An excellent web site is available that provides an interactive Discussion Forum where questions related to addiction medications will be answered by some of the leading addiction experts in the United Kingdom. Click here (smmgp.groupee.net/groupee) and scroll down the page to the Online Surgery section to post your questions.

Medications taken for a medical problem can trigger cravings and relapse in a recovering addict. Some drugs have mood altering and other effects that will trigger specific receptor areas in the brain that can lead the addict back to active addiction. This is true for prescription drugs and over-the-counter medications such as cough syrups, mouthwashes, antihistamines, cold and sinus medications, pain relievers, nasal sprays, decongestants and more.

Pharmacotherapy for Drug Addiction and Alcoholism

Below is a list of medications, from the newest ones currently available to the ones longest in use.

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Heroin & Pain Pill Addiction

BUPRENORPHINEwas approved by the FDA October 9, 2002 as a new treatment for heroin and other opioid addictions in the U.S. As experience with the drug has grown, it is now known that it can cause dependence and withdrawal symptoms when stopped. It has major advantages compared to methadone or naltrexone. Buprenorphine is more effective at reducing drug cravings than naltrexone. While methadone is typically prescribed daily, buprenorphine is only needed every other day and there is a lower risk of overdose occurrence compared to methadone. It is the first narcotic drug approved for addictions that can be prescribed by physicians in their offices.

Although insurance coverage seems to be growing, there may be problems with both private and Medicaid insurance reimbursement for prescriptions and physician services so you should check carefully in advance.

Two formulations were approved. The first, Subtex, has only buprenorphine and is used in the first few days a patient starts treatment. The second, Suboxone, contains buprenorphine and naloxone. Naloxone blocks the effects of opioids and is likely to cause intense withdrawal if misused intravenously. It’s used for people on maintenance drug therapy.

Subutex has been available for the treatment of opioid dependence in France since 1996. It has received marketing authorization in over 30 countries around the world, including most of Europe and is marketed in 25 countries.  As of October 2006 the European Commission has approved Suboxone for use in all 25 European Union countries, Iceland and Norway.  In the U.S. this medication can be obtained from any physician who has taken the required 8-hour training. Physicians who are already certified as addiction specialists are exempt from the training requirements.

SAMHSA Buprenorphine Physician & Treatment Program Locator
A nationwide registry of physicians who have taken this training is available at buprenorphine.samhsa.gov/bwns_locator/index.html. You can choose Physician List Search at the bottom of the page to search by city, county, zip code or state or just click on the state you want on the map.

Suboxone Assisted Treatment (SuboxoneAssistedTreatment.org)
A comprehensive site on buprenorphine containing clinic locators, state and federal regulations, patient success stories, patient forums,and a staff on call coast to coast 24/7 to help anyone in need. Other information on opiates and addiction are covered as well.

NALTREXONE can help lessen alcohol's positive effects. It blocks the parts of your brain that "feel" pleasure when you use alcohol and narcotics. When these areas of the brain are blocked, you feel less need to drink alcohol, and can stop drinking more easily.

Naltrexone has been shown to improve treatment outcomes in alcoholics when combined with psychosocial treatments such as Alcoholics Anonymous meetings, addiction counseling, family therapy, group therapy, and hospital or residential treatment, among others.

A recent study supported by the National Institutes of Health showed that patients who received naltrexone, specialized alcohol counseling, or both showed the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management, an intervention consisting of nine brief, structured outpatient sessions provided by a health care professional. This is the largest clinical trial ever conducted of pharmacologic and behavioral treatments for alcohol dependence.

Anton RF, et al. ³Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence: The COMBINE Study: A Randomized Controlled Trial.² Journal of the American Medical Association. 295(17):pages 2003-2017, 2006

Naltrexone is also now available through long-acting injections. In a clinical study conducted at 24 sites, once-a-month Naltrexone injections combined with psychotherapy was found to significantly reduce heavy drinking in patients being treated for alcohol dependency. Results found a reduction in heavy drinking within the first month of treatment, and this response was maintained over the six-month treatment period. There were few side effects.

Garbutt, J, et al. "Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A Randomized Controlled Trial." JAMA. 293(13): 1617-1625, 2005.

LAAM is a long acting form of methadone. Individuals treated with LAAM only need to take the medication every 2-3 days.

METHADONE is a long acting medicine that reduces opiate craving and blocks the effect of illegal opiates. It requires frequent visits to a network of clinics that can be found at www.atforum.com. Side effects include the need to keep taking the medication, cognitive slowing and depression. While logistically hard to take because of the need to go to specialized clinics, methadone continues to save thousands of lives.

Addiction Treatment Watchdog (atwatchdog.org)
This educational web site is geared to the needs of patients on medications for opiate addiction.  It has a Clinic Report database and submittal form for reporting on the quality of treatment at specific methadone clinics, a section on clinic complaints, a resource section which includes Methadone Advocacy Organizations, a Methadone Watchdog section which answers questions on methadone maintenance, a chat room and two message boards (one for those in recovery and one for friends and families seeking information on opiate addiction).

Medical Assisted Treatment (medicalassistedtreatment.org)
This national organization was founded by advocates for the medical treatment of addiction. It supports the idea of addiction as a medical illness rather than a social ill and acts as a mediator for patients to assure that quality treatment is available. Someone is available 24 hours a day for emergency calls at (770) 527-9119, (770) 428-8769 or office (770) 428-0871. Their web site provides a great deal of information on opiate drug treatment, patients' rights, methadone maintenance, legal issues, news, addiction science, an online forum, and over 30 online videos on various aspects of addiction. Click on Opiate Drug Treatment in the left hand menu to find information on methadone, buprenorphine, ibogaine and naltrexone.

DESIPRAMINE (Norpramin) is an antidepressant that may be useful in facilitating opiod abstinence in opiod maintained patients.

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Cocaine Addiction

Please report your experiences with these on our
message board.

GABAPENTIN OR GABITROL

What it does: an anticonvulsant which reduces cocaine use, makes cocaine cravings easier to overcome and relapses less severe.

How it works: increases brain GABA

Side effects: sedation

Availability: by prescription from physicians

J Clin Psychiatry 2004:65:84-86 Gabapentin Reduces Cocaine use Among Addicts From a Community Sample,Raby WN reprints rabywil@pi.cpmc.columbia.edu.

What it does: an anti epileptic drug which reduces cocaine cravings.

How it works: increases the amount of the neurotransmitter GABA in
the brain.

Side effects: sleepiness and fatigue.

Availability: Vigabatrin isn't licensed in the USA but is available to people who live in Canada and other countries.

Further information about Vigabatrin can be found by typing in “Vigabatrin and Cocaine” in a search engine.

BACLOFEN OR LIORESAL

What it does: a muscle relaxant found to curb cocaine cravings and reduce use of cocaine especially in chronic, heavy users.

How it works: increases the amount of GABA in the brain.

Side effects: drowsiness, weakness, fatigue, nausea.

Availability: by prescription from physicians.

J Clin Psychiatry 2003:64:1440-1448 Randomized Placebo-Controlled trial for Cocaine dependence Shoptaw,S etc- reprints Shoptaw@friendsresearch.org

What it does: an amino acid that curbs cocaine cravings and repairs damage in the brain caused by cocaine use in animals. Human trials will begin
in 2004.

How it works: restores glutamate levels to normal in the area of the brain where addiction occurs.

Availability: over the counter.

For specific suggestions of other amino acids that can lessen cravings see nutrition in the Holistic Approaches section of this web site.

What it does: provides a weaker version of cocaine's effects.

How it works: blocks the stimulant effects of cocaine.

Side effects: unknown to us.

Availability: only by participating in research trials.

Information about clinical trials on cocaine can be found at ClinicalTrials.gov. Just enter the word cocaine in the "Search Clinical Trials" box.

DISULFIRAM (ANATBUSE)

What it does: It is an anti-alcoholic agent that makes drinking of alcohol or use of cocaine highly unpleasant.

How it works: It increases acetaldehyde in the blood.

Side effects: nausea and vomiting, sometimes very severe, if any alcohol or cocaine is used.  Other common side effects including rapid heart rate, difficulty breathing, low blood pressure, confusion and fainting.

Availability: by prescription from physicians

Recent research suggests that disulfiram (also known as Antabuse), a medication used to treat alcohol addiction, is effective in reducing cocaine abuse, especially in conjunction with cognitive behavioral therapy.  

Carroll KM, et al. "Efficacy of Disulfiram and Cognitive Behavior Therapy in Cocaine-Dependent Outpatients: A Randomized Placebo-Controlled Trial."  Archives of General Psychiatry. 61:264-272, 2004.

MODAFINIL (PROVIGIL)

What it does: reduces high from cocaine and also reduces cocaine cravings

How it works: unknown... but it does increase glutamate in the brain

Side effects: most common side effects are headache, back pain nausea, nervousness, insomnia and anxiety

Availability: by prescription from physicians

Warning: it is a schedule 4 drug so there is some potential for addiction to it

Dackis CA, Kampman KM, Lynch KG, Pettinati HM,O'Brien CP. "A double blind, placebo controlled trial of modafinil for cocaine dependence." Neuropsychopharmacology. 30: 205-211, 2005.

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Methamphetamine Addiction

The antidepressant paroxetine (Paxil) was found in one study to decrease methampetamine craving compared to placebo.

The National Institute of Drug Abuse (NIDA) has recently established the Methamphetamine Clinical Trials Group (MCTG) to conduct studies of medications for methamphetamine. The first MCTG protocol is examining use patterns of methamphetamine and the withdrawal syndrome, followed by studies of the compound ondansetron. Ondansetron, an anti-nausea drug, blocks a specific type of binding site for the neurotransmitter, serotonin. Human laboratory studies have indicated that ondansetron can block the effects of methamphetamine. In addition to ondansteron, NIDA has about a dozen other compounds that are being studied as possible medications for treating various aspects of methamphetamine addiction.

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Inhalant Addiction

GAMMA-VINYL-GABA (GVG) OR VIGABATRIN

What it does: an anti epileptic drug which reduces cravings for inhalants and other drugs (cocaine, heroin, nicotine)

How it works: increases the amount of the neurotransmitter GABA in the brain, which decreases dopamine production.  An appropriate dose of vigabatrin taken before exposure to nicotine, cocaine or inhalants(which increase dopamine production) can block their effects on the brain.

Side effects: sleepiness and fatigue.

Availability: Vigabatrin isn't licensed in the USA but is available to people who live in Canada and other countries.

Research: A new study at the U.S. Department of Energy showed that animals previously trained to expect toluene (a substance found in inhalants) in a given location spent far less time "seeking" toluene in that location after being treated with GVG than animals treated with a placebo. This elimination of craving is similar to the aversion seen in earlier studies of GVG with cocaine, nicotine and heroin.

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Alcoholism

TOPIRIMATE (topomax) shows promise in treating alcoholism. This anti- convulsant, mood stabilizing medication can help reduce the alcohol cravings of alcohol abusers, making it easier to withdraw from alcohol. The researchers of a recent significant study published in The Lancet on the use of topirimate for alcohol abuse postulated that it reduces alcohol cravings by reducing brain levels of the neurotransmitter dopamine (which is believed to create the pleasurable sensations alcoholics  get from drinking).  The topirimate seems to reduce the cravings and anxiety associated with withdrawal, and potentially resets the brain's chemistry. Topirimate has also been found to be helpful in treating binge eating disorder. The following online article provides more information about the above four medications.

Research Study: Johnson BA, Ait-Daoud N, Bowden CL, et al. "Oral topirimate for treatment of alcohol dependence: a randomized trial. The Lancet. 361:1677-1685, 2003. ( download pdf)

NEFAZODONE (Serzone) is an antidepressant which has been found in one study to cause significant reduction in alcohol cravings, drinks/week and days of alcohol used. Serzone has been associated with some severe liver problems which have led Bristol Myers Squib Canada to withdraw it from the market in Canada. Anyone using it in the United States or elsewhere should have their physician closely monitor their liver function tests.

ONDANSETRON (Zofran) which is used to treat the nausea and vomiting caused by certain chemotherapies has been found to stop cravings and decrease alcohol consumption and increase abstinence in people who are early-onset alcoholics. FDA approval for Ondansetron for early-onset alcoholism treatment is currently being considered.

NALTREXONE can help lessen alcohol's positive effects. It blocks the parts of your brain that "feel" pleasure when you use alcohol and narcotics. When these areas of the brain are blocked, you feel less need to drink alcohol, and can stop drinking more easily.

Naltrexone has been shown to improve treatment outcomes in alcoholics when combined with psychosocial treatments such as Alcoholics Anonymous meetings, addiction counseling, family therapy, group therapy, and hospital or residential treatment, among others. However, adherence to daily oral doses has often been a problem, making its use in the treatment of alcohol dependence limited.  While nausea is the most common side effect, other side effects include headache, anxiety, dizziness, fatigue, vomiting and insomnia.

The recent development of long-acting naltrexone injections may help with this problem of inconsistent use of the medication.  In a recent clinical study conducted at 24 sites, once-a-month Naltrexone injections combined with psychotherapy was found to significantly reduce heavy drinking in patients being treated for alcohol dependency.  Results found a reduction in heavy drinking within the first month of treatment, and this response was maintained over the six-month treatment period.  There were few side effects. 
 
Garbutt, J, et al. "Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A Randomized Controlled Trial." JAMA. 293(13): 1617-1625, 2005.

DISULFIRAM (Antabuse) has been in use since 1951. Studies have shown that it reduces the craving for alcohol and reduces the risk of relapse. It works by making you feel sick to your stomach if you have a drink. If you do have a drink Antabuse causes flushing, headache, nausea and vomiting, dizziness and lowered blood pressure, among other effects. It can cause severe side effects, although these are rare. Disulfiram begins to effect alcohol metabolism within 1-2 hours and reaches a peak in 12 hours. It is slowly excreted from the body over 2 weeks.

CAMPRAL (genereic name: acamprosate), a drug that is widely used in Europe to reduce alcohol cravings in problem drinkers who have quit, has now been approved by the U.S. Food and Drug Administration. The FDA approved Campral after studies showed that more subjects who were given the drug stayed away from alcohol, compared with those who were given a placebo. However, they cautioned that Campral might not be effective for people who are currently drinking when they start taking the drug, or for those who are misusing other substances. The drug will be available in the U.S. by the end of 2004.

Campral reduces alcohol relapse by reducing the bad feelings that result when a person abstains. It works by stimulating GABA, an amino acid that acts as a neurotransmitter, transferring chemical messages between neurons in the brain. GABA can also be taken as part of amino acid therapy. (For more information on amino acid therapy see the chart on amino acids under Nutrition in the Holistic section of this web site).

The following online article provides more information about the above four medications:
Richard A. Rawson, PhD, Michael J. McCann, M.A., Albert L. Hasson, MSW “Pharmacotherapies for Substance-Abuse Treatment.” Counselor Magazine. October, 2000.
counselormagazine.com

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Nicotine

NICOTINE REPLACEMENT PRODUCTS provide nicotine without smoking. This helps to lessen the body's craving for nicotine and to reduce withdrawal symptoms. Replacement products come in several forms: gum, patch, nasal spray, inhaler and lozenge. Nicotine gum, patch and lozenges can be bought over-the-counter. The nasal spray and inhaler (brand name Nicotrol) require a doctor's prescription.

BUPROPION (brand names Zyban or Wellbutrin) is an antidepressant drug that can be used to help some people stop smoking. It is taken as a pill and requires a doctor's prescription. Although
it does not contain nicotine, it can help people resist the urge to smoke. Bupropion is often used for 7-12 weeks, beginning 1 or 2 weeks before smoking is stopped. It can be used for smoking cessation maintenance for up to six months. Side effects may include insomnia and dry mouth.

VARENICLINE (Chantrix) - is the first treatment that specifically targets the neurobiological mechanism of nicotine dependence. Studies show that the drug successfully stimulates dopamine (the brain's pleasure chemical) and blocks nicotine receptors. This reduces nicotine withdrawal symptoms and cravings, helping to prevent a full relapse. The drug also blocks the effects of nicotine if you begin to smoke again.

Chantix is a prescription medication sold in tablet form. It is generally prescribed for 12 weeks. If you quit smoking during that time, your doctor may prescribe Chantix for another 12 weeks to enhance long-term success. Side effects may include nausea, vomiting, gas, headache and insomnia.

Researchers found Chantix to be more effective than a placebo in helping people quit smoking. In two studies, Chantix helped more people quit smoking than did bupropion (Zyban) ‹ the only other nicotine-free drug used as a quit-smoking aid.

Foulds J, Steinberg MB, Williams J, et al. "Developments in pharmacotherapy for tobacco dependence: past, present and future."

* It should be noted that FDA regulators have reported that a connection between Chantix and serious psychiatric problems including depression, agitation and suicidal behavior is "increasingly likely."

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