Reprinted from the "Medications" issue of Visions Journal, 2007, 4 (2), pp. 9-10
The core symptoms of drug addiction are a powerful and unexplainable compulsion and a craving to use a drug. Compulsions can cause you to continue using a drug even when you don’t want to, and cravings can cause you to start using a drug again after all your best efforts to quit. These are the key focus areas that we addiction physicians pay most attention to in terms of treatment.
New medications in the field of addiction medicine are providing us with ways to help our patients stay drug and alcohol free. Therapy has always involved a combination of psychological and social healing. We now have a growing number of pharmacological treatments aids to add to—not replace—the standard therapies.
The type of addiction medication used varies according to which substance a patient is addicted.
Disulfiram (Antabuse) causes a very unpleasant reaction (e.g., aggressive vomiting) when a person drinks even a tiny amount of alcohol. This is a form of aversion therapy. A patient must take disulfiram daily until they're able to establish permanent self-control.
Naltrexone (Revia) is usually used to reverse an opiate overdose when used intravenously, but when taken orally, it may reduce the craving for alcohol. The major side effects are nausea and abdominal pain.1
Acamprosate (Campral) has also been shown to reduce alcohol cravings. It has recently become available in Canada. Acamprosate has been used in Europe for many years and is a welcome asset in craving management. It has minimal side effects.
Nicotine replacement systems (NRS) are well known to everyone and include patches, gum, oral inhalers and lozenges. These contain nicotine and are designed to minimize withdrawal symptoms. They can even be used in combination, in pregnancy, in young people ages 12 to 17 and in people who have heart disease.2
Bupropion (Zyban) was initially introduced as an antidepressant, but has been shown to reduce cravings and some of the discomfort of withdrawal.3 Bupropion can be used together with any of the NRS applications.
Varenicline (Champix) is a new oral tablet that has recently become available in British Columbia. It also works by reducing the craving for nicotine.4 It is important to note that varenicline will cause stomach problems of varying degrees in all patients, but this will settle.
Using bupropion and an NRS together or individually will double your chance of quitting smoking. If varenicline on its own is used instead of bupropion and/or NRSs, you have a four times greater chance of quitting compared to using no aids.
Major addiction medicine approaches
Opiates are a group of medications used to relieve pain. However, in some people they can become addictive. They can induce a euphoric-type high. Opiates are either derived from the seeds of the opium poppy or manufactured synthetically. The opiate group includes both legal prescription opiates (Dilaudid, morphine, oxycodone) and illegal street drugs (heroin).
All opiates are addictive and, when prescribed by a doctor, should only be used as recommended.
Methadone is an opiate drug that has proven over the last three decades to be a remarkable treatment for opiate addiction. Methadone acts chemically on the brain’s receptors for opiate drugs. It fills these receptors, relieving the need for other opiate drugs.5 As you get used to methadone, it doesn’t change behaviour, feelings or thoughts. There is no high from taking methadone properly; hence, it doesn’t fuel addiction. Although you will be physically dependent on methadone, you will be free from some of the compulsions of addiction.
Buprenorphine (Suboxone) is also an opiate medication that has the same effect as methadone, but is different in some ways. Suboxone is a combination of buprenorphine and naloxone (a compound that, if injected, blocks the effects of pain-killing opiates). Suboxone is a very safe drug, with minimal risk of overdose. An optimal dose can be achieved in a very short period of time: Suboxone usually takes less than one week, whereas methadone dosage needs to be increased slowly and carefully over a longer period of time. Suboxone won’t be sufficient for anyone using larger opiate doses, however, because it has no further benefit beyond a certain dosage. Depending on the dosage, Suboxone may only need to be taken every second or third day. It will be available in Canada shortly.
It's important to remember that drug addiction is often associated with other mental illnesses. And it is important to treat these mental health conditions with the medications prescribed by your doctor. These may include antidepressants, antianxiety drugs and drugs to treat schizophrenia, bipolar disorder and other illnesses. The benefits of these additional medications should not be minimized. These treatments—plus ongoing support and counselling—are needed to ensure that your mental well-being is at its healthiest.
It is important to note that these new drugs are not a replacement for existing, well-recognized therapies for addiction, such as counselling, acupuncture and 12-step groups, to mention just a few. These drugs are additional tools that can be used in your recovery.
About the author
Jennifer is an addiction physician practising in Metro Vancouver and the Fraser Valley. She is certified with the Canadian Society of Addiction Medicine, the American Society of Addiction Medicine and the International Society of Addiction Medicine.
O’Brien, C.P. & Swift, S. (2005 November). Emerging pharmacologic treatments for alcohol dependence: Case studies in naïve and refractory therapies. Tarrytown, NY: Continuing Medical Education Program, University of Kentucky College of Medicine and Rxperience .
Action on Smoking and Health. (December 2005). Nicotine replacement therapy: Guidance for health professionals on changes in the licensing arrangements for nicotine replacement therapy. London, UK: author. newash.org.uk/files/documents/ASH_445.pdf.
Pipe, A., Reid, R.D. & Quinlan, B. (2007). Systematic approaches to smoking cessation. Quoted in T. Tebbutt & D. Pletz, Implementation of a minimal contact smoking cessation program at an acute care facility in Ontario, based on the Ottawa model (PowerPoint presentation). Kitchener, ON: St. Mary’s Regional Hospital. www.waterloowellingtonlhin.on.ca/uploadedFiles/Home_Page/Be_Informed/Implementation%20of%20a%20Hospital-Wide%20Smoking%20Cessation%20Protocol.pdf.
Oncken, C., Gonzales, D., Nides, M. et al. (2006). Efficacy and safety of the novel selective nicotinic acetylcholine receptor partial agonist, varenicline, for smoking cessation. Archives of Internal Medicine, 166(15),1571-1577.
Craven, J. (2005). Handbook of recovery: For clients of methadone maintenance treatment, their families, friends and caregivers. London, ON: SupportNet Studios Inc.