Cerebrum just published an interesting article on the ethical implications of using drugs to treat drug addiction. In particular, the scientists examine the benefits of naltrexone, an opioid receptor antagonist. (This means that the drug blocks receptors that normally bind opiates, like heroin. Methadone, in contrast, activates opioid receptors but appears to be an antagonist for NMDA receptors.) The scientists begin the article by discussing one of the few studies that actually investigated the benefits of naltrexone:
Despite not using opioids for a long period, incarcerated opioid addicts relapse at an alarming rate following their release from custody, even when they are under the supervision of a parole officer. It may be thought that the period of incarceration would “get the opioids out of their system” and “teach them a lesson,” but this is apparently not enough to prevent re-addiction and re-incarceration in a majority of opioid-addicted offenders. The availability of naltrexone may provide real benefits to these individuals, the criminal justice system and the public at large.
Studies conducted in the 1990s suggested that daily ingestion of a naltrexone pill taken by mouth reduced the frequency of relapse in parolees. Naltrexone has a high affinity for opiate receptors and prevents the high from heroin or other opioids by blocking their access to the receptor. In the only randomized, controlled clinical trial of probationers with a history of opioid addiction, Dr. James Cornish and colleagues in Philadelphia found that 59 percent of opioid-addicted parolees who received standard parole supervision–but not naltrexone–relapsed and were re-incarcerated within a year of their release. In contrast, a randomly assigned group of similar parolees who received both standard parole supervision and naltrexone from a research nurse stationed at the parole office had a relapse rate of only 25 percent.
What do you think? Is it wrong to simply substitute one drug for another? Or should extended-release naltrexone (once it’s approved by the FDA) become a mandatory part of drug rehab? Personally, I think the best way to think of these anti-addiction drugs is as a self-control booster. They clearly don’t erase the desire for the opiate – that’s why 25 percent of addicts still relapse – but they make it easier to resist the chemical temptation. And addicts need all the help they can get.
As I’ve argued before, I think the scourge of addiction is one of those rare societal problems that neuroscience can, at least in theory, really help alleviate.