Medications to Assist Recovery;
http://www.addictionrecoveryguide.org/medication/methamphetamine
I Alcoholism
á Baclofen
á Campral
á Chantix
The following online article provides more information about four of the medications described below: Rawson RA, McCann MJ, Hasson L. Pharmacotherapies for Substance-Abuse Treatment. Counselor Magazine. October, 2000.
What it does: An anticonvulsant, mood stabilizing medication that can help reduce alcohol cravings
How it works: Reduces brain levels of the neurotransmitter dopamine (which is believed to create the pleasurable sensations alcoholics get from drinking), potentially resetting the brain's chemistry
Side effects: Numbness
and tingling in the hands and feet, difficulty concentrating, confusion,
nervousness, headache, drowsiness and mood swings.
Special Alert: The FDA is notifying healthcare providers and
patients with new data indicating an increased risk of cleft lip and/or cleft
palate in infants exposed to Topirimate (Topamax¨) during pregnancy.
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: In a 2008
study Topirimate was more effective than placebo in reducing body mass index,
all liver enzyme levels, cholesterol levels, and systolic and diastolic blood pressure,
which might lower the risk of fatty liver degeneration and cirrhosis as well as
heart disease. It significantly decreased obsessive thoughts and compulsions
about using alcohol, increased participantsÕ well being, and improved some
aspects of quality of life, thereby lessening the risk of relapse.
Johnson BA, Rosenthal N, Capece JA, et al. Improvement
of physical health and quality of life of alcohol-dependent individuals with
topiramate treatment: US multisite randomized controlled trial. Arch
Intern Med. 168(11):1188-99, 2008.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a697012.html
BACLOFEN (Lioresal or Gablofen¨)
What it does: A muscle relaxant found to reduce alcohol cravings
How it works: Increases the amount of GABA, a neurotransmitter in the brain which has a relaxing effect
Side effects: Drowsiness,
dizziness, weakness, upset stomach, confusion.
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: Baclofen
was effective in inducing abstinence from alcohol and reducing alcohol craving
and consumption in alcoholics. This small study suggests that baclofen may be a
potentially useful drug in the treatment of alcohol-dependent patients.
Addolorato G, Leggio L, Safety
and efficacy of baclofen in the treatment of alcohol-dependent patients.
Curr Pharm Des. 16(19):2113-7, 2010.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a682530.html
What it does: Naltrexone is an opioid antagonist that can help reduce the desire for alcohol and lessen alcoholÕs positive effects.
How it works: It blocks the parts of your brain that feel pleasure when you use alcohol. When these areas of the brain are blocked, you feel less need to drink alcohol, and may be able to stop drinking more easily.
Side effects: Nausea,
headache, constipation, dizziness, anxiety and insomnia.
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: Naltrexone has been shown to improve treatment outcomes in alcoholics when combined with treatments such as Alcoholics Anonymous meetings, addiction counseling, family therapy, group therapy, and hospital or residential treatment. However, adherence to daily oral doses has often been a problem.
Long-acting naltrexone injections
may help with the problem of inconsistent use of the medication. In a clinical
study conducted at 24 sites, once-a-month Naltrexone injections combined with
psychotherapy significantly reduced heavy drinking in patients being treated
for alcohol dependency within the first month of treatment, and this response
was maintained over the six-month treatment period with few side effects.
Garbutt JC, Kranzler HR, O'Malley SS, et al. "Efficacy
and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A
Randomized Controlled Trial." JAMA. 293(13): 1617-1625, 2005.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a685041.html
What it does: Antabuse has been in use since 1951. Studies show that it reduces the craving for alcohol and reduces the risk of relapse.
How it works: Antabuse causes unpleasant effects if you drink even small amounts of alcohol such as flushing, headache, nausea and vomiting. It 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.
Side effects: Skin rash,
headache, drowsiness, weakness, upset stomach, tiredness.
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: In a
systematic review six of eleven studies reported a significantly better effect
on abstinence for patients treated with disulfiram, with patients having
significantly more days until relapse and fewer drinking days.
J¿rgensen CH, Pedersen B, T¿nnesen H. The
Efficacy of Disulfiram for the Treatment of Alcohol Use Disorder.
Alcohol Clin Exp Res. 2011 May 25. [Epub ahead of print]
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a682602.html
What it is: This drug is widely used in Europe to reduce alcohol cravings in problem drinkers who have quit. The FDA approved it after studies showed that more participants who were given the drug stayed away from alcohol, compared with those who were given a placebo. However, 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.
How it works: Campral reduces alcohol relapse by reducing the bad feelings that result when a person abstains. It works by stimulating GABA, 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 this chart on amino acids in the Holistic section of this web site.)
Side effects: Diarrhea,
gas, upset stomach, loss of appetite, dry mouth, dizziness.
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: A recent
systematic review of 24 studies with 6,915 participants showed that acamprosate
appears to be an effective and safe treatment in alcohol dependent patients for
supporting continuous abstinence after detoxification from alcohol. When added
to psychosocial treatment strategies, acamprosate reduced the risk of returning
to any drinking after detoxification compared with treatment with a placebo.
The cumulative abstinence time was also clearly increased.
Ršsner S, Hackl-Herrwerth A, Leucht S, et al. Acamprosate
for alcohol dependence. Cochrane Database of Systematic Reviews
2010, Issue 9. Art. No.: CD004332.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a604028.html
What it is: Ondansetron is used to treat the nausea and vomiting caused by certain chemotherapies. It has been found to stop cravings, decrease alcohol consumption and increase abstinence in people who are early-onset alcoholics.
How it works: Ondansetron appears to work by acting on serotonin, one of the brain's many neurotransmitters. An imbalance between two chemical messengers in the brain, serotonin and dopamine is believed to create a craving for alcohol. Ondansetron blocks a serotonin receptor, which decreases alcohol-induced dopamine release, resulting in a decrease in alcoholic-drinking behavior.
Side effects: Diarrhea,
headache, constipation, weakness, dizziness, tiredness.
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: A total of
271 patients with diagnosed alcoholism received treatment with ondansetron (1
microg/kg, 4 microg/kg, or 16 microg/kg twice a day) or placebo for 11 weeks
plus group cognitive behavioral therapy. Patients with early-onset alcoholism
taking ondansetron had fewer drinks per day. Ondansetron, 4 microg/kg twice per
day, was better than placebo in increasing the percentage of days abstinent per
week. Results suggest that ondansetron (particularly the 4 microg/kg twice per
day dosage) is an effective treatment for patients with early-onset alcoholism.
Johnson BA, Roache JD, Javors MA, et al. Ondansetron
for reduction of drinking among biologically predisposed alcoholic patients: A
randomized controlled trial. JAMA. 284(8):963-71, 2000.
For more information: www.kap.samhsa.gov/products/manuals/tips/pdf/TIP49_LitRev.pdf
What it is: Chantix is a prescription medication that has generally been used for smoking cessation but has recently been studied as a viable option for treatment of alcohol dependence.
Availability: Physician prescription
Research: A 2013 study by scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that varenicline (marketed under the name Chantix), approved in 2006 to help people stop smoking, significantly reduced alcohol consumption and craving among people who are alcohol-dependent. The findings were published in the Journal of Addiction Medicine (ncbi.nlm.nih.gov/pubmed/23728065).
Two hundred men and women with alcohol dependence were recruited across 5 clinical sites. Patients received varenicline or placebo. Varenicline was titrated during the first week to 2 mg a day, which was maintained during weeks 2 to 13. The varenicline group had significantly lower weekly percent heavy drinking days, drinks per day, drinks per drinking day, and alcohol craving compared with the group who took a placebo. Adverse events were expected and mild. Varenicline significantly reduced alcohol consumption and craving, making it a potentially viable option for the treatment of alcohol dependence.
For more information on Chantix please see Varenicline on our nicotine medication page.
*Please note that FDA regulators have reported that a connection between Chantix and serious psychiatric problems including depression, agitation and suicidal behavior is "increasingly likely." A report from The Institute for Safe Medication Practices also linked Chantix to a wide array of health and safety problems. They include accidents and falls, potentially lethal heart rhythm disturbances, heart attacks, seizures, diabetes and various psychiatric disturbances.
What it is: Gabapentin is a medication currently approved for treating seizures and nerve pain.
How it Works: Its activity in the GABA neurotransmitter pathway suggests it might alleviate alcohol craving, which is believed to involve GABA activation in a specific part of the brain (amygdala). Previous studies have shown that Gabapentin reduces this activity. This may increase rates of sustained abstinence and no heavy drinking and decrease alcohol-related insomnia and sad or anxious mood.
Side Effects: Can cause
drowsiness, dizziness, headache, anxiety, constipation.
For a complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: In this 12-week study conducted from 2004-2010, 150 men and women with current alcohol dependence were given either gabapentin (900 mg or 1800 mg a day) or placebo. Gabapentin was associated with abstinence rates of 11.1% and 17% after 12 weeks in patients receiving 900 and 1,800 mg/day, respectively, compared with 4.1% for those in the placebo group. The no heavy drinking rate was 22.5% in the placebo group, 29.6% in the 900-mg group and 44.7% in the 1800-mg group of gabapentin. Gabapentin was effective in treating alcohol dependence and relapse-related symptoms of insomnia, sad or anxious mood, and craving. Patients reporting alcohol dependence were better able to stay sober and the medication produced no serious side effects.
Mason BJ, Quello S, Goodell V, et al. Gabapentin treatment for alcohol dependence: A randomized clinical trial. JAMA Intern Med. Published online November 4, 2013.
II Cocaine Addiction
á Baclofen
á Nocaine
GABAPENTIN (Neurontin¨)
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, a neurotransmitter in the brain that has a calming effect, increasing relaxation and reducing stress and anxiety
Side effects: Drowsiness,
dizziness, headaches, blurred vision, anxiety, heartburn.
For a more complete list of side effects see this NIH page.
Availability: Physician prescription
Research: Raby Wn. Gabapentin
Reduces Cocaine use Among Addicts From a Community Sample. J Clin
Psychiatry 2004:65:84-86.
For more
information: www.nlm.nih.gov/medlineplus/druginfo/meds/a694007.html
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, dizziness, weaken, muscle pain,
nausea, constipation.
For a more complete list of side effects see this NIH page.
Availability: Physician prescription
Research: American
Journal of Psychiatry 2009;166:1269-1277. Randomized, double-blind, placebo-controlled trial of
vigabatrin for the treatment of cocaine dependence in Mexican parolees.
This study demonstrates the safety and efficacy of short term vigabatrin for
cocaine dependence.
For more
information: www.nlm.nih.gov/medlineplus/druginfo/meds/a610016.html
BACLOFEN (Gablofen¨; 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, a neurotransmitter that has a calming and relaxing effect
Side effects: Drowsiness,
dizziness, weakness, fatigue, nausea, headache, constipation.
For a more complete list of side effects see this NIH page.
Availability: Physician prescription
Research: J Clin Psychiatry 2003:64:1440-1448 Randomized Placebo-Controlled trial for Cocaine dependence Shoptaw,S etc- reprints Shoptaw@friendsresearch.org. Baclofen plus substance abuse counseling significantly reduced cocaine use in recovering addicts compared to placebo plus counseling.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a682530.html
What it does: An amino acid that curbs cocaine cravings and repairs damage in the brain caused by cocaine use in animals
How it works: Restores glutamate levels to normal in the area of the brain where addiction occurs
Side effects: Gastrointestinal
disturbance, diarrhea, nausea, vomiting, fatigue, skin rash
For a more complete list of side effects see this web page.
Availability: Over the counter
For specific suggestions of other amino acids that can lessen cravings see our Nutrition page.
For more information: www.mskcc.org/mskcc/html/69310.cfm
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.
For more information: explore.georgetown.edu/news/?ID=2914&PageTemplateID=295
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, vomiting (sometimes very severe, if any alcohol or cocaine is used), rapid heart rate, difficulty breathing, low blood pressure, confusion and fainting. For a more complete list of side effects see this NIH page.
Availability: Physician prescription
Research: 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.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a682602.html
MODAFINIL (PROVIGIL)
What it does: Promotes longer total sleep time and decreases daytime sleepiness in abstinent cocaine users
How it works: May increase the release of dopamine in the brain's reward center
Side effects: Anxiety,
depression, diarrhea, dizziness, dry mouth, headache. Modafinil should be
avoided by people with certain types of heart disease such as mitral valve
prolapse.
For a more complete list of side effects see this NIH page.
Availability: Physician prescription
Warning: A schedule 4 drug with potential for addiction
Research: American Journal of Psychiatry. 2010; 167(3):331-40. Normalizing effects of modafinil on sleep in chronic cocaine users. Progressive abstinence from cocaine was associated with worsening sleep. Modafinil taken in the morning produced longer total sleep time and shorter time to fall asleep in the third week of abstinence.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a602016.html
III Inhalant Addiction
Please report your experiences with these on our message board.
GAMMA-VINYL-GABA (GVG) or VIGABATRIN (Sabril¨)
What it does: An anti epileptic drug, which reduces cravings for inhalants and other drugs (cocaine, heroin, nicotine)
How it works: The medication 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, dizziness, weakness, muscle pain, weight gain and shaking. For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: A 2004
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.
Lee DE, Schiffer WK, Dewey SL. Gamma-vinyl GABA (vigabatrin) blocks the
expression of toluene-induced conditioned place preference (CPP). Synapse.
54(3):183-5, 2004.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a610016.html
IV Methamphetamine Addiction
á Paxil
The National Institute of Drug Abuse (NIDA) established the Methamphetamine Clinical Trials Group (MCTG) to conduct studies of medications for methamphetamine.
What it does: An antidepressant, Paxil was found to decrease methamphetamine craving
How it works: Paxil contains the compound ondansetron that can block the effects of methamphetamine withdrawal.
Side effects: Headaches,
dizziness, weakness, nausea, constipation and heartburn
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: In one
study the antidepressant paroxetine (Paxil) was found to decrease
methamphetamine craving compared to placebo.
Piasecki MP, Steinagel GM, Thienhaus OJ, Kohlenberg BS. An
exploratory study: the use of paroxetine for methamphetamine craving. J
Psychoactive Drugs. 2002 Jul-Sep;34(3):301-4.
Studies done at the National Institute of Drug Abuse have shown that Paxil can lessen withdrawal symptoms.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a698032.html
What it does: An antidepressant, Wellbutrin was found to be effective in reducing methamphetamine abuse in low to moderate users and to reduce cue-induced cravings.
How it works: During withdrawal, the brain of a methamphetamine addict resembles the brain of a depressed patient. Antidepressants may help during these beginning stages of treatment. Bupropion offers promise as an anti-addiction medication reducing symptoms of depression and cue-induced cravings.
Side effects: Headaches,
dizziness, weakness, nausea, constipation and heartburn
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: In a study
conducted at UCLA bupropion reduced cue-induced craving for methamphetamine in
20 participants. This data provides a rationale for further studies evaluating
bupropion in the treatment of methamphetamine dependence.
Newton TF, Roache JD, De La Garza r, et al. Bupropion
Reduces Methamphetamine-Induced Subjective Effects and Cue-Induced Craving.
Neuropsychopharmacology 31(7): 1537–1544, 2006.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a695033.html
What it does: May be effective in treating sleep disorders and methamphetamine withdrawal symptoms and improving cognitive function.
How it works: This central nervous system stimulant is chemically and pharmacologically dissimilar to other stimulants such as the amphetamines. The dopamine- and glutamate-enhancing actions of modafinil may help reduce withdrawal severity. The stimulant properties of modafinil may also ease the disturbed sleep patterns, poor concentration and low energy levels characteristic of methamphetamine withdrawal. It is well tolerated and has low abuse liability.
Side effects: Headache,
dizziness, drowsiness, nausea, constipation and heartburn
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: Modafinil is an important drug being studied which appears to improve cognitive functioning and may also complement behavioral counseling for methamphetamine abuse.drugabuse.gov/publications/drugfacts/methamphetamine
In a pilot study 80 methamphetamine-dependent
patients received either modafinil (200 mg a day) or placebo for 10 weeks and
12 weeks post-treatment follow-up. Modafinil showed promise in reducing
methamphetamine use in selected methamphetamine-dependent patients. The study
findings support definitive trials of modafinil in larger multi-site trials.
Shearer J, Darke S, Rodgers C, et al. A
double-blind, placebo-controlled trial of modafinil (200 mg/day) for methamphetamine
dependence. 104(2):224-33, 2009.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a602016.html
What it does: An antidepressant that was found to decrease methamphetamine use
How it works: Mirtazapine helps release several brain chemicals including norepinephrine, serotonin and dopamine that are involved in mood.
Side effects: drowsiness,
dizziness, anxiousness, confusion, increased weight and appetite
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: In a small 12-week study of 60 patients, the addition of mirtazapine to substance use counseling decreased methamphetamine use among active users despite low to moderate medication adherence.
Colfax NC, Santos GM, Das M, et al. Mirtazapine to reduce methamphetamine use: a randomized controlled trial. Arch Gen Psychiatry. 2011;68(11):1168-1175.
For more information: www.nlm.nih.gov/medlineplus/druginfo/meds/a697009.html
V Nicotine Addiction
Please report your experiences with these on our message board.
What they do: provides nicotine without smoking
How they work: 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
Side effects: gum (dizziness, headache, nausea); nasal spray (runny nose, throat irritation, coughing, sneezing, watery eyes); patch (dizziness, headache, nausea, vomiting, diarrhea); inhaler (mouth and throat irritation, runny nose, sinus pressure, headache, gas); lozenge (heartburn, sore throat, mouth problems, irregular or fast heart beat). For a more complete list of side effects, visit this NIH page.
Availability: Nicotine gum, patch and lozenges can be bought
Research: A
meta-analysis of nicotine replacement therapy products indicates that they are
an effective intervention in achieving sustained smoking abstinence.
Moore D, Aveyard P, Connock M, et al. Effectiveness
and safety of nicotine replacement therapy assisted reduction to stop smoking:
systematic review and meta-analysis. BMJ. 2009 Apr 2;338:b1024.
For more information on these products: www.nlm.nih.gov/medlineplus/ency/article/007438.htm
BUPROPION (brand names Zyban and Wellbutrin)
What it does: An antidepressant drug that can be used to help some people stop smoking.
How it works: 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: Insomnia, dry mouth, dizziness, headache, nausea, constipation. For a more complete list of side effects, visit this NIH page.
Availability: By prescription from a physician
Research: Treatment with bupropion is associated with improved ability to resist cue-induced craving and a reduction in cue-induced activation of limbic and prefrontal brain regions. A reduction in craving is associated with reduced activation in prefrontal brain regions. Culbertson CS, Bramen J, Cohen MS, et al. Effect of bupropion treatment on brain activation induced by cigarette-related cues in smokers. Arch Gen Psychiatry. 68(5):505-15, 2011.
For more information on this medication: www.nlm.nih.gov/medlineplus/druginfo/meds/a695033.html
*Please note that FDA regulators have reported that a connection between Chantix and serious psychiatric problems including depression, agitation and suicidal behavior is "increasingly likely." A report from The Institute for Safe Medication Practices also linked Chantix to a wide array of health and safety problems. They include accidents and falls, potentially lethal heart rhythm disturbances, heart attacks, seizures, diabetes and various psychiatric disturbances.
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.
What it does: This is the first treatment that specifically targets the neurobiological mechanism of nicotine dependence.
How it works: 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.
Side effects: Nausea, vomiting, gas, heartburn, vomiting, headache. For a more complete list of side effects,visit this NIH page.
Availability: By prescription from a physician
Research: 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. Drug Alcohol Rev. 25(1):59-71,
2006.
2012 Warning issued from the FDA: In a large, meta-analysis of clinical trials that compared patients who received the smoking cessation drug Chantix (varenicline) to patients who received a placebo (an inactive treatment), a higher occurrence of major adverse cardiovascular events (cardiovascular-related death, nonfatal heart attack, and nonfatal stroke) was seen in patients using Chantix compared to placebo. These events were uncommon in both the Chantix and placebo groups, and the increased risk was not statistically significant, which means it is uncertain whether the excess risk for the Chantix group was due to the drug or due to chance.
Patients taking Chantix should contact their health care professional if they experience new or worsening symptoms of cardiovascular disease, such as chest pain, shortness of breath, calf pain when walking, or sudden onset of weakness, numbness, or difficulty speaking. Patients should also contact their health care professional if they have any questions or concerns about Chantix.
For more information on this medication: www.nlm.nih.gov/medlineplus/druginfo/meds/a606024.html
FDA 101: Smoking Cessation Products
(www.fda.gov/ForConsumers/ConsumerUpdates/ucm198176.htm)
A good discussion of the different smoking cessation products available,
differentiating between products that contain nicotine and products that do
not.
VI Opiates, Heroin & Pain Pill Addiction
BUPRENORPHINE (Buprenex¨;
Butransª; Subutex¨, Suboxone)
What it does: Buprenorphine was approved by the FDA October 9, 2002 as a new treatment for heroin and other opioid addictions. It can cause dependence and withdrawal symptoms when stopped and is the first narcotic drug approved for addictions that can be prescribed by physicians in their offices.
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.
Two formulations were approved. The first, Subutex, 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. ItÕs used for people on maintenance drug therapy.
How it works: Opioids attach to receptors in the brain. Buprenorphine works by stimulating the brain opioid receptors but only partially satisfying them by not being a perfect fit. Thus Buprenorphine helps to ease withdrawal symptoms and drug cravings by activating the opiate receptors but not in an intense enough way to produce the heightened feelings of euphoria that heroin would produce. If a user attempts to take another opiate such as heroin while taking buprenorphine, there will be no effect.
Side effects: Headaches,
flu-like symptoms, dizziness, constipation, upset stomach, sleep problems.
For a more complete list of side effects visit this NIH page.
Availability: This medication can be obtained by a prescription 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.
Research: A clinical trial compared counseling and short-term detoxification with suboxone (2 weeks) with counseling and extended suboxone treatment (12 weeks) in 154 patients aged 15 to 21. The extended suboxone treatment led to better control of symptoms of opioid withdrawal, a reduction in drug use on long-term follow up, and better treatment retention. The medication was well tolerated and people remained alert and could function well during the day. Woody GE, et al. Extended vs. short-term buprenorphine-naloxone for treatment of opioid-addicted youth. JAMA. 2008; 300(17):2003-2011.
NIDA's Clinical Trials Network Prescription Opioid
Addiction Treatment Study (POATS)
In this first large scale study on treatment of prescription opioid addiction,
more than 600 outpatients addicted to prescription opioids received Suboxone in
combination with brief standard medical management. Half of the participants
also received varying intensities of addiction counseling as provided by
trained substance abuse or mental health professionals. Results showed that
approximately 49 percent of participants reduced prescription painkiller abuse
during extended (at least 12-week) Suboxone treatment. This success rate dropped
to 8.6 percent once Suboxone was discontinued. Participants who received
intensive addiction counseling did not show better outcomes when compared to
those who did not receive this additional counseling. "The study suggests
that patients addicted to prescription opioid painkillers can be effectively
treated in primary care settings using Suboxone," said NIDA Director Nora
D. Volkow, M.D. November, 2011.
For more information: www.kap.samhsa.gov/products/brochures/pdfs/buprenorphine_facts.pdf
SAMHSA Buprenorphine Physician &
Treatment Program Locator
A nationwide registry of physicians who have taken this training
is available atbuprenorphine.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 (ReVia¨; Vivitrol¨)
What it does: Naltrexone is an opioid antagonist medication that binds to opioid receptors but does not activate them. It may be most useful for highly motivated recently detoxified patients who want total abstinence as well as individuals at the experimenting stage of opioid use or those who are in early stages of their addiction.
How it works: Naltrexone blocks the part of your brain that feels pleasure when taking narcotics. Because it blocks the opioid receptors it prevents the body from responding to opiates It can be taken by mouth once daily or every other day, has minimal side effects and is not addicting. A favorable treatment outcome requires some form of psychotherapy, careful monitoring of medication compliance and effective behavioral interventions.
Side effects: Nausea,
vomiting, diarrhea, constipation, headache, dizziness.
For a more complete list of side effects visit this NIH page.
Cautions: www.fda.gov/downloads/Drugs/DrugSafety/UCM206669.pdf
Availability: Physician prescription
Research: A recent study on an injectiable long-acting form of naltrexone (Vivitrol) kept more addicts off opioids than placebo did. The six-month study of 250 patients found that 90% of those who received a monthly injection of naltrexone stayed off opioids, compared with 35% of those in the placebo group. (Krupitsky, 2011).
For more information: www.kap.samhsa.gov/products/brochures/pdfs/naltrexone_facts.pdf
METHADONE (Dolophine¨; Methadone Diskets¨; Methadone Intensolª; Methadose¨)
What it does: Methadone is a long acting medicine that reduces opiate craving and blocks the effect of opiates. It requires frequent visits to a network of clinics that can be found at www.atforum.com.
How it works: Methadone blocks the receptors in the brain that are affected by opiates such as heroin, enabling users to gradually detoxify from opiates without experiencing painful withdrawal symptoms. Methadone occupies the receptors in the brain that opiates use, blocking the high feeling that opiates provide and making the user feel more stable. This reduces the drug cravings and withdrawal symptoms that often lead to relapse. Because MethadoneÕs effects last between 24 and 36 hours, most patients can be maintained on one daily dose.
Side effects: Drowsiness,
weakness, nausea, constipation, headache, loss of appetite.
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: See the National Institute of Drug Abuse Research Summary on Methadone available here.
For more information: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682134.html
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.
What it does: Desipramine is a tricyclic antidepressant that may be useful in facilitating opioid abstinence in opioid maintained patients.
How it works: Long-term use of heroin suppresses the production of the neurotransmitters norepinephrine and dopamine which help regulate mood and are involved in the development of depression. Thus heroin users are likely to experience post-withdrawal depression which can be treated with an antidepressant such as desipramine that counteracts this suppression.
Side effects: Nausea,
dry mouth, constipation, fatigue, nightmares, sweating.
For a more complete list of side effects visit this NIH page.
Availability: Physician prescription
Research: Nunes EV, Levin FR. Treatment
of depression in patients with alcohol or other drug dependence: a
meta-analysis. JAMA. 2004 Apr 21;291(15):1887-96
Antidepressant medication has a modest beneficial effect for patients with
combined depressive- and substance-use disorders including opiate dependence.
It is not a stand-alone treatment, and therapy directly targeting the addiction
is also indicated.
For more information: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682387.html