Medications for Treatment

With the remarkable progress in scientific understanding of the brain and of the underlying causes of addiction, pharmaceutical manufacturers have made new treatments available. In the last decade, thousands of people have traveled the road to recovery while taking newly developed prescription medications.

Taken as either tablets, drinkable liquids or through injection, medications are not magic bullets for solving the misery of addiction. Experts say that they must be used as part of a comprehensive treatment plan that includes behavioral therapy as well as services to address the individual medical, psychological, social, vocational and legal needs of the patient.

Many of the medications are especially important in the early stages of recovery. They help to mute cravings enough to allow people to think more clearly. This way, the addicted person can begin to establish the critically important recovery plan. However, medications don't work for everyone. For some, they produce serious side effects which is why medication should always be taken under the supervision of a physician.

Increasingly people in recovery and addiction experts believe that prescription medications can significantly reduce relapse and that they complement mutual help efforts, providing significant new hope for many addicted people.

Following is a list of FDA-approved medications for addiction treatment.

Opiate Treatment

There are three types of medications designed to treat opiate addiction: agonists, antagonists, and partial agonists.

1. Opiate Agonists

Drugs that activate receptors in the brain are termed agonists. Agonists occupy a receptor and turn it on. An opiate agonist is a synthetic opiate that stabilizes the level of opiates in the bloodstream (to prevent withdrawal and craving), but doesn't produce a comparable euphoria or high.Opiate Agonists include Methadone and Levo-Alpha-Acetyl Methadol (LAAM®).

• Methadone is the most common medication for heroin addiction treatment and also the most controversial. Well-run methadone maintenance programs – with appropriate drug monitoring, counseling services (individual, group, and family), and vocational resources and referrals – have been demonstrated to decrease heroin use and related crime, increase employment, improve physical and mental health, and markedly reduce the incidence of needle sharing. Methadone also decreases drug craving.
  
• LAAM has a longer half-life than methadone. It was approved by the Food and Drug Administration in 1994 for use in the treatment of opioid dependence and made subject to the same Federal rules as methadone for the treatment of opioid dependence.

2. Opiate Antagonists:

Opiate Antagonists also bind to receptors, but instead of activating the receptors an antagonist effectively blocks the receptors. Antagonists don't turn on the receptor, but they do prevent the receptor from being activated by an agonist compound. It is as if an antagonist is a key that fits in a lock but doesn't open it.

• Naltraxone (reVia®) is an opioid antagonist that blocks the effect of heroin and other opioids. It does not have addictive or psychoactive properties, does not lead to tolerance and produce physical dependence. It has a long half-life and its therapeutic effects can last up to three days. 

3. Opiate Partial Agonists:

In some ways, partial agonists are very similar to full agonists. Partial agonists bind to and activate receptors, and at lower doses, the full agonists and partial agonists produce effects that are essentially indistinguishable. However, increasing the dose of a partial agonist does not produce as great an effect as does increasing the dose of a full agonist.

• Buprenorphine's unique pharmacological profile and safety profile increase its appeal to opioid addicted persons as well as to the medical professionals treating them. Buprenorphine is a partial opioid agonist. At low doses, it behaves as an agonist, and at high doses, as either an agonist or antagonist, depending on the circumstances.
  
  There are two commercial buprenorphine medications on the market, Suboxone® and Subutex®. Subutex® contains only buprenorphine. Suboxone® contains naloxone in addition to the buprenorphine. Naloxone is added to Suboxone® to stop people from injecting ("shooting-up") Suboxone® tablets. If Suboxone® is injected, the naloxone can give patients bad withdrawal symptoms.
  With buprenorphine medications, long waits for a methadone clinic slot and daily trips for treatment are no longer the only option for people seeking care because prescriptions increase the potential number of treatment slots and allow up to a month's supply of the medication to be prescribed at once.

Alcohol Treatment

Acamprosate:

In 2004, the FDA approved the drug Campral® (acamprosate), for treating alcohol dependent individuals seeking to continue to remain alcohol-free after they have stopped drinking. Campral may not be effective in patients who are actively drinking at the start of treatment, or in patients with other drug problems. While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse. Campral is not addictive.

Naltrexone:

Naltrexone (marketed as Revia® and Vivitrol®) is an opiate antagonist used to treat alcohol dependence by both reducing the urge to consume alcohol and by making drinking less pleasurable. Recent research has shown Naltrexone to be effective as a once-a-day pill or a monthly injection. It is successful in helping alcoholics moderate their drinking. Naltrexone was first approved by the FDA in 1994 and approved in injectible form (as Vivitrol) in 2006.

Disulfiram:

Disulfiram (marketed as Antabuse) inhibits intermediate metabolism of alcohol, causing a build-up of acetaldelhyde and a reaction of flushing, sweating, nausea, and chest pain if a patient drinks alcohol.