Addiction Treatment Medications

Treatment medications can help those who have struggled with addiction get and stay in recovery. The Food and Drug Administration (FDA) has only approved treatment medications for alcohol use disorder and opioid use disorder.

This article will provide a brief look at these medications, how they are used, and how they can benefit those in recovery from alcohol or opioid addiction.

Treatment Medications for Alcohol Addiction

There are several medications approved by the FDA for the treatment of alcohol use disorder.

Acamprosate

Acamprosate is a medication that is often used after a person has initiated detox to assist patients in maintaining abstinence from alcohol. Patients generally begin taking acamprosate around five days after their last use of alcohol.¹

Since some individuals may not be fully completed with detox within a five-day timespan, they may begin acamprosate while still in detox based on their provider’s recommendation.

Acamprosate appears to be more effective after a person has completed detox and is abstinent from alcohol before beginning treatment.¹

Disulfiram

Disulfiram is one of three medications approved by the FDA to treat alcohol use disorder. It is also available under the brand name Antabuse.²

Disulfiram is not an anti-craving medication. It works by producing a series of adverse effects that occur if a person consumes alcohol while taking the medication. This so-called “disulfiram-alcohol reaction” can include nausea, sweating, vertigo, palpitations, rapid heart rate, and low blood pressure. ²

Research indicates that the severe discomfort caused by these symptoms can be effective in discouraging alcohol use in people with alcohol dependence.²

Naltrexone

Naltrexone is a medication approved to treat alcohol use disorder and opioid use disorder (see below).³

It is available in pill form, which can be taken daily as part of a comprehensive treatment plan for alcohol use disorder. Naltrexone can help curb alcohol cravings and must be started after a person finishes detox. Otherwise, it can cause symptoms such as nausea and vomiting. ³

Naltrexone is also available in an injectable form, which is administered by a medical provider once a month, as determined appropriate for the ongoing treatment of alcohol and opioid use disorders. ³

Treatment Medications for Opioid Addiction

As with alcohol use disorder, there are multiple FDA-approved medications for the treatment of opioid addiction.

Methadone

Methadone is an opioid agonist that may be used indefinitely for the treatment of opioid use disorder. It may also be used during detox to manage withdrawal symptoms.⁴

Methadone helps to relieve both withdrawal symptoms and cravings and, when used appropriately, does not elicit the kind of euphoria as short-acting opioids, such as heroin.⁴

Buprenorphine

Buprenorphine is a partial opioid agonist, meaning that it does not bind as tightly to the opioid mu receptor compared to full opioid agonists such as methadone. This is important because it still helps alleviate pain and causes euphoria. But because of it’s “ceiling effect”, it has less potential for overdose and therefore can be used to treat opioid use disorder.  The “ceiling effect,” meaning that at a certain threshold, it stops producing the desired opioid effects and no longer impacts cardiovascular function or breathing. This helps reduce the risk of misuse and makes it safer in case of overdose.^4,5,6

It can be taken in several forms: tablet, sublingual (under the tongue) film, or injectable formulation.⁵

Buprenorphine can be used to help with opioid withdrawal as well as long-term treatment after detoxification is completed. One of the risks of giving buprenorphine to help ease opioid withdrawal is the potential for it to lead to precipitated withdrawal if administered while full opioid agonist (such as heroin or methadone) is still bound to the mu receptor. Precipitated withdrawal is uncomfortable so physicians may choose to wait to administer buprenorphine after the individual has experienced some withdrawal symptoms, which signals that the opioid is no longer bound to the mu receptor and is being cleared through the body.

Note: Subutex is the old brand name for buprenorphine, and although this brand no longer exists, some treatment professionals and clients still mention this brand. (Subutex is not to be confused with Suboxone which is an entirely different medication.) ⁴

Suboxone

Suboxone is the brand name for the combination of buprenorphine and naloxone. As mentioned previously, buprenorphine is a partial agonist and as a result, has some opioid properties, but naloxone is an opioid antagonist, meaning it causes opioid withdrawal and is given as a lifesaving opioid overdose remedy.

The naloxone in Suboxone helps to discourage misuse of the drug. ⁷ If an opioid-dependent person attempts to misuse Suboxone by injecting it, they may go into immediate opioid withdrawal.⁷

Since Suboxone does contain naloxone, the individual had a higher potential for precipitated withdrawal if full agonist opioid are in the person’s system, compared to buprenorphine. As a result, it is highly recommended to administer Suboxone once the individual is showing moderate signs of opioid withdrawal to endure that full agonist opioid are not longer in the body. Suboxone may not be taken safely until a person no longer has any opioids in their system.⁷ 

Naltrexone

Naltrexone is the only treatment medication approved for both alcohol and opioid use disorder.

In the case of opioids, naltrexone works by blocking the euphoric and sedative effects of drugs like heroin and prescription painkillers. It can also help curb cravings and has no potential addiction or abuse.³

How Effective Are Addiction Treatment Medications?

Treatment medications are effective as a pharmacological intervention for alcohol and opioid addiction and may also help with withdrawal, ongoing maintenance, and cravings. For example, acamprosate can significantly reduce the likelihood of drinking and is associated with an increased duration of abstinence from alcohol.⁸

Medications such as methadone, buprenorphine, and naltrexone are effective in reducing symptoms related to opioid addiction and are associated with an increased likelihood of staying in substance use disorder treatment.⁹ Treatment medications can be most effective when prescribed and administered by a medical professional.

These medications work best as one component in a comprehensive treatment plan that also includes various types of evidence-based behavioral therapies.