IIHIIII USOO5587381A United States Patent (19) 11) Patent Number: 5,587,381 Sinclair 45 Date of Patent: Dec
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IIHIIII USOO5587381A United States Patent (19) 11) Patent Number: 5,587,381 Sinclair 45 Date of Patent: Dec. 24, 1996 (54) METHOD FOR TERMINATING 4,882,335 11/1989 Sinclair ................................... 514/282 METHADONE MAINTENANCE THROUGH 4,935,428 6/1990 Lewis ...................................... 514/282 T G 5,086,058 2/1992 Sinclair et al. ......................... 514/282 SE OF THE OPIATE-TAKEN 5,096,715 3/1992 Sinclair ................................... 424/449 5,272,149 12/1993 Stalling ................................... 514/255 76 Inventor: John D. Sinclair, Nokkalanniemi 7, 5,472,943 12/1995 Crain et al. ............................... 514/12 SF-02230 Espoo, Finland Primary Examiner-Russell Travers Assistant Examiner-William R. A. Jarvis (21) Appl. No.: 410,529 Attorney, Agent, or Firm-Ronald J. Kubovcik (22 Filed: Mar. 27, 1995 (57) ABSTRACT (51) Int. Cl." ..................... A61K 31/485; A61K 31/44; A method is provided for effectively terminating methadone A61K 31/135 maintenance therapy and the addiction to other legally 52) U.S. Cl. .......................... 514,282, 514,295, 514,279; available opiates by selectively extinguishing the opiate s 51 4289. 514/648 taking responses. Selective extinction is produced having (58. Field of Search 51 4282 295 sessions in which detoxified addicts make opiate-taking 514/279, 289,648 responses while an opiate antagonist blocks the positive reinforcement, interspersed by periods when the antagonist 56) References Cited is absent and all responses except opiate-taking can be emitted. A similar method but with instructions not to take U.S. PATENT DOCUMENTS the opiate can subsequently be used to protect against 3.493657 2/1970 Lewenstein 424/260 resumption of illegal opiate use, or separately with patients 3,773.655 i /i973 Pachter et al. 424/260 addicted to illegal opiates producing reinforcement through 3,966,940 6/1976 Pachter et al. ... 424,260 the opioidergic system. 4,767,764 8/1988 Ciganek ....... ... 514/282 4,785,000 11/1988 Kreek et al. ............................ 514/282 9 Claims, 3 Drawing Sheets U.S. Patent 5,587,381 (6>1/6) undu L 'exiou Oud DIV U.S. Patent Dec. 24, 1996 Sheet 2 of 3 5,587,381 la () E O (Ju u 6>/Iuu) extolu eu eZDhuo.3 U.S. Patent Dec. 24, 1996 Sheet 3 of 3 5,587,381 CD .9 o f - V (Ju L u 6>/Iuu) exonul euop Duhe W 5,587,381 1. 2 METHOD FOR TERMINATING including side-effects and illegal diversion of the metha METHADONE MAINTENANCE THROUGH done, but almost all of the disadvantages are caused by or EXTINCTION OF THE OPIATE-TAKING increased by the lack of an effective method for terminating RESPONSES the therapy. The present invention provides a safe and effective method for terminating methadone maintenance. After con FIELD OF THE INVENTION trolled withdrawal, the patient takes methadone while an opiate antagonists blocks positive reinforcement. As a result, The present invention relates to a treatment of opiate the methadone-taking responses are extinguished and the addiction in which the drug-taking responses of detoxified 10 craving for methadone is eliminated. An additional proce addicts are extinguished over a limited number of sessions dure is also provided to help guard against resumption of by being emitted while the positive reinforcement is blocked opiate use. by an opiate antagonist. The present invention has the following significant advan tages: - DESCRIPTION OF THE PRIOR ART 15 1. It is legally acceptable. Many years ago, A. Wikler 1. U.S. Pat. No. 3,493,657, which issued Feb. 3, 1970, among others speculated that heroin addiction might be describes a composition combining morphine and naloxone treated with an extinction procedure involving opiate for parenteral use for providing a strong analgesic without antagonists: "the narcotic antagonist-maintained "undesired or dangerous side effects.” patient, while still in the hospital... should be required 2. U.S. Pat. No. 3,966,940, which issued Jun. 29, 1976, 20 to self-inject genuine, guaranteed pure heroin repeat describes a composition combining methadone with a quan edly” (Wikler, 1973, p. 615). Theoretically, the proce tity of naloxone sufficient "to induce withdrawal symptoms dure almost certainly would be useful. Practically, when said composition is administered parenterally but however, it has never been used clinically. Probably a insufficient to negate the action of said methadone when the major reason why it has not been used is because it composition is administered orally' to block the incentive 25 would be illegal. In the United States, heroin normally for diverting the oral methadone composition to illicit cannot legally be given to any patient. The practical parenteral use. difficulties and the feelings of most clinicians against allowing heroin self-administration in a treatment cen 3. U.S. Pat. No. 4,882,335, which issued Nov. 21, 1989, ter have probably also help to keep the procedure from describes a method for treating alcoholism in which the 30 being used. alcohol-drinking response is extinguished by being emitted Permission has been obtained for experimental tests of while an opiate antagonists blocks the positive reinforce Wikler's idea. Mello et al. (1981) found that naltrexone ment from alcohol. effectively suppressed heroin self-administration in an oper The applicant is of the opinion that the prior art neither ant situation. A second study (see O'Brien et al., 1988) also teaches nor suggests the instant invention. The method for 35 found some evidence for suppression but was limited by using the opiate antagonists, their dosages, and the purpose dysphoria. The third study (Meyer, 1988) allowed patients to of the present invention are different from those in U.S. Pat. work for and obtain heroin in a treatment ward. Because of Nos. 3493,657 and 3,966,940; the field of the instant the setting, the procedure should not be expected to extin invention and the specific methods involved are different guish the previously learned opiate-taking responses and from those of U.S. Pat. No. 4,882,335. 40 thus would not be very effective as a treatment, but it should extinguish opiate-taking in the ward. Half of the subjects did BACKGROUND OF THE INVENTION stop working for heroin almost completely after the first Opiate addiction is a major health problem, with close to dose and showed a progressive decrease in craving. a million users in the United States. The traditional treat Although others continued to work for it, they also showed ments attempt to increase the addict's will power to with 45 a progressive decrease in craving after the third day. How stand the craving for opiates but do not decrease the craving ever, because the patients did not show an "extinction burst', itself. For a large percentage of addicts this is not sufficient: i.e., an initial increase in responding for heroin when the eventually they, give in to the craving and resume using the antagonist was first introduced, the author concluded that the drugs. data "did not appear to be consistent with models of operant 50 extinction in the animal literature” (p. 164) and explained The most successful treatment currently used is metha the results instead in terms of discriminative learning. The done maintenance therapy. It reduces mortality progressive decreases in craving, however, are not consis (Grönbladh et al., 1990) and social problems related to tent with discriminative learning. Furthermore, an extinction criminality (Ladewig, 1990). The relative success of this burst is not always found in animal studies and especially procedure is largely does to the fact that it does deal with the 55 not in animal studies with drug taking and opiate antago opiate craving. The craving is satisfied with a legally nists: no extinction bursts were found in rat studies with prescribed opiate-methadone-and thus the patient has alcohol drinking (Sinclair, U.S. Pat. No. 4,882,335, 1989; little motivation to obtain illegal opiates. Sinclair, 1990) which otherwise were always consistent with Unfortunately, methadone maintenance therapy has "a extinction, nor was one found by Davis and Smith (1974) in serious limitation . because clients have difficulty 60 a study they felt showed extinction of opiate-seeking with tapering off methadone” (Ladewig, 1990, p. 246). Clini naloxone in rats. cians, most addicts, and society in general would prefer that The legally-acceptable and practical method disclosed in methadone maintenance were only a temporary phase for the the present invention, in which methadone is self-adminis patient, eventually replaced by a drug-free existence. This tered after an antagonist is given, has not previously been ideal, however, is seldom met, and for many addicts metha 65 proposed. Furthermore, it should work even better than done maintenance appears to be a life-long program. There Wikler's method. Heroin is taken in a wide variety of are other disadvantages to methadone maintenance therapy, situations. The methadone-taking response, however, needs 5,587,381 3 4 to be extinguished primarily, or with many patients exclu holism rather than opiate addiction and thus differs in many sively, in a single situation-at the treatment center where it ways from the present invention. Of most importance, the has previously been given-and, from a practical viewpoint, alcoholism treatment must begin while the subjects are still this is an ideal situation for conducting extinction sessions. physiologically dependent in order to avoid the giving 2. It reduces craving and should be effective. Extinction alcohol to withdrawn alcoholics forbidden by ethical guide requires that the opiate-seeking responses be made lines. This procedure, however, would be medically very while reinforcement is blocked. The only way that dangerous for opiate addicts because the antagonist would opiate antagonists have previously been used in the cause precipitous withdrawal. treatment of opiate addiction is with a procedure 5.