In the United States alone, approximately one-half million people are addicted to heroin. Estimates of heroin incidence (122,000 new users) in recent years suggest an increased incidence and an emerging pattern of drug use among the young. For many years, heroin addiction has been associated with increased criminal activity and human suffering. In the past 10 years, there has been a dramatic increase in the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and tuberculosis among intravenous heroin users. From 1991 to 1995 in major metropolitan areas, the annual number of heroin-related emergency room visits has increased from 36,000 to 76,000, and the annual number of heroin-related deaths has increased from 2,300 to 4,000. The associated morbidity and mortality further underscore the human, economic, and societal cost of heroin addiction.

Over the last 20 years, a significant body of evidence has accumulated on the neurobiology of heroin addiction and on the safety and efficacy of narcotic (methadone) maintenance treatment. Although there have been other medications (e.g., levo-alpha acetylmethadol [LAAM]) subsequently determined safe and effective in narcotic maintenance treatment, the focus of this consensus development conference will be on methadone, because methadone has been the medication used in most narcotic treatment research. Most recent data indicate that there are approximately 112,000 patients in narcotic maintenance treatment. Evaluation studies have consistently shown methadone treatment to be effective in reducing drug use and crime and in enhancing social productivity. More recent studies demonstrate that methadone treatment is an effective method for preventing the spread of HIV, HCV, and tuberculosis among intravenous drug users.

To address the most important and controversial issues surrounding narcotic maintenance treatment, the Office of Medical Applications of Research and the National Institute on Drug Abuse of the NIH have organized this 2½ day conference to present the available data on opiate agonist treatment for heroin addiction. The conference will bring together national and international experts in the fields of basic and clinical neuroscience, epidemiology, natural history, prevention and treatment of heroin addiction, as well as representatives from the public.

After 1½ days of presentations and audience discussion, an independent, non-Federal consensus panel chaired by Lewis L. Judd, M.D., Chairman, Department of Psychiatry, University of California at San Diego School of Medicine, will weigh the scientific evidence and write a draft statement that will address the following key questions:

• What is the scientific evidence to support a conceptualization of opiate addiction as a medical disorder including natural history, genetics and risk factors, pathophysiology, and how is diagnosis established?

• What are the consequences of untreated opiate addiction to individuals, families and society?

• What is the efficacy of current treatment modalities in the management of opiate addiction including detoxification alone, non-pharmacological/psychosocial treatment, treatment with opiate antagonists, and treatment with opiate agonists (short-term and long-term)?

• What is the (scientific evidence for the) most effective use of opiate agonists in the treatment of opiate addiction?

• What are the important barriers to effective use of opiate agonists in the treatment of opiate addiction in the U.S. including perceptions and the adverse consequences of opiate agonist use, legal, regulatory, financial and programmatic barriers?

• What are the future research areas and recommendations for improving opiate agonist treatment and improving access?

The panel will present its draft statement to the public for comment at 9 a.m. on Wednesday, November 19. Following this public comment session, the panel will release its revised consensus statement at a news conference at 1 p.m. and take questions from the media. Dr. Judd will moderate the news conference. The consensus statement is the report of an independent panel and is not a policy statement of the NIH or the Federal Government.

The NIH Consensus Development Program was established in 1977 as a form of "science court" to resolve in an unbiased manner controversial topics in medicine. To date, NIH has conducted 107 such conferences addressing a wide range of controversial medical issues important to health care providers, patients, and the general public. An average of six consensus conferences are held each year.

Additional information about this conference, including the meeting agenda, local area hotels, and directions to NIH, is available at the NIH Consensus Development Program Web site at http://consensus.nih.gov. To register for the conference, call 301-468-MEET, send e-mail to NIHconsensus@ProspectAssoc.com, or visit the Web site.

NOTE TO RADIO EDITORS: An audio report of the conference results will be available November 19-28, 1997 from the NIH Radio News Service by calling 1-800-MED-DIAL (1-800-633-3425) or by visiting http://www.radiospace.com/nihhome.htm on the Web.