MEDICATION-ASSISTED TREATMENT -

The Good, the Bad, the Ugly

We have come a long way in standards for addictions treatment. There are many medications available today that help patients avoid relapse and gain solid recovery from addictive illness.

That's the "Good". The Bad is that, unless the patient is in a medication-friendly program and has the ability to pay, this option is denied them. The Ugly part is that there are still some addiction treatment programs, including nationally famous ones, who are against medication-assisted treatment, despite research showing this works. There are also still some holdouts in twelve step programs who are against using medication for addictive disorders.

There are medications to treat craving for alcohol, cocaine, and opiates, as well as for other drug addictions. Some are old, some are new, some are old ones given a new name. All are on the market, FDA approved, and available after rigorous research to show their effectiveness.

The goal is not to substitute one medication for another. It is to keep the patient from relapsing so they can focus on learning how to live without the drug to which they are addicted and not be distracted by craving and the compulsion to use alcohol and/or other drugs.

Let's start with the newest. It is Vivitrol. It is an injection that lasts one month and has been shown to decrease craving for alcohol. It's actually an old drug called naltrexone, once used in the 40s for opiate craving. It did not work. It was then marketed in the 90s as ReVia, in pill form, for alcohol craving. Studies indicate it works 80% of the time. The injection costs around $1,000.

Other medications available for those with Alcohol Dependence are Antabuse and acamprosate.

Antabuse has been around a long time. It stops the stomach from breaking down alcohol and if the patient drinks alcohol while taking the medication, they begin vomiting, as alcohol becomes toxic. This works well with those motivated to combat the compulsion to take a drink, knowing they will get sick. It does not seem to work for those who cannot override the compulsion, they drink anyway, and become ill. Another problem is that some patients will simply not take the medication so they can drink alcohol.

Acamprosate is one of the newest anti-craving pills for those who want to stop drinking alcohol. It is marketed as Campral. 

Studies have found that Topamax, used for seizure or mood disorders, seems to ease the craving for cocaine. Mentioned in previous newsletters, methadone and buprenorphine (Suboxone, Subutex) are highly successful medications in treating those with Opioid Dependence.

One might appropriately suggest the patient could abuse these medications like they do their drug of choice. The answer is both yes and no. Most of the medications mentioned are not abusable. Practitioners who prescribe those that are must be compelled to have protocols in place to detect misuse of the prescription. This is easily done through specialized urinalysis testing and requiring patients to be in formal addictions treatment programs.

I had a patient call last week. He said "I want to be totally clean, I want off Suboxone. I want to stop now." What he and many others do not realize is that being on the medication is what keeps them "clean" and anything that helps prevent relapse into use of the drug cannot be "dirty."

This is a wake-up call and it goes out to anyone associated with the treatment of and support of those with addictive illness. Educate yourself about each of the medications available for those with addictive illness and learn how patients can access the medication. Don't turn your back on valuable tools that prevent relapse. It is unethical.

Next, help your patient or family member find a way to access funding for the medication if they cannot afford to pay for it.

Addictions professionals who prescribe or recommend medication must assure there is a solid continuing care plan that includes ongoing work with addictions professionals and use of twelve step recovery groups. The medication does not stand alone but is part of a comprehensive recovery plan. With the exception of methadone, none of the medications will need to continue once the patient is stabilized in their recovery .