addictions: Issues for the Government and Private Sector -- Copyright -- Acknowledgments -- Preface -- Note to the Reader -- Contents -- Executive Summary -- STATE OF THE SCIENTIFIC KNOWLEDGE ON ADDICTION -- NIDA'S MEDICATIONS DEVELOPMENT DIVISION -- EFFECTIVENESS OF TREATMENT -- TREATMENT FINANCING -- TRAINING AND EDUCATION -- FEDERAL REGULATORY ISSUES -- Food and Drug Administration -- Drug Enforcement Administration -- STATE REGULATORY ISSUES -- Interim Actions -- Long-Term Actions -- MARKET OBSTACLES AND CREATING INCENTIVES -- Size of the Market -- Drug Pricing and Intellectual Property Rights -- Societal Stigma -- NEED FOR FEDERAL LEADERSHIP -- CONCLUSIONS -- OPTIONS FOR FURTHER CONSIDERATION -- REFERENCES -- 1 Introduction -- PUBLIC-HEALTH REPERCUSSIONS OF ILLICIT DRUG USE -- Health Consequences: Violence -- Health Consequences: AIDS -- Health Consequences: Tuberculosis -- Health Consequences: Drug-exposed Infants -- ECONOMIC COSTS OF ILLICIT DRUG USE TO SOCIETY -- EXTENT OF ILLICIT DRUG USE -- ROLE OF PHARMACOTHERAPY -- REFERENCES -- 2 Overview of the State of Scientific Knowledge Concerning Drug Addiction -- CONCEPTS OF DRUG ADDICTION -- BIOLOGICAL CORRELATES AND PSYCHOPHARMACOLOGY OF ADDICTION -- Opiate Addiction -- Cocaine Addiction -- MDD AND STRATEGIES FOR THE DISCOVERY OF A COCAINE MEDICATION: DESCRIPTION AND CRITICAL ANALYSIS -- Introduction -- Source of Compounds -- Medication Preclinical Screening -- In Vitro Screen-Receptors and Mechanisms of Action -- In Vivo Screen-Behavioral Tests -- Specific Conclusions and Recommendations for the MDD -- Clinical Trials -- Human Behavioral Models -- CONCLUSIONS AND RECOMMENDATIONS -- REFERENCES -- 3 Assessment of the Medications Development Division -- STRUCTURE AND FUNCTIONS OF THE MEDICATIONS DEVELOPMENT DIVISION.Mission and History -- Research Focus on Opiates and Cocaine -- Program Objectives -- Organizational Structure -- Budget Process -- Resources and Funding Instruments -- Types of Grants and Contracts -- Interagency Agreements -- CRADAs -- Screening Agreements -- Training -- RELATIONSHIPS WITH OTHER FEDERAL AGENCIES AND THE PRIVATE SECTOR -- Food and Drug Administration -- Drug Enforcement Administration -- Office of Protection from Research Risks -- Pharmaceutical Industry -- ASSESSMENT OF THE MEDICATIONS DEVELOPMENT DIVISION -- Staff and Resources -- Drug-Discovery Programs -- Clinical Trials -- Clinical-Research Training -- Relationships with Regulatory Agencies -- Interaction with the Private Sector -- SUMMARY -- CONCLUSIONS AND RECOMMENDATIONS -- REFERENCES -- 4 Treatment Setting and Effectiveness -- TREATMENT SETTING -- Opiate Addiction -- Cocaine Addiction -- DEMOGRAPHIC AND FINANCIAL PROFILE -- Opiate-Dependent Patients -- Cocaine-Dependent Patients -- TREATMENT EFFECTIVENESS AND COST-EFFECTIVENESS -- Methadone Maintenance Treatment -- Effectiveness -- Cost-Effectiveness -- Cocaine Addiction Treatment -- Effectiveness -- Cost-Effectiveness -- CONCLUSIONS AND RECOMMENDATION -- REFERENCES -- 5 Treatment Financing and Trends in Health Insurance -- FINANCING OF TREATMENT -- Financing the Treatment of Opiate Addiction -- Financing the Treatment of Cocaine Addiction -- FINANCING OF LAAM FOR THE TREATMENT OF OPIATE ADDICTION -- IMPACT OF HEALTH INSURANCE TRENDS ON MEDICATIONS DEVELOPMENT -- Trends in Drug Abuse Treatment Benefits -- REFERENCES -- 6 Training and Education -- EXPANDING THE CORE OF RESEARCHERS AND CLINICIANS -- Training Programs -- Fellowships -- Certification -- Conclusions and Recommendations -- INCREASING KNOWLEDGE AND SKILLS AMONG PRIMARY CARE PHYSICIANS -- Required Education in Medical Schools -- Residency Training.Continuing Education -- Conclusions and Recommendations -- COMPREHENSIVE DRUG ABUSE CENTERS -- Proposed Model -- Existing Research and Training Centers -- CSAT Centers -- NIDA Research Centers -- Conclusions and Recommendations -- SUMMARY -- REFERENCES -- 7 Federal Laws and Regulations -- CREATION OF A DRUG BY THE PHARMACEUTICAL INDUSTRY -- FOOD AND DRUG ADMINISTRATION -- Recent Initiatives to Expedite Availability of New Drugs -- Market Exclusivity and Orphan Drug Status -- FDA Guidelines on Evaluation of Anti-Addiction Drugs -- DRUG ENFORCEMENT ADMINISTRATION -- Scheduling -- Quotas -- Regulatory Authority Over Anti-Addiction Drugs In Development -- CONCLUSIONS -- REFERENCES -- 8 State Laws and Regulations -- STATE REGULATORY LANDSCAPE -- Scheduling -- Treatment -- Admission Criteria -- Staffing Requirements -- Patient Registries -- Drug Screening -- Medication Take-Home Policies -- Clinical Research -- LAAM: A CASE STUDY -- Federal Regulations -- State Regulations -- Scheduling/Rescheduling -- Treatment Regulations -- Clinic Approval -- CONCLUSIONS -- RECOMMENDATIONS -- Interim Actions -- Long-Term Actions -- REFERENCES -- 9 Market Obstacles and Creating Incentives -- MARKET OBSTACLES TO PRIVATE-SECTOR INVESTMENT -- Nature and Size of the Market -- Drug Pricing and Intellectual Property Rights -- Societal Stigma -- Clinical Research on Anti-Addiction Medications -- Product Liability -- NEED FOR FEDERAL LEADERSHIP -- CONCLUSIONS -- OPTIONS FOR FURTHER CONSIDERATION -- REFERENCES -- Appendix A Acknowledgements -- Appendix B Organization and Mission Statements of NIDA's Medications Development Division and Its... -- MEDICATIONS DEVELOPMENT DIVISION MISSION STATEMENT -- Biometrics Branch Mission Statement -- Chemistry and Pharmaceutics Branch Mission Statement -- Clinical Trials Branch Mission Statement.Pharmacology and Toxicology Branch Mission Statement -- Regulatory Affairs Branch Mission Statement -- Appendix C Diagnostic Criteria for Psychoactive Substance Dependence -- Appendix D Survey of Pharmaceutical Companies -- ATTACHMENT 1 -- ATTACHMENT 2 -- Appendix E Model Federal Programs in Pharmaceutical R&amp -- D -- ANTIEPILEPTIC DRUG DEVELOPMENT PROGRAM -- Background -- Elements of Success -- NATIONAL CANCER INSTITUTE CANCER-DRUG DISCOVERY AND DEVELOPMENT PROGRAMS -- Background -- Preclinical Research -- Clinical Research -- Elements of Success -- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES DRUG DISCOVERY AND DEVELOPMENT PROGRAMS -- Background -- Preclinical Research -- Clinical Research -- Elements of Success -- REFERENCES -- Appendix F Workshop Agenda and Participants -- WORKSHOP AGENDA -- PARTICIPANT LIST -- Appendix G Health Care Reform Legislation -- UNIVERSALITY OF COVERAGE -- PRESCRIPTION DRUG BENEFITS -- DRUG ABUSE TREATMENT BENEFITS -- INSURANCE REFORM -- FINANCING HEALTH CARE REFORM AND THE FATE OF MEDICAID -- CONCLUSIONS -- REFERENCES -- Appendix H Acronyms.Drug addictionTreatmentCocaine abuseTreatmentSubstance abuseTreatmentDrug addictionTreatment.Cocaine abuseTreatment.Substance abuseTreatment.616.86/32061Fulco Carolyn1660534Liverman Catharyn T1086332Earley Laurence E1616182National Institute on Drug Abuse.Committee to Study Medication Development and Research.Institute of Medicine (U.S.).Division of Biobehavioral Sciences and Mental Disorders.MiAaPQMiAaPQMiAaPQBOOK9910828852203321Development of medications for the treatment of opiate and cocaine addictions4040440UNINA