A Perspective on Opioid Pharmacotherapy: Where We Are and How We Got Here

Four decades of concerted pharmacotherapy research has netted us three medications approved for the treatment of opioid addiction. The clinical pharmacology, safety, efficacy, and clinical use of these medications are familiar to most clinical researchers and clinicians in addiction medicine. Less common is an understanding of the social and political forces behind the choice of these particular agents for their development and how these forces continue to influence how clinicians interact with patients who have opioid use disorder. This review brings into focus those forces and puts into context how we came to have these particular medications. What we know determines our views of the world we live in, including our patients and ourselves, as well as those to whom we give power to govern us. The issues are raised by the author, who does not provide resolutions; answers to the questions of how to address the issues must come from the reader.