Opiate addiction and the locus coeruleus. The clinical utility of clonidine, naltrexone, methadone, and buprenorphine.

Detoxification from opiate addiction has been a medical problem for as long as opiate drugs have been available. Treatment before the discovery of clonidine involved giving another opioid drug with less dangerous consequences of chronic use, such as the long-acting and orally administered once a day methadone, for another opioid mu agonist like heroin, which must be taken intravenously many times a day, thus making rehabilitation, work, and avoidance of hepatitis, HIV, and other illnesses difficult. Although methadone has proved to be very beneficial, it still has significant abuse potential. Naltrexone, because it blocks the effects of all opiates, has facilitated the transformation from addiction to a drug-free state for many recovering addicts. By alleviating withdrawal symptoms and by lessening the detoxification period, clonidine similarly has improved the prospect of recovery from opiate addiction. Relapse, whether withdrawal is treated with clonidine or other new agents or not, occurs with great regularity because repeated opiate use can induce a new acquired drive state--the drive for opiates. In addition, with powerful withdrawal symptoms during abstinence, opiate relapse is difficult to prevent without an adequate treatment program. The efficacy of clonidine and other medical magic bullets for withdrawal distress needs to be given as part of a long-term recovery program which not only allows the brain to re-establish normal homeostatic changes in the drug-free state but also provides sufficient motivation for new approaches to achieving and sustaining pleasurable existence.