LAAM in the Treatment of Opiate Addiction Treatment Improvement Protocol (TIP) Series 22
Tip 22: LAAM in the Treatment of Opiate Addiction
[Front Matter]
[Title Page]
LAAM in the Treatment of Opiate Addiction Treatment Improvement Protocol (TIP) Series 22
Ira J. Marion, M.A. Consensus Panel Chair
U.S. Department of Health and Human Services Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fishers Lane Rockville, MD 20857 DHHS Publication No. (SMA) 95-3052 Printed 1995.
This publication is part of the Substance Abuse Prevention and Treatment Block
Grant technical assistance program. All material appearing in this volume except
quoted passages from copyrighted sources is in the public domain and may be reproduced
or copied without permission from the Center for Substance Abuse Treatment
(CSAT) or the authors. Citation of the source is appreciated.
This publication was written under contract number ADM 270-91-0007 from the
Center for Substance Abuse Treatment of the Substance Abuse and Mental Health
Services Administration (SAMHSA). Sandra Clunies, M.S., served as the CSAT Government
project officer. Robert A. Lubran, M.S., M.P.A., was the Government content advisor.
Carolyn Davis, Constance Gartner, Linda Harteker, Lise Markl, Barbara Shapiro,
and Deborah Shuman served as writers.
The opinions expressed herein are the views of the consensus panel members
and do not reflect the official position of CSAT or any other part of the U.
S. Department of Health and Human Services (DHHS). No official support or
endorsement of CSAT or DHHS for these opinions or for particular instruments or software
that may be described in this document is intended or should be inferred. The
guidelines proffered in this document should not be considered as substitutes for
individualized patient care and treatment decisions.
CSAT Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance
and Evaluation Branch to facilitate the transfer of state-of-the-art protocols
and guidelines for the treatment of alcohol and other drug (AOD) abuse from
acknowledged clinical, research, and administrative experts to the Nation's AOD abuse
treatment resources.
The dissemination of a TIP is the last step in a process that begins with the
recommendation of an AOD abuse problem area for consideration by a panel of experts. These
include clinicians, researchers, and program managers, as well as professionals
in such related fields as social services or criminal justice.
Once a topic has been selected, CSAT creates a Federal resource panel, with
members from pertinent Federal agencies and national organizations, to review the
state of the art in treatment and program management in the area selected. Recommendations
from this Federal panel are then communicated to the members of a second group,
which consists of non-Federal experts who are intimately familiar with the topic.
This group, known as a non-Federal consensus panel, meets in Washington
for 5 days, makes recommendations, defines protocols, and arrives at agreement
on protocols. Its members represent AOD abuse treatment programs, hospitals,
community health centers, counseling programs, criminal justice and child welfare
agencies, and private practitioners. A Chair (or Co-Chairs) for the panel is charged
with responsibility of ensuring that the resulting protocol reflects true group
consensus.
The next step is a review of the proposed guidelines and protocol by a third
group whose members serve as expert field reviewers. Once their recommendations
and responses have been reviewed, the Chair approves the document for publication.
The result is a TIP reflecting the actual state of the art of AOD abuse
treatment in public and private programs recognized for their provision of high quality
and innovative treatment.
This TIP, titled LAAM in the Treatment of Opiate Addiction, presents
current knowledge about the use of levo-alpha-acetyl-methadol (LAAM), an opioid agonist
medication approved for use in 1993. LAAM suppresses opiate withdrawal symptoms for
more than 72 hours, and it can be administered no more frequently than every
other day. Thus, daily visits to the program clinic are not required for LAAM-maintained
patients, as are visits for patients on methadone. In addition to the difference
in dosing schedule, no take-home doses of LAAM are permitted under Federal
regulations, and women of child-bearing potential must be tested monthly for pregnancy.
The introduction of LAAM into the current treatment system will require programs
to educate staff and patients about the use of LAAM. This TIP describes the
medication itself, its mode of action, possible side effects, and interactions with
other medications. A separate chapter on clinical use of LAAM presents guidelines
for selecting patients who may benefit from LAAM and starting and maintaining
them on the medication. A chapter on treatment planning addresses issues that
may arise for counselors and patients, such as structuring free time and creating
incentives for treatment progress. Issues for program managers and administrators,
including staff education and costs of LAAM, are discussed in another chapter. A
chapter on regulatory and ethical issues is included. As LAAM is introduced, programs
will be a source of important data about its use, and the TIP presents suggestions
for research in several areas.
This TIP represents another step by CSAT toward its goal of bringing national
leadership to bear in the effort to improve AOD abuse treatment.
Other TIPS may by ordered by contacting the National Clearinghouse for
Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for
hearing impaired), (800) 487-4889.
The Treatment Improvement Protocol (TIP) series fulfills CSAT's mission to
improve alcohol and other drug (AOD) abuse and dependency treatment by providing
best practices guidance to clinicians, program administrators, and payers.
This guidance, in the form of a protocol, results from a careful consideration
of all relevant clinical and health services research findings, demonstration
experience, and implementation requirements. A panel of non-Federal clinical researchers,
clinicians, program administrators, and patient advocates employs a consensus process
to produce the product. This panel's work is reviewed and critiqued by field
reviewers as it evolves.
The talent, dedication, and hard work that TIPs panelists and reviewers bring
to this highly participatory process have bridged the gap between the promise
of research and the needs of practicing clinicians and administrators. We
are grateful to all who have joined with us to contribute to advance our substance
abuse treatment field.
Nelba Chavez, Ph.D.
Administrator
Substance Abuse and Mental Health Services Administration
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