1. Medications used in Treatment of Alcohol and Drug Use Disorders
Gloria J. Baciewicz MD
Strong Recovery

2. Medications used in Treatment of Alcohol and Drug Use Disorders
What are the medications that are sometimes used in treatment?
How does treatment help with the lifelong management of substance use disorder?

3. Medications for addiction treatment
FDA approved meds exist for:
Alcohol
Opioids
Nicotine
No approved meds yet for:
Cocaine
Cannabis
Methamphetamine

4. Meds Approved for Treatment of Alcohol Use Disorder
Disulfiram (Antabuse) 1950
Naltrexone (ReVia) 1994
Acamprosate (Campral) 2004
Naltrexone monthly injection (Vivitrol) 2006

5. Disulfiram (Antabuse)
Disulfiram-alcohol reaction
Blocks acetaldehyde dehydrogenase
Acetaldehyde builds up
250 mg per day
Check LFT’s at baseline and 1 month after

6. Naltrexone (ReVia)
Opioid antagonist: Affects endogenous opioids released by alcohol consumption, decreases alcohol craving and use
Check LFT’s at baseline and 1 month after
Main side effect = nausea
Recent pharmacogenetic studies: NTX more effective in persons with G polymorphism of the gene OPRM1 (Anton R et al, Arch Gen Psych 2008)

7. Acamprosate (Campral)
Blocks glutaminergic NMDA receptors & activates GABA type A receptors
Decreases alcohol craving and use
666 mg tid
No routine lab testing needed, few side effects
Recent pharmacogenetic studies: more effective in patients with the common allele of the genetic variant rs located in the GRIN2B gene

8. Injectable Naltrexone (Vivitrol)
IM Monthly 380 mg
Expensive--about $700 per month
Extra paperwork (faxes to the company)
NYS Medicaid now supports this med

9. Summary of meds for alcohol dependence
Naltrexone & acamprosate both have a place in treatment.
Both have only moderate effects but are important clinical tools
Disulfiram (Antabuse) still has some limited use
Monthly Injectable naltrexone is increasingly being used

10. Drugs Approved for Treatment of Opioid Use Disorder
Replacement therapies:
Methadone
Buprenorphine/naloxone (Suboxone)
Partial agonist at mu receptor
Problems with ORT : stigma, availability
Antagonist therapies:
Naltrexone: oral or monthly injection

11. THE MEANING OF SUCCESS in Methadone Maintenance SUCCESS = TREATMENT RETENTION Treatment retention produces: Reduced illicit drug use Reduced criminal activity Increased employment Improved general health status Lower rates of HIV/AIDS

12. Juice Bar Adequate dosage Additional psychosocial services
What Produces Better Treatment Retention?
Adequate dosage
Caplehorn, J R. Bell, J. Kleinbaum, D G. Gebski, V J. Methadone dose and heroin use during maintenance treatment.Addiction. 88(1):119-24, 1993 Jan.
Additional psychosocial services
Mc Lellan AT, Arndt IO, Metzger DS, Woody GE, O' Brien CP. The effects of psychosocial services in substance abuse treatment. JAMA 1993;269(15):
Juice Bar

13. Buprenorphine Partial agonist Subutex, Suboxone
Less respiratory depression
Abusable but much less dangerous than other opioids

14. Opioid Overdose Reversal: Naloxone (Narcan) Intranasal Kits
5:30-6:30 pm
First Tuesday of the Month
Strong Recovery
RSVP to:

15. Drugs for Nicotine Use Disorder
Nicotine Replacement Therapy: Gum, patches, nasal spray, inhalers
Bupropion (Wellbutrin, Zyban)
Varenicline (Chantix)
Partial agonist at nicotine receptor

16. Components of Comprehensive Drug Addiction Treatment
A variety of scientifically-based approaches to drug addiction treatment exist. Drug addiction treatment can include behavioral therapy (e.g., counseling, cognitive therapy, or psychotherapy), medications, or their combination. Case management and referral to other medical, psychological, and social services are crucial components of treatment for many people as well. The best programs provide a combination of therapies and other services to meet the needs of the individual patient, which are shaped by such issues as age, race, culture, sexual orientation, gender, pregnancy, parenting, housing, and employment, as well as physical and sexual abuse.
Several of the key principles underlying this approach to treatment follow.

17. Does treatment work? 30-50% abstinent after first year
Complete abstinence not always achievable
What’s an effective outcome?
Reduction of use
Improvement in health or social functioning
Reduced threats to public health & safety

18. CalData study 1994
$1 Treatment
$7 saved in other areas

19. How Does Treatment Work?
Prolonged alcohol and drug use changes the brain – “neuroplasticity”
Addiction “hijacks” the pleasure centers of the brain
Addiction treatment programs and meds help “retrain the brain”
Old pathways remain and can be triggered