Common Medications Used in Medication-Assisted Treatment
The first phase of any substance use disorder treatment is detox. This is when an individual stops taking a substance to rid the body of any remaining toxins. It is not unusual to delay seeking treatment or entering detox due to the typical withdrawal symptoms that are associated with drug and alcohol dependence. However, with growing evidence and an abundance of research, medication-assisted treatment (MAT) can be used to ease these withdrawal symptoms, ensuring that your detox is manageable, comfortable, and under control.
When you first enter a detox program, all individuals will be seen and assessed. Following the evaluation given by a medical professional, a detox plan and protocol of medication-assisted treatment will be established to help treat any symptoms you may experience. Additionally, patients will be evaluated by mental health experts, such as psychiatrists, to ensure they are assessed for any mental health issues that may be apparent so these can also be appropriately managed throughout the withdrawal process.
Although medication-assisted treatment (MAT) can be introduced in the detox stage, medication can be used for different reasons, at different stages, and for different durations throughout the whole recovery process. According to The National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, and many other agencies, medication-assisted treatment, which is medication combined with counseling and behavioral therapies, provides a whole-patient approach to the treatment of substance use disorders.
Medication for Alcohol Withdrawal Symptoms
Detoxing from alcohol is the first step in the process of treatment for an alcohol use disorder. When an individual has engaged in excessive or chronic alcohol abuse they will likely have developed a physical dependence on the substance. This means that when they decide to stop drinking they will experience alcohol withdrawal symptoms.
Alcohol withdrawal syndrome (AWS) encompasses the series of symptoms that occur in individuals who are alcohol dependent after a reduction in alcohol consumption. Acute alcohol withdrawal symptoms can range from mild to severe and can arise as soon as eight hours after someone’s last drink.
Depending on the history of alcohol abuse and the intensity of physical dependence, additional symptoms can continue further 24 hours after someone has decided to stop drinking, additionally, more severe effects can emerge two to four days after abstinence. Alcohol withdrawal symptoms include:
- Anxiety
- Mood swings
- Depression
- Fatigue
- Vomiting
- Nausea
- Sweating
- High blood pressure
- Increased heart rate
- Insomnia
- Irritability
- Hand Tremor
- Seizures
In some cases of individuals with an intense alcohol use disorder, a person may develop severe alcohol withdrawal symptoms, also known as delirium tremens (DTs), a neurological syndrome that is only present in around 5% of patients who experience alcohol withdrawal symptoms. They are extremely rare and are only seen in those who have a long history of alcohol abuse. Symptoms of delirium tremens may include:
- Agitation
- Hallucinations
- Extreme confusion or disorientation
- Seizures
When entering a detox, professionals may administer a medication-assisted treatment (MAT) to help you control and ease any alcohol withdrawal symptoms. Additionally, further medications may be prescribed to help manage and control cravings to aid you so you are able to work on your recovery actively.
Benzodiazepines
Benzodiazepines are considered sedative medications that are commonly used for their calming effects. These types of tranquilizers are often prescribed to treat panic disorders, anxiety, panic attacks, insomnia, and seizures. The form of the drug is often the first choice for doctors when prescribing medications to help manage more serious alcohol withdrawal symptoms. Benzodiazepines have been found to significantly reduce the risk of seizures in individuals suffering from more severe alcohol withdrawal.
Benzodiazepines that are longer-acting and with active metabolites are often the first-line choice of medication as they reduce the risk of recurrent seizures or withdrawal. Alternatively, benzodiazepines that are shorter-acting are more effective in elder patients going through withdrawal or for individuals with chronic liver issues that are directly related.
Benzodiazepines that have been FDA approved to effectively manage alcohol withdrawal syndrome include:
- Clorazepate
- Chlordiazepoxide
- Diazepam
- Oxazepam
Benzodiazepines can be used in several types of drug detox. However, the drug itself has a high risk of dependence and care needs to be taken when used during detox.
Acamprosate
Acamprosate is one of three FDA-approved medications to treat alcohol use disorders. It is commonly prescribed after detox has been completed and is used for the maintenance of abstinence. It helps reduce cravings by reacting with the neurotransmitter system within the brain to help restore balance. Campral is the brand name of the drug that is used the most.
Anticonvulsants
As well as benzodiazepines, medical professionals may also prescribe alternative seizure medications to help manage symptoms during severe alcohol withdrawal. Depending on the patient in question and their experience of substance abuse, seizure medications may be prescribed as a replacement for benzodiazepines. Although these forms of anticonvulsants have a decreased risk for abuse compared to benzos, they don’t prevent delirium tremens. Some examples of anticonvulsant medications include:
- Gabapentin
- Carbamazepine
- Valproic Acid
- Oxcarbazepine
Anti-nausea Medications
During detox, it is not uncommon for patients to experience nausea, a key symptom of withdrawal. To help treat these specific withdrawal symptoms, doctors may prescribe anti-nausea medications. Some examples of anti-nausea medications that are prescribed include:
- Promethazine
- Metoclopramide
- Zofran
Disulfiram
Disulfiram is often prescribed during detox and throughout the recovery process for those in treatment for an alcohol use disorder. The drug interferes with the enzyme that helps break alcohol down in the body. The drug is designed to produce negative and physical effects if someone consumes even a small amount of alcohol. If the drug is used as prescribed and an individual drinks alcohol, the negative effects can be felt as soon as ten minutes after their last drink, the negative effects include:
- Nausea
- Vomiting
- Anxiety
- Headache
- Sweating
Ultimately, the effects should discourage individuals from drinking and an association between drinking and these negative symptoms will be developed. Disulfiram is used to discourage drinking patterns and behaviors.
Medication for Opioid Use Disorder Treatment
Opioids are a class of drugs that interact with opioid receptors that are found on nerve cells in the brain and body and work by reducing feelings of pain. They include prescription painkillers, synthetic opioids, and heroin. Opioids reduce an individual’s perception of pain as well as cause drowsiness, euphoria, nausea, or confusion. Oxycodone and hydrocodone are examples of prescription painkillers while fentanyl and methadone are examples of synthetic opioids.
Opioid use disorders are similar to other substance use disorders, however, opioids can cause physical opioid dependence in as little as four to eight weeks, increasing the chances of individuals developing an opioid addiction. This means that when individuals abruptly stop using opioids, symptoms can be experienced, including:
- Chills
- Generalized pain
- Cramps
- Insomnia
- Vomiting
- Intense cravings
Because of the severity of the symptoms a motivation is created to continue using opioids in a bid to prevent withdrawal symptoms.
Medication-assisted treatment is a proven effective means to treat opioid use disorders; involving the use of medication alongside behavioral and counseling therapies. Medications can be prescribed to help relieve withdrawal symptoms, relieve cravings, and block the euphoric effects induced by opioids. There are three FDA-approved medications that are used to treat opioid addiction.
Methadone
Methadone works by activating opioid receptors found in the brain, although a full opioid agonist, it is a long-acting drug and therefore produces effects that differ from other full agonists, such as morphine or heroin. Methadone has long-lasting action that is gradually onset when therapeutic doses are taken. This means that patients taking the drug do not experience a ‘high’ but there is an easing of withdrawal symptoms and a reduction in cravings.
Methadone treatment suppresses the compulsive want and use of opioids and allows brain circuits that have been affected to restore their balance. Methadone maintenance therapy allows individuals to also participate in alternative therapies to work on other areas of their lives that have been affected by their opioid use disorder, such as improving social productivity. Methadone is a safe form of treatment for women who have opioid dependence and are pregnant or breastfeeding, preventing complications of withdrawal and opioid addiction while reducing the health risks for both the mother and child.
Methadone is a long-acting opioid which means that it may take several days for the medication to reach its full effects, therefore repeated doses increase the chances of an accumulation of the drug within the body. Although research has found that higher doses of the drug have better results than moderate doses, patients typically begin on a low dose which slowly increases over time. Methadone maintenance treatment is undergone for at least 12 months and can be extended. Once treatment is beginning to end, patients slowly taper off of the medication under medical supervision.
FDA-approved methadone products include:
- Dolophine
- Methadose
- Diskettes
Because of the drug’s addictive qualities and the risk of abuse, Methadone is a highly regulated medication and is distributed through opioid treatment programs. Patients will show up at a clinic where they will take their methadone dose under the supervision of a medical professional.
Buprenorphine
Buprenorphine is a partial opioid agonist which means that, although it binds to opioid receptors, it activates them at a weaker scale compared to full opioid agonist drugs, such as methadone or illicit opioids. This means that the medication can reduce withdrawal symptoms and cravings without the experience of intense ‘highs’ and ‘lows’.
The drug induces a ‘ceiling effect’, which means that after a certain dosage the effectiveness will not increase but remain constant. Compared to methadone, buprenorphine treatment induces fewer risks of abuse, has a lower chance of dependence and fewer withdrawal symptoms are experienced once the drug has stopped being used. FDA-approved buprenorphine products include:
- Cassipa sublingual film
- Bunavail buccal film
- Probuphine implant for subdermal administration
- Subutex sublingual tablet
- Suboxone sublingual tablet
- Zubsolv sublingual tablets
Naltrexone
Naltrexone is an opioid antagonist, which means that it works by blocking the activation of opioid receptors. This decreases cravings and prevents opioid drugs from producing any sort of ‘high’. Naltrexone is not used to suppress or help control opioid withdrawal symptoms. It is provided as a long-acting injectable, therefore the effects can last for weeks. FDA-approved naltrexone products include:
- Vivitrol intramuscular
Other Medications Used in Substance Abuse Treatment
Some medications are used to address relapse prevention and withdrawal symptoms for certain drug use, while other medications are designed to address certain symptoms that are apparent due to withdrawal and are prevalent throughout the recovery journey. Ultimately, medication-assisted treatment differs for all cases and individuals.
Other common medications that may be prescribed throughout your treatment process are:
Antidepressants
While we often associate withdrawal symptoms to be physical, different substances can also induce psychiatric and mental health issues throughout the withdrawal process.
Antidepressants help relieve symptoms of anxiety, depression, and several other mental health disorders. The drugs work by attempting to correct chemical imbalances of neurotransmitters in the brain that are thought to be responsible for changes in behavior and mood.
Antipsychotics
For individuals in detox who have been diagnosed with co-occurring disorders or psychiatric issues, a medical professional can prescribe antipsychotic medication. This form of medication can be used to treat bipolar disorders schizophrenia, dementia, and many other psychiatric issues. Although this medication does not cure psychosis, it helps control and reduces many of the accompanying symptoms. In some cases, antipsychotics have been prescribed to help treat certain symptoms of withdrawal, such as intense anxiety and major agitation.
Modafinil
Modafinil is commonly used to treat sleepiness that is often caused by sleep disorders such as narcolepsy. Modafinil promotes wakefulness by changing the number of natural substances in the brain that are associated with controlling sleep and wakefulness. They are prescribed to prevent tiredness throughout the recovery process.
Addiction Treatment at Ebb Tide
At Ebb Tide, we are committed to breaking any stigma that surrounds individuals and their families suffering from a substance abuse disorder through education and bringing o light awareness to our local communities.
We want to empower all individuals who pass through our rehabilitation programs with the right support, hope, and tools required to achieve long-term sobriety. Whether you are seeking treatment for an alcohol use disorder to an opioid use disorder, we provide the best possible treatment options and experiences for you and your loved ones.
We offer a range of rehabilitation programs ranging from an intensive outpatient program to partial housing treatment. Each program is run by a range of exceptional experts who will work with you, ensuring that when you leave you are empowered with t a variety of reliable recovery tools.
We know that recovery doesn’t stop when your treatment program does so we work thoroughly with each of our clients to ensure an aftercare plan is in place, enabling everyone to get the right support and help that is necessary for the early stages of recovery.
If you believe you or a loved one is living with a substance use disorder, contact us today to discuss how we can help you get back to living a happy, healthy, and sober lifestyle.