Introduction | Opioid Dependence: Epidemiology and Natural History | Clinical Pharmacology of Methadone | Medication Interactions | Rationale for Opioid Agonist Substitution Treatment | Safety and Toxicity | Effectiveness of Opioid Agonist Maintenance Treatment | Methadone Dose and Treatment Duration | Drug Counseling and Behavioral Components of Agonist Maintenance Treatment | Co-Occurring Substance Use and Other Psychiatric Disorders | Co-Occurring Medical Disorders and Provision of Medical Care | Pain Management During Opioid Agonist Maintenance Treatment | Pregnancy and Opioid Dependence | Federal Rules Governing Opioid Agonist Maintenance Treatment | Public Health Considerations | References
Opioid dependence is a chronic and severe disorder associated with substantial risk of mortality, morbidity, and adverse social, vocational, familial, and legal consequences. The goals of treatment are to prevent or reduce the adverse consequences and to improve the patient's functioning and quality of life. Opioid agonist maintenance treatment generally refers to a comprehensive approach, including medications in combination with drug counseling, behavioral monitoring, and provision of or referral to psychiatric, medical, or vocational services. Since its development in the 1960s, this approach has proven to be the most effective treatment for opioid dependence.