trained in it and it is considered to be a low
priority in already overloaded curricula.^217
Although pharmacists who engage in tobacco
cessation interventions are effective in providing
those services,^218 and despite the important role
pharmacists can play in preventing the misuse of
controlled prescription drugs,^219 most are not
well trained to perform these functions, have
little confidence to do so and believe that most
patients are not interested in having them
intervene.^220
A study in California found that the majority of
pharmacists (88 percent) indicated that they
would be interested in receiving specialized
training in tobacco cessation counseling but
fewer than eight percent had received any formal
training.^221 A study of pharmacists in Florida
found that 29.2 percent reported that they
received no addiction-related education in
pharmacy school and 53.7 percent reported that
they had never referred a patient to addiction
treatment.^222
Inadequate Use and Development of Pharmaceutical Treatments for Addiction ......
The underutilization of pharmaceutical therapies
in addiction treatment is another example of the
disconnect between addiction treatment services
and medical care. Many addiction treatment
providers are unable to prescribe pharmaceutical
therapies and medical professionals who could
prescribe such therapies fail to address
addiction. A related problem is that some
medical professionals appear to have a
disproportionate concern about the safety risks
of addiction medications relative to medications
aimed at treating other medical conditions. For
example, although side effects for some
addiction medications have been noted and
safety concerns raised--particularly with regard
to smoking cessation treatments,^223 side effects
exist for many medications aimed at treating
other health conditions and typically are
acknowledged as an acceptable risk of treatment.
Even when utilizing pharmaceutical treatments,
medical professionals often fail to prescribe
them at therapeutic doses. For example,
methadone, which is used in treatment for
addiction involving opioids, often is not
prescribed as clinically recommended,
undermining its effectiveness.^224 Specifically,
although it is well understood that dosages
between 60-100 mg per day promote retention in
treatment and reduction of opioid use,^225 34
percent of patients are given doses of less than
60 mg per day and 17 percent are given doses of
less than 40 mg per day.* 226 Treatment
programs more likely to give suboptimal doses
of methadone include those with directors who
take a 12-step approach to addiction
treatment.^227Furthermore, despite the potentially vast market
for pharmaceutical treatments for addiction, the
pharmaceutical industry has not made
substantial investments in the development of
new and effective addiction treatment
medications.^231 One of the most significant
contributing factors to the increased medical
treatment of mental health disorders, such as
depression and anxiety, in the past two decades
has been the development and marketing of
pharmaceutical treatments for these
conditions.^232 However in recent years, the
pharmaceutical industry has cut back
dramatically on investments in the development
of new pharmaceutical therapies for these and
other mental health conditions.^233 The large
profits that pharmaceutical companies were able
to accrue from medications that were modified* Although initial methadone treatment begins at
dosages under 40 mg/day, the amount is increased
gradually until cravings disappear.The Institute of Medicine and the Office of
National Drug Control Policy (ONDCP) have
recommended that treatment for addiction
involving opioids be integrated into mainstream
medical practice to improve availability and
quality.^228 New York City has been a leader in
this area with its Methadone Medical
Maintenance program established more than 25
years ago,^229 yet only 56 percent of need for
methadone treatment in New York City was met
in 2009;^230 inadequate training of providers may
have restricted its expansion and integration
with mainstream medical care.