versions of drugs already approved by the Food
and Drug Administration meant that investments
in innovative new medications were limited.
Coupled with the rising cost of research and
development, the fact that pharmaceutical
companies face dramatic losses once the patents
on many of their largest money-making drugs
expire makes the current climate for the
development of new innovative medications
quite unfavorable.^234
This is particularly unfortunate since recent
advances in addiction science have highlighted
specific neurotransmitter receptors and
transporters that underlie addiction and that are
promising targets for the development of
medications to prevent and treat addiction.^235
Aside from economic concerns, other factors
inhibiting investments in new pharmaceutical
interventions for addiction include an
underestimation of the market for addiction
treatment medications (i.e., the size of the
population with addiction), the belief that the
majority of those with addiction lack health
insurance and the ability to pay for medications,
and the long-standing stigma associated with the
use of illegal substances and the disease of
addiction.^236
Translating the rapidly-evolving science of
addiction into science-based treatments will
require dramatic changes in incentives for the
pharmaceutical industry to invest in innovative
medications, increased public understanding that
addiction is a treatable disease, and increased
involvement of the health care system in its
prevention and treatment.^238
Inadequate Quality Assurance ...................................................................................
Addiction treatment providers do not speak with
clarity or consistency about what the goals of
treatment are, what counts as quality treatment,
how performance and outcomes should be
measured and what practices should be
implemented to improve treatment and achieve
measurable outcomes.* 239 And because
addiction treatment for the most part is not
integrated into mainstream health care, quality
assurance standards and efforts to improve such
standards in mainstream medicine largely do not
apply to addiction treatment.^240 For example,
organizations like the Council on Graduate
Medical Education and the National Advisory
Council on Nurse Education and Practice are
public-private partnerships with Congressional
mandates to provide sustained assessment of the
needs of the medical and nursing fields.^241
However, these organizations do not appear to
address addiction treatment and comparable
organizations for addiction treatment do not
exist.Efforts to assure quality treatment within the
mainstream medical system for patients with
addiction are not typically adhered to. For
example, as far back as 1979, the American
Medical Association (AMA) adopted as policy
the AMA Guidelines for Physician Involvement
in the Care of Substance-Abusing Patients,
which states that every physician must assume
clinical responsibility for the diagnosis and
referral of patients with addiction and explicates
the particular competencies needed to fulfill that
responsibility. Other similar efforts followed,
with a national conference sponsored by the
Office of National Drug Control Policy, the
Leadership Conference on Medical Education in
Substance Abuse, in 2004. Despite these and
other efforts by government and professional
organizations to put forth guidelines and
principles aimed at ensuring proper training in
risky substance use and addiction, physicians
continue to be insufficiently equipped to address
the needs of their substance-involved patients.^242* See Chapter IX.For the most part, SUDs [substance use
disorders] have not been high priority targets
for the pharmaceutical industry. Even for
smoking cessation, which offers a huge
potential market, investments are negligible
compared with the costs associated with
developing medications to treat the
consequences of smoking.^237--Volkow & Skolnick, 2012