The proportion of the entire population of heavy substance abusers that is considered to be a realistic target market for pharmacotherapy is small relative to the target market of medications for other diseases. Although there are other clinical conditions for which the market penetration of medications is proportionately low, the absolute magnitude of an overall market may be so large that even low penetration of a substantially priced drug can be financially attractive to industry, as in the case of the smoking cessation market.
A combination of factors minimizes the attractiveness of the cocaine abuse market to industry, including: a relatively modest potential market (2.1 million heavy users), low proportion of users currently in treatment (250,000 enrollees on any given day), concerns about compliance in this population, and apparent market expectation of a low price point. This appears to be corroborated by the methadone market, where a relatively effective, low-priced medication in a well-established, long-standing treatment system achieves, at best, a 25 percent penetration of the small population of opiate addicts (i.e., about 125,000 patients enrolled in methadone treatment per day out of about 500,000 opiate addicts). The penetration of LAAM is less than five percent of the methadone market, i.e., less than one percent of the opiate addiction market, and the use of naltrexone for opiate addiction falls below that of LAAM.
Drawing inferences about the potential market for a new cocaine abuse medication from the market experience of other medications for substance abuse must consider the market-limiting characteristics of the treatment systems for opiate addiction to which methadone and LAAM are subject. The market conditions for a new cocaine abuse medication would differ if it is provided via more traditional means of physician prescribing and distribution through pharmacies, rather than if it is a Schedule II or Schedule III controlled substance warranting the forms of controlled treatment delivery required for methadone and LAAM. Nevertheless, their status as medications for illegal substance abuse, similarities in the user populations, and other characteristics make methadone, LAAM, and naltrexone useful, though imperfect, market comparators for a new cocaine abuse medication. As a group, the markets for these medications more closely resemble the potential market for a cocaine abuse mediation than markets for other medications, and industry looks to these markets accordingly when assessing the market for potential cocaine abuse medications.
The uncertainty about the number of cocaine users, especially the secondary users, places a wide confidence interval around the potential size of the market for cocaine abuse treatment. For the purposes of gauging the potential market for a new pharmacotherapy for cocaine addiction, it may be optimistic to use an estimate of 250,000 current daily enrollees in treatment. Projections of market penetration must consider that some primary users and many secondary abusers may be treated for other addictions and with behavioral therapy to the exclusion of pharmacotherapy, particularly in the context of the current treatment system. Given that many cocaine addicts abuse multiple substances and have diverse health and behavioral disorders, it may be that one or a few medications for cocaine abuse will be insufficient for treating this population. To the extent that multiple medications are needed, the market potential for any one medication would be reduced.