MAT Options: The Anti-Addiction Medications You Need to Know

“(Anti-addiction medications) have been proven as the gold standard for really helping people recover… That makes a huge difference in folks coming forward and looking for treatment.” ~ Marlies Perez, Division Chief, Substance Use Disorder Compliance Division, California Department of Health Care Services

The National Center on Addiction and Substance Abuse reports that more than 1 in 7 Americans age 12 and older struggle with some kind of Substance Use Disorder (SUD). Unfortunately, only 10% of those people receive specialized professional care they need. One of the most effective treatment strategies involves Medication-Assisted Treatment — the combination of education, counseling, long-term support, and anti-addiction drugs that support recovery from addiction. Currently, MAT is the preferred first-line treatment option for top evidence-based rehab programs, because it helps 70% of patients successfully regain their long-term sobriety. 

Contents

1. How Does MAT Support Recovery 1.1. Types of Anti-Addiction Drugs 2. MAT: An Underused Recovery Tool 2.1. Evidence-Based Rehab and MAT 3. List of Anti-Addiction Medications 2019 3.1. Buprenorphine 3.2. Buprenorphine Naloxone 3.3. Methadone 3.4. Naltrexone 3.5. Acamprosate 3.6. Baclofen 3.7. Benzodiazepines 3.8. Bupropion 3.9. Buspirone 3.10. Calcium Carbimide 3.11. Carbamazepine 3.12. Dextroamphetamine 3.13. Disulfiram 3.14. Gabapentin 3.15. Methylphenidate 3.16. Mirtazapine 3.17. Modafinil 3.18. Nalmefene 3.19. Naloxone 3.20. Phenobarbital 3.21. Propranolol 3.22. Rigvastigmine 3.23. Tiagabine 3.24. Topiramate 3.25. Varenicline 3.26. Vigabatrin 4. Other Medications 5. What’s the Bottom Line?

“Get your loved one the help they need. We provide outpatient addiction treatment in Denver and Summit County, see more here.”

How Does MAT Support Recovery?

“With medication assistance treatment (MAT), which is using a medicine to treat a disease, success rates are over 70 percent – 70 percent of people will be abstinent in one year.” ~ Raj Masih, the Potomac Highland Guild’s Substance Abuse Anti-Stigma Initiative

The recovery drugs used during MAT help in several ways:

1. Withdrawal Symptoms– Some medications are very effective at easing the harshly unpleasant symptoms of withdrawal experienced during drug or alcohol detox. The Substance Abuse and Mental Health Services Administration says MAT is used in almost 80% of medical detoxes.

This support during detox is extremely important, because while detox alone is NOT drug treatment, it is absolutely necessary for a safe and successful recovery.

2. Relapse Prevention – MAT patients receive anti-addiction medications to reduce or eliminate substance cravings and to restore healthy brain function.

3. Dual Diagnosis Treatment  – Because up to two-thirds of people with SUD also battle one or more co-occurring mental illnesses such as depression, anxiety, bipolar disorder, or PTSD, simultaneous treatment of both conditions needs to be part of the recovery plan.

Types of Anti-Addiction Drugs

Specifically in terms of those medications that help with withdrawal symptoms and cravings, there are several different classes:

• Replacements: Opioid Replacement Therapy — also called opioid maintenance or substitution – is when a safer opioid medication with a lower potential for abuse is given to the addict in place of their drug of choice.. 

ORT is a “harm reduction” strategy where the primary goal may not be total abstinence, but rather an attempt to “manage” drug use and give the patient a better chance to live a happier and more productive life. It may or may not be part of a more comprehensive treatment plan.

ORT may also be used for for a short period of time during medically-supervised detox to help with withdrawal symptoms.

• Agonists –These are prescription medications that bind to the same receptors in the addict’s brain as the drug of abuse, thereby blocking its effects and reducing cravings.
• Aversion Medications – These seek to modify behavior and curb substance use by triggering immediate and harshly-unpleasant reactions if the substance is used.

MAT: An Underused Recovery Tool

“There is no other disease where approved medications are not provided to everyone who needs them. We used to consider people with mental illness inferior, even possessed. Scientific advances have combated stigma around a wide variety of brain diseases, but not addiction.” ~ Dr. Kelly Clark, President, American Society of Addiction Medicine

As effective as these medications are, however, they are not yet in universal use. There are several reasons for this:

• Risk of Dependence – Many specialists in the addiction recovery field are aware that certain MAT drugs such as Suboxone or Methadone carry the risk of creating a new addiction. 
• Stigma – Addiction is now recognized by medical science as a chronic disease of the brain, but there is still a stigma that stubbornly persists. Far too often, people who are struggling with alcohol or drug dependence are unfairly criticized for their perceived weakness selfishness, or lack of willpower.

This stigma and the associated shame and embarrassment becomes a barrier to care. People would rather continue to suffer than admit they need help. 

As a result, just 10% of people with an addictive disorder receive proper treatment. By comparison, the rate or care for other chronic diseases – asthma, diabetes, hypertension, or cancer, for example – is approximately 80%.

• Physician shortage – Currently, there are more than 900,000 doctors in America who can legally prescribe opioid pain medications. Surprisingly, however,  less than 7% of providers have the additional training and special DEA license needed to prescribe some anti-addiction drugs. In over half of all U.S. counties, there are no doctors who can prescribe some of the most popular MAT medications.  

To make matters worse, even after  after receiving that training and license, these doctors are limited by law as to the number of addiction medication patients they can have at any one time. Combined with the shortage, this can often mean lengthy waiting lists.

• Physician bias – Sadly, too many primary physicians choose not to treat SUD patients, claiming that they are non-compliant, difficult, and that they create disruptions in the waiting room.
• Inadequate insurance coverage – All anti-addiction medications are not covered by all insurance plans. Furthermore, there are frequently complicated requirements for pre-authorization. Even upon approval, some carriers put limits on dosages and treatment length.

“We treat both addiction and co-occurring disorders and accept many health insurance plans. Take a look at our outpatient rehab program.”

Evidence-Based Rehab and MAT

“…we can’t just base our service on philosophy, we have to look at the data and base our treatment on the best way to save lives.” ~ Dr. Marvin Seppala

The concept of addiction as a brain disease has only gained acceptance relatively recently. Too many mental health professionals and even some rehab programs still address addiction the same way they always have, with outdated strategies that fail to take new developments into account. Because of this philosophy and the aforementioned difficulties, just 1 in 3 rehab programs provide MAT. Women’s Recovery promotes vivitrol. You can learn about our vivitrol program, as we believe it’s one of the best MAT options currently available.  For decades, the generally-approved rehab strategy demanded complete abstinence. In the past, most providers rejected the idea that substance abusers could recover by using – and possibly becoming dependent – on another substance. On some levels, this is actually a legitimate concern. There are habit-forming MAT drugs with a potential for abuse.  Just as significant, successful recovery is best realized when there is complete freedom from ALL addictive substances. But when addiction is rightfully regarded as a chronic disease, the evidence shows that recovery is supported better when medication is included as a treatment option.

Empirically-based programs accept MAT for three primary reasons:

FIRST, the newest MAT drugs  are non-addictive, and present virtually no potential for misuse, meaning they DO support abstinence. SECOND, even among those recovery medications that can be abused, the dangers can be safely managed. Prescribed over the short-term and closely monitored, they can be an effective part of a more complete recovery program. THIRD, compared to the potential dangers of continued substance abuse – disease, overdose, and death – harm reduction, while imperfect, becomes a positive step in the right direction.

List of Anti-Addiction Medications 2019

DISCLAIMER: Every medication in this list, including off-label uses, dosages, regimens, and side-effects, are presented for information purposes only, and are NOT to be considered medical advice. Any actual treatment plans or proposed medications should be discussed with your healthcare provider.

Most-Common Medications Used

Buprenorphine

Prescribed for Opioids and possibly Cocaine Brand names: Subutex, Probuphine. Butrans, Belbuca, and BuprenexBuprenorphine is a long-lasting opioid that binds to receptors within the brain to block the effects of more dangerous opioids, producing less of a high and less respiratory depression. It also has a “ceiling effect”, meaning the effects of ANY opioid do not increase after a certain point, regardless of how much is taken. Unfortunately, “bupe” medications are extremely tightly-controlled, requiring additional training and a special license from the DEA. Doctors are also limited as to the number of patients they may treat with it. Side Effects: When taken with other depressants such as alcohol, other opioids, or benzodiazepine tranquilizers, the risk of overdose is significantly increased. Dosage: A buprenorphine regimen as soon as opioid withdrawal starts. SPECIAL NOTE: Most substance abuse specialists agree that because of the risk of addiction, this medication should not be taken long-term. Day 1: 8 mg once daily, taken sublingually Day 2 -onward: The dose doubles, to 16 mg  ORT schedule: Dosages may be adjusted in 2 mg or 4 mg increments, up to a maximum of 24 mg until withdrawal symptoms are suppressed. Probuphine is the only FDA-approved buprenorphine implant.

Buprenorphine

Naloxone

Prescribed for: Opioids Brand names: Zubsolv, Suboxone Per the US Institute on Drug Abuse, Suboxone is the first-line treatment option for opioid abusers who:

• Are able to comply with their recommended medication schedule
• Are socially stable
• Cannot go to a methadone clinic every day
• Are employed at a job that prohibits sedating medications

This formulation combines naloxone with buprenorphine as an abuse deterrent. However, it can still be abused if injected or crushed and snorted. Side Effects: Can cause physical dependence. Dosage: Maintenance treatment: 16 mg/4 mg, sublingually once per day.

Methadone

Prescribed for: Opioids Brand names: Methadose, Dolophine Methadone Maintenance Therapy (MMT), a type of ORT, is the most-commonly-prescribed treatment for opioid addiction. There are more than 700 methadone clinics in the United States.  When included as part of a comprehensive recovery plan, 67% of MMT patients are able to abstain completely from illicit opioids, and up to 95% can at least curb their use. Despite this, methadone is powerfully-addictive and carries a high potential for abuse and overdose. 40% of all single-drug prescription fatal overdoses involve methadone. This is TWICE the death rate of any other single opioid. Side Effects: Dependence, withdrawal, and respiratory and central nervous system depression – especially when methadone is used to treat pain. Dosage: The initial dose should be administered when withdrawal symptoms present. Day 1: Initial dose: 20 to 30 mg orally. If after 2-4 hours, withdrawal symptoms have not been reduced or if they reappear, an additional dose of 5 to 10 mg may be given. 40 mg is the MAXIMUM recommended Day 1 dose. Week 1: The dose is adjustable as needed to manage withdrawal symptoms.  CAUTION –Methadone levels in the body will accumulate during the first several days of dosing. MMT has 4 dosing goals:

• Prevention of opioid withdrawal symptoms
• Reduce opioid cravings to tolerable levels
• Block the  effects of illicit opioids
• Ensure patient safety

The effective dose range is between 80 to 120 mg a day, with greater success at higher doses.

• Patients given less than 46 mg of methadone are 5 times more likely to use heroin as those receiving higher doses.
• Patients given more than 80 mg of methadone are only one-fourth as likely to abuse heroin as those taking 60 mg or less.

Naltrexone

Prescribed for: Opioids, alcohol, and cocaine Brand name: Vivitrol, ReVia Naltrexone treats both opioid AND alcohol dependence. Whether given via injection (Vivitrol) or orally (ReVia), it completely blocks the effects of either substance. Patients do not experience the pleasurable effects of alcohol or opioids, and it curbs cravings for both opioids and cocaine. Naltrexone is NOT an opioid, giving it several advantages over medications containing buprenorphine or methadone:

• Zero risk of abuse, dependents, or addiction.
• ReVia can be prescribed as a take-home medication, unlike methadone.
• Any doctor can prescribe naltrexone, unlike buprenorphine. 
• Vivitrol injections are administered by a doctor and only required once a month.

Naltrexone is extremely effective, especially when included in a comprehensive treatment plan. Compared to counseling-only patients receiving a placebo, patients who are given both counseling and naltrexone:

• Have a higher rate of opioid-abstinent weeks
• Experience less cravings
• Are at a reduced risk of relapse
• Stay in treatment longer

Because of its high effectiveness, overall safety, extremely low potential for abuse, and other benefits, Women’s Recovery is proud to offer Vivitrol services to any client who is struggling with opiate or alcohol addiction. However, There are a few concerns that have so far prevented the widespread use of naltrexone:

• Before taking Naltrexone, patients must first complete detox and remain opioid-free for up to 14 days.
• Naltrexone patients cannot use ANY opioid, even legitimately-prescribed painkillers.
• Injectable Vivitrol costs up to $1500 per shot, and this can be prohibitively expensive if not covered by insurance.

Side Effects: Use of ANY opioids during or within 2 weeks prior to taking naltrexone can trigger opioid withdrawal symptoms. Dosage: ReVia (alcohol dependence) k50 mg once daily; (opioid dependence) 25 mg for the initial dose. If withdrawal symptoms do not present, then the daily dose increases to 50 mg. Vivitrol – 380 mg injection every 4 weeks

“We accept many health insurance plans. Get your life back in order, take a look at our outpatient program.”

Other Anti-Addiction Prescription Medications

Acamprosate 

Prescribed for: Alcohol  Brand names: Campral Acamprosate reduces alcohol cravings in people who have already stopped drinking. In some ways, it acts in a similar fashion as both replacement and agonist medications, because it stabilizes the chemical brain signals that are disrupted during alcohol withdrawal. When part of a comprehensive treatment program that includes psychosocial counseling and support, acamprosate is effective at promoting both a reduction in alcohol consumption and an increase in total abstinence. However, it is not an effective treatment for alcoholism when used alone.  In other words, acamprosate helps patients maintain their sobriety, but it is not effective at helping patients become abstinent in the first place.  Acamprosate is the first-line choice for alcoholics already suffering from liver damage or disease, but not recommended for those with kidney problems. Side Effects: Kidney failure, major depression, and suicidal ideation/behavior. Dosage: Two 333 mg, three times daily

Baclofen

Prescribed for: Alcohol (Off-label) Brand names: Gablofen, Kemstro, Lioresal, Lioresal Intrathecal Baclofen is a anti-spastic medication and muscle relaxant that also has sedative and ani-anxiety properties Patients receiving it for at least 3 months are far more likely to refrain from drinking, 71% to 29%. Baclofen has virtually no potential for misuse. Side Effects: Discontinuing baclofen abruptly can trigger symptoms similar to benzodiazepine or alcohol withdrawal. Dosage: Day 1: 5 mg one time per day, increasing by Day 7 to 10 mg three times daily.

Benzodiazepines

Prescribed for: Alcohol, benzodiazepines Brand names: Valium (diazepam), Librium (chlordiazepoxide), Xanax (alprazolam) and Klonopin (clonazepam), are the most-commonly prescribed “benzos” during addiction recovery Benzodiazepines are minor tranquilizers that are usually given for insomnia, anxiety or seizures. However, they are severely habit-forming, making them safe only when taken short-term. Side Effects: Among those who are tranquilizer-dependent, abrupt discontinuation is extremely dangerous – even fatal. Benzos should always be gradually tapered, under close medical supervision.. Dosage: A typical Valium regimen for alcohol withdrawal starts on Day 1 with 10 mg four times daily, gradually decreasing to 5 mg taken once in the morning by Day 7.

Bupropion

Prescribed for: Smoking, possibly cocaine Brand names: Zyban, Wellbutrin Bupropion reduces the severity of nicotine cravings and withdrawal symptoms. When used off-label, it also greatly reduces cocaine cravings and the severe depression experienced during cocaine detox. Significantly, Bupropion has no potential for abuse, and it causes less sexual dysfunction, sleepiness, and weight gain than other antidepressants.  However, it is not recommended for patients with eating disorders, epilepsy,  who are using alcohol or tranquilizers, or who are experiencing withdrawal from either. Side Effects: Bupropion increases the risk of epileptic seizures. Dosage: Initial dose: 150 mg once per day for the first 3 days, increasing to 150 mg taken twice daily. The duration of therapy is 7-12 weeks.

Buspirone

Prescribed for: Opioids Brand names: Buspar Buspirone, an anti-anxiety medication that also boosts the effectiveness of antidepressants, is at least as effective as methadone maintenance therapy at easing opioid withdrawal symptoms. Because buspirone does not produce euphoria, is not sedating, does not impair motor function, and doesn’t trigger withdrawal symptoms, it is considered to be much safer than benzodiazepines or barbiturates. It has no potential for abuse. Side Effects: Buspirone is not recommended for patients with diabetes, kidney or liver problems, or by anyone taking an MAO inhibitor. Dosage: Among heroin addicts given buspirone, the effective dosage was 45 mg, taken daily.

Calcium Carbimide

Prescribed for: Alcohol Brand names: Temposil Calcium carbimide is an aversion medication that interferes with the way alcohol is metabolized by the liver. If the person drinks at all, even one drink, they will experience an immediate and severely unpleasant reaction. And while this promotes an abstinence-only approach, it does not reduce cravings for alcohol.

• Throbbing, painful headache
• Profuse sweating
• Nausea and uncontrollable vomiting
• Rapid heartbeat
• Breathing difficulty
• Extreme nausea
• Copious vomiting
• Rash

When included within a comprehensive program that includes counseling and other strategies, calcium carbimide success rates are greater than 50%. There is one major potential drawback — the adverse reaction can be triggered by ANY type of alcohol, even the kind that is found in household or personal hygiene products – colognes and perfumes, hand sanitizer, deodorants, body lotions, air fresheners, cleaners, etc.  And, since calcium carbimide requires lifestyle changes, compliance with the recommended regimen is generally poor. Side Effects: Increases white blood cell count. Dosage: Between 50 mg and 100 mg every 12 hours.  Calcium carbimide should NEVER be given to someone who is intoxicated.

Carbamazepine

Prescribed for: Alcohol Brand names: Tegretol Carbamazepine is typically prescribed for neuropathic pain or epilepsy. As a recovery medication, it is particularly effective for patients who have unsuccessfully attempted to detox from alcohol in the past. Unlike benzodiazepines, carbamazepine has no potential for abuse. Due to potential harm to the unborn fetus, carbamazepine is not recommended for pregnant women. Side Effects: Carbamazepine interferes with the production of red and white blood cells and platelets. Use also increase the risk of suicidal ideation and behavior. Dosage: The effective dose for a 5-day taper is between 600 and 800 mg, gradually decreasing to 200 mg.

Dextroamphetamine

Prescribed for: Methamphetamine Brand names: Dexedrine Dextroamphetamine is a stimulant that is generally used as a treatment for narcolepsy or to treat Attention Deficit Hyperactivity Disorder (ADHD). But a 8-week study found that it also reduces the withdrawal symptoms and cravings associated with methamphetamine abuse. Of special relevance, “d-AMP” reduces intravenous methamphetamine use just as well as methadone reduces heroin use. Because it is a powerful stimulant, dextroamphetamine has a high potential for misuse. Side Effects: Even at the recommended dose, d-amp can cause rapid heartbeat and increased blood pressure. Dosage: The study determined that the appropriate dosage is 60 mg of dextroamphetamine daily.

Disulfiram

Prescribed for: Alcohol, possibly cocaine Brand names: Antabuse Disulfiram is the oldest anti-alcohol medication in America, first used in 1951. As an aversion medication, it produces an immediate and severe reaction within 5 minutes of any alcohol being consumed:

• Painful headache
• Flushed, reddened skin
• Shortness of breath
• Accelerated heartbeat
• Severe nausea
• Copious vomiting

Like other aversion medications, Disulfiram does not reduce alcohol cravings. Because it requires extreme lifestyle changes – to the point of completely avoiding all products containing alcohol –  overall compliance is poor. Dosage: 250 mg, once daily Side Effects: Headache, decreased libido, metallic taste in the mouth

Gabapentin

Prescribed for: General substance abuse, but primarily alcohol Brand names: Neurontin, Fanatrex, Realise, Gabarone Gabapentin is a non-opioid pain medication prescribed for a wide variety of medical conditions, including post-surgical pain and neuropathy. However, as a recovery drug, it is also effective at treating

• Non-seizure alcohol withdrawal symptoms
• Secondary supportive treatment for SUD
• Anxiety disorders

When given in sufficiently-high doses, gabapentin increases the number of days that patients can remain completely free from alcohol. It also reduces the amount of alcohol consumed on drinking days. Because it is not an opioid, gabapentin has a lower abuse potential than other painkillers. But this does not mean there is NO potential for misuse. 2 out of every 3 patients prescribed gabapentin “self-medicate” or abuse it recreationally. Side Effects: The FDA warns that gabapentin use make increase suicidal thoughts and behaviors. Dosage: Drug trials indicate the most effective dose is 1800 my daily.

Methylphenidate

Prescribed for: Methamphetamine and cocaine Brand names: Ritalin, Concerta, Biphentin, Aptensio, Medikinet, Daytrana, Equasym, Metadate, Methylin, Quillivant, QuilliChew Methylphenidate is a stimulant typically prescribed for narcolepsy or ADHD. Of special relevance, America consumes 80% of the global supply. Researchers with Stony Brook University found that just one dose of this medication corrects brain pathways impaired by chronic cocaine abuse.  Methylphenidate is a stimulant , so it affects the same areas of the brain as cocaine and methamphetamine. However, because it is absorbed by the brain more slowly than either, it satisfies cravings without producing the same intense euphoric high. In this way, methylphenidate is similar to ORT medications. Side Effects: Restlessness,   suppression of , and weight loss Dosage: Participants in the Stony Brook University study received 20 mg of methylphenidate.

Mirtazapine

Prescribed for: Methamphetamine Brand names: Remeron Mirtazapine is usually prescribed as an antidepressant, but it also helps with other mental illnesses such as anxiety, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. As a recovery medication, a 2011 study found that mirtazapine significantly reduces methamphetamine use. As a corollary benefit, it also reduces risky sexual behavior. Encouragingly, these benefits are realized even when compliance with a medication regimen is low. This dovetails nicely with a 2010 study, where cue-related methamphetamine-seeking among test animals went down 50% when they were given mirtazapine. Side Effects: In some individuals, mirtazapine may increase suicidal ideation and behavior. Dosage: Participants in the 2011 study received 30 mg of mirtazapine.

Modafinil

Prescribed for: Cocaine Brand names: Provigil Because modafinil promotes wakefulness,  it is typically prescribed for hypersomnia or narcolepsy. As a recovery medication, a 2009 study determined that modafinil reduces cocaine cravings and increases the number of abstinent days among active users. While the potential for abuse is very low, abrupt  discontinuation of modafinil may trigger withdrawal symptoms. Side Effects: Headaches – 33% of patients and nausea – 11% Dosage: Effective doses for study participants were 200 mg and 400 mg, given daily.

Nalmefene

Prescribed for: Opioids and Alcohol Brand names: Selincro Nalmefene reverses overdoses from methadone and other long-lasting opioids. It also reduces alcohol consumption, resulting in:

• Fewer days where alcohol is consumed at all
• Fewer days of heavy drinking
• Decreased daily alcohol consumption

Nalmefene is generally given to problem drinkers who don’t want to totally abstain from alcohol. Significantly, nalmefene can be taken “as needed”, on days when the patient feels they are  more likely to drink. Keep in mind, however, that merely cutting back is not a viable long-term solution for someone with a medically-diagnosed Alcohol Use Disorder. This is why the label reads “should only be prescribed in conjunction with continuous psychological support”. Side Effects: Patients needing alcohol detox or who have recently experienced alcohol withdrawal should not take nalmefene. Dosage: One daily 18 mg dose,taken “as needed”

Naloxone

Prescribed for: Opioids Brand names: Evzio, Narcarn Naloxone is an emergency medication that can reverse an opioid overdose. Often available without a prescription, naloxone is easily-administered, and it works immediately. Naloxone is not a “recovery medication” in the strictest sense of the word, but surviving an overdose may convince  the victim to finally seek treatment. Side Naloxone immediately induces severe opioid withdrawal in someone with any amount of opioids in their system. Dosage: The intravenous dosage is .4 to 2 mg every 2-3 until the victim is revived with a reassessment after 10 mg.

Phenobarbital

Prescribed for: Alcohol and benzodiazepines Brand names: Nembutal, among others Typically prescribed for anxiety, epilepsy, or insomnia, phenobarbital is also effective at controlling the tremors and convulsions that appear during benzodiazepine or alcohol withdrawal. It also helps detox patients manage their anxiety. Side Effects: Like other barbiturates, phenobarbital is a highly-addictive depressant that affects the central nervous system.  In fact, the effects are so powerful that phenobarbital is frequently used during physician-assisted suicide and lethal injection executions. Dosage: Initial dose: Administered intravenously, 10 mg per kilogram of patient body weight. An additional dose of 130 mg or 260 mg may be given every 30 minutes as needed, determined by the presents and severity of  withdrawal symptoms. There is no established maximum dose of phenobarbital – how much a patient takes is determined but how well it is working.

Propranolol

Possible treatment for: Alcohol and cocaine  Brand names: InnoPran, Inderal Prescribed to treat high blood pressure, propranolol also shows promise with PTSD and performance anxiety. University of Cambridge researchers think that propranolol can alter the emotional memory of cue-related triggers associated with compulsive drug-seeking and drinking. At this point, propranolol use to treat SUD is still in the research stage. Side Effects: An overdose of propranolol overdose can trigger seizures and even cardiac arrest. This medication is not recommended for patients diagnosed with depression or who are struggling with suicidal thoughts. Dosage: To date, the only anti-addiction studies involving propranolol have involved laboratory rats.

Rivastigmine

Prescribed for: Methamphetamine Brand names: Exelon Rivastigmine is primarily used to treat dementia caused by Parkinson’s or Alzheimer’s. A 2012 study found that rivastigmine diminishes the subjective positive experience of using meth, even though that loss of enjoyment doesn’t translate to a reduction in the number of times the subject chooses to use meth. Side Effects: Nausea/vomiting, appetite suppression, and weight loss. Rivastigmine  has been linked with a higher death rate than other similar drugs. Dosage: Participants in the 8-day study received up to 6 mg of rivastigmine daily. Researchers concluded that with higher dosages and longer treatment, outcomes could be improved.

Tiagabine

Prescribed for: Cocaine Brand names: Gabitril Tiagabine, an anticonvulsant, is usually given to treat epilepsy. According to a 2002 study, high doses of tiagabine reduces cocaine use. Side Effects: Among individuals who do not have epilepsy, tiagabine may trigger seizures, especially when taken concurrently with other medications that lower the seizure threshold – alcohol or amphetamines, for example. This risk is further magnified at dosages over 8 mg per day. Dosage: Participants in the 2012 study received 24 mg of medication per day.

Topiramate

Prescribed for: Alcohol and cocaine Brand names: Topamax Topiramate, an anticonvulsant, is typically used as a treatment for epilepsy or migraine headaches. Per a 2013 study, when compared to a placeno, topiramate use nearly triples the proportion of cocaine-abstinent days. Promisingly,  multiple studies have confirmed that topiramate is an effective treatment for alcohol abuse. Patients report:

• Taking nearly 3 fewer daily drinks
• Reducing the number of heavy drinking days by 28%
• Increasing the number of alcohol-free days by 26%

Side Effects: Topiramate may disrupt internal heat regulation. Drinking while taking this medication  can trigger seizures. Dosage: In the majority of trials, the effective dose was set at 300 mg per day.

Varenicline

Prescribed for: Smoking and alcohol Brand names: Champix, Chantix Varenicline is the most-effective anti-smoking prescription medication. Compared to those given a placebo, patients are three times more likely to stop smoking. But a 2013 study found that participants given varenicline reduced their number of heavy drinking days by 22%. Side Effects: 30% of varenicline patients report experiencing nausea. Dosage: Days 1-3: .5 mg, once daily Days 4-7: .5 mg, twice daily Day 8-onward: 1 mg,  twice daily

Vigabatrin

Prescribed for: Cocaine, methamphetamine, alcohol, and heroin  Brand Name: Sabril Typically prescribed for epilepsy, the anticonvulsant vigabatrin reduces the pleasurable drug-induced release of dopamine.  In one study, 40% of people treated with vigabatrin and counseling remained cocaine-abstinent. Side Effects: 40% of long-term users of vigabatrin suffer eye damage. Approximately 1 person in 500 will experience suicidal thoughts when using this medication.

Other Medications That Support Recovery

There are several other prescription medications that can ease the transition from active addiction to sobriety.

• Clonidine (Kapvay, Catapres)– Eases opioid withdrawal by lowering heart rate and blood pressure. 

85% of patients receiving both clonidine and naltrexone successfully complete drug rehab.

• Chlorpromazine (Thorazine, Largactil) – Reduces restlessness and anxiety, and may also alleviate nausea and vomiting.
• Folic Acid (Vitamin B9) – Folic acid replenishment during recovery from alcoholism alleviates symptoms of depression.
• Haloperidol (Haldol) – Treats alcohol withdrawal-induced hallucinations and psychosis.
• Imipramine (Tofranil) – Boosts levels of serotonin and norepinephrine, thereby  helping with depression.
• Methocarbamol (Robaxin) – As a muscle relaxant, this medication helps alleviate withdrawal-related spasms.
• Pregabalin (Lyrica) – Treats both the anxiety and the seizures that manifest during alcohol withdrawal.
• Pyridoxine (Vitamin B6) – Vitamin replacement restores the normal neurotransmitter formation.
• Thiamine (Vitamin B1) – This is the first line treatment  for Wernicke–Korsakoff syndrome (WKS), a life-threatening condition caused by alcohol-related brain damage.

What’s the Bottom Line about Anti-addiction Medications?

No matter how effective they are, medication-assisted treatments do not “cure” addiction. Unfortunately, there is no such thing as a “magic pill” that instantly and permanently restores normal brain chemistry and function, eliminates drug and alcohol cravings, erases genetic vulnerability, and, most of all, somehow fixes all of the social, personal, environmental, mental health, and economic factors that played a role in the development and progression of the addiction. Completely on their own, these medications are not particularly effective at aiding real recovery.  But when part of a  more comprehensive treatment program, MAT is an invaluable and extremely effective evidence-based strategy that can help someone struggling with active  addiction safely and successfully regain and maintain their sobriety.

To learn more about the MAT options that are right for you, contact Women’s Recovery TODAY.