Question 4: How have U.S. regulations about treatment for heroin addiction evolved?
Answer: U.S. regulations about treatment for heroin addiction evolved through three time periods:
U.S. regulations about treatment for heroin addiction have evolved from strict prohibition of medical prescription of heroin to treat addiction, which began in 1914 and continued into the 1960s. Initial pilot studies testing methadone maintenance treatment for heroin addiction began in 1964, and methadone maintenance treatment was formally approved in 1972. Scientific advances prompted major reviews of Federal regulations by the Institute of Medicine in 1995 (Substance Abuse and Mental Health Services Administration, 2000b) made significant changes in U.S. regulations about treatment for heroin addiction, reducing Federal regulations and paving the way for new pharmacotherapies to treat heroin addiction.
1914-1972
Although heroin became a controlled substance under the Harrison Act of 1914, the law did not expressly prohibit the medical prescription of heroin to treat addiction. The U.S. Government concluded that the Harrison Act intended to prohibit such medical uses of controlled substances, prosecuting individual doctors who prescribed the drugs. In 1919, the U.S. Supreme Court upheld the Government’s position in Webb v. United States. In response, about 40 localities opened municipal narcotic clinics to treat addiction using a variety of methods, including medical prescription of narcotics, but by the mid-1920s, these clinics had all been closed by the Federal Government (Joseph, Stancliff, and Langrod, 2000).
1972-2000
Methadone maintenance treatment for heroin addiction was first approved by the U.S. Food and Drug Administration in 1972, subject to three levels of Federal regulation:
- Food and Drug Administration rules that pertained to all prescription drugs
- Drug Enforcement Administration rules that governed all controlled substances
- Unique Department of Health and Human Services rules limiting methadone maintenance treatment to strictly controlled opioid treatment programs, which also were subject to additional State or local rules
2000-Present
Substance Abuse and Mental Health Services Administration, 2000a), was approved for office-based dispensing by the Food and Drug Administration in 2002.
References
Courtwright D. A century of American narcotic policy. In: Institute of Medicine. Treating Drug Problems: Volume 2. Washington, DC: IOM, 1992, pp. 1-62. Available online at: books.nap.edu/openbook.php?isbn=0309043964. [Accessed March 23, 2006.]
Hentoff N. The treatment of patients - I. The New Yorker 1965;June 26:32-77.
Joseph H, Stancliff S, Langrod J. Methadone maintenance treatment (MMT): a review of historical and clinical issues. The Mount Sinai Journal of Medicine 2000;67(5 & 6):347-64. Available online at: http://mountsinai.site-ym.com/?page=Journal_of_Medicine/67/6756.shtml. [Accessed March 23, 2006.]
Marion IJ. Methadone treatment at forty. NIDA Science & Practice Perspectives 2005;3(1):25-31. Available online at: http://archives.drugabuse.gov/perspectives/vol3no1.html. [Accessed March 23, 2006.]
National Institutes of Health. Effective Medical Treatment of Opiate Addiction: Consensus Development Conference Statement. Bethesda, MD: NIH, 1998. Available online at: http://consensus.nih.gov/1997/1998TreatOpiateAddiction108html.htm. [Accessed March 22, 2006.]
Rettig R, Yarmolinsky A (eds.). Federal Regulation of Methadone Treatment. Washington, DC: Institute of Medicine, 1995, pp. 1-16. Available online at: books.nap.edu/catalog.php?record_id=4899. [Accessed March 22, 2006.]
Substance Abuse and Mental Health Services Administration. About Buprenorphine Therapy. Rockville, MD: SAMHSA, 2000a. Available online at: http://buprenorphine.samhsa.gov/about.html. [Accessed March 23, 2006.]
Substance Abuse and Mental Health Services Administration. Drug Addiction Treatment Act of 2000. Rockville, MD: SAMHSA, 2000b. Available online at: http://buprenorphine.samhsa.gov/data.html. [Accessed March 23, 2006.]
In This Section
- Certificate Programs
- Methadone Research Web Guide
- Acknowledgments
- Introduction
- Part A
- Question 1: When was opioid addiction first observed in the United States?
- Question 2: What is the history of opioid addiction in the United States?
- Question 3: What is the history of U.S. regulation of heroin?
- Question 4: How have U.S. regulations about treatment for heroin addiction evolved?
- Question 5: What is methadone?
- Question 6: When was methadone maintenance introduced to treat heroin addiction?
- Question 7: How has the U.S. Government been involved in research on methadone maintenance treatment?
- Question 8: What is the international approach to maintenance treatment for heroin addiction?
- Part B
- Part C
- Part D
- Methadone Research Web Guide Tutorial
- Questions: Methadone Research Web Guide
- Answers: Methadone Research Web Guide
- Methadone Research Web Guide
- Degree Programs
- Virtual Lectures
- Research Publications
Important Dates
NIDA International Forum
June 14–17, 2013
Online Registration Deadline:
May 6, 2013
FELLOWSHIPS
IAS/NIDA Fellowships
Application Deadline:
February 10, 2013
NIDA International Program Fellowships
Application Deadline:
April 1, 2013
Global Health Program for Fellows and Scholars
Application Deadlines: Vary
GRANTS
Brain Disorders in the Developing World: Research Across the Lifespan
(Non-AIDS)
R01 PAR-11-030and R21 PAR-11-031
Application deadline:
February 14, 2013
MEETINGS
American Association for the Advancement of Science
February 14–18, 2013
Boston, Massachusetts, USA
International Drug Abuse Research Society (IDARS)
April 15–19, 2013
Mexico City, Mexico
2013 International Conference on Global Health: Prevention and Treatment of Substance Abuse and HIV
April 17–19, 2013
Taipei, Taiwan
Yih-Ing Hser, Ph.D.