Reprint of: Biotechnologies and the future of opioid addiction treatments

Biotechnological treatment, including addiction treatment, is the way of the future. Researchers and pharmaceutical companies praise depot injections, agonist/antagonist implants, deep brain stimulation, and hapten conjugate vaccines as medicine's greatest chance for reducing illegal usage, reducing the danger of overdose and severe withdrawal, and preventing drug diversion to criminal markets.

Old conflicts around ideas of addiction and treatment are revealed by marketing and the use of new technologies: between medical condition and will disorder, between criminal justice and health, and between patient choice and system control. This article analyzes the arc of long-acting opioid therapy and implications for the future using the examples of depot naltrexone and implantable and injectable buprenorphine in the United States. These include the emergence of Vivitrol courts and "carceral prescription," in which criminal justice systems order drugs to lock up brain receptors in the same way that they would lock up individuals, as well as the usage of buprenorphine formulations positioned as increasing both patient benefit and provider control.

It is also taking into account what was learned from discussions on long-acting contraceptive methods like Norplant and Depo-Provera. While several new long-acting formulations are being developed, the success of these new technologies will be determined more by whether or not they are accompanied by a new addiction treatment ethics that emphasizes therapeutic alliance, concordance over compliance, and a genuine commitment to allowing patients to narrate and be believed.