Pharmacotherapy is the use of prescribed medication to assist in the treatment of addiction.
Pharmacotherapies can be used to reduce the intensity of withdrawal symptoms, to manage cravings and to reduce the likelihood of a lapse or relapse by blocking a drug or addictive behaviour’s effect.
Currently there is evidence to support the prescription of a limited range of medications in some types of addiction. Encouragingly, researchers are continuing their search to find other possible treatments, and in the future there may be more medications that can be offered to people.
Medications presently recommended for the treatment of addiction should sometimes only be used after or alongside other treatments, or under the supervision of an addiction medical specialist. Medication is also usually not the only answer, and it is important to understand that pharmacotherapies may not work for everyone. For these reasons, if you are curious about any medications for addiction you should speak to your general practitioner first to get personalised medical advice about what treatment and support could be best for you.
Pharmacotherapies for Alcohol Addiction
In some instances, medication may be considered to manage alcohol addiction.
Acamprosate (Campral) and Naltrexone (ReVia, Contrave)
Acamprosate (Campral) and Naltrexone (ReVia, Contrave) are the two most common medications prescribed to manage alcohol craving, and can reduce the likelihood of a lapse or relapse. Whether or not you are suitable for these medications will depend on factors such as your kidney health, liver health, and possible interactions with other medications your are taking.
Disulfiram (Antabuse) is another medication that is occasionally prescribed, and works by making people feel sick if they consume alcohol. It is important to know that the reaction people experience when drinking alcohol on top of disulfiram can be very dangerous, so this treatment is only ever advised when there is supportive care available and complete abstinence is the intention of the person receiving treatment. Disulfiram also costs more than other approved medications for alcohol addiction (acamprosate and naltrexone).
Medication is usually not the only answer however and it is important to understand that pharmacotherapies for alcohol addiction may not work for everyone. In addition, medications approved for the treatment of alcohol addiction should sometimes only be used after or alongside other treatments, or under the supervision of an addiction medical specialist. For these reasons, if you are curious about any of the pharmacotherapies we have described speak to your general practitioner first to get personalised medical advice about what treatment and support could be best for you.
Pharmacotherapies for Opioid Addiction
Buprenorphine and methadone are opioid medications used to treat opioid use disorder (also known as opioid addiction or opioid dependency). People can develop opioid use disorder through heroin use or misuse of opioid-based prescription medications (e.g. codeine and oxycodone).
People living with opioid use disorder often experience difficulty stopping or reducing their opioid use because of uncomfortable withdrawal or craving. However the risks of continued heroin or other opioid misuse include death, overdose, infections and other poor health outcomes. Buprenorphine and methadone reduce these risks, by providing regular dosing of safer opioid medication. This reduces craving for other opioids and prevents withdrawal symptoms from happening, to help people control their use and stabilise their life.
Long-Acting Injectable buprenorphine
Injectable buprenorphine has been used to treat opioid use disorder in Australia since 2018. The medication is free and subsidised through the Pharmaceutical Benefits Scheme. There are two brands (Buvidal® and Sublocade®), available in weekly or monthly formulations. They are injected subcutaneously (into the fatty tissue under the skin), and can only be prescribed by addiction specialists and general practitioners who have undertaken additional training. Each injection contains a liquid which forms into a gel-like ‘depot’ beneath the skin, that gradually releases buprenorphine until it is completely absorbed. These are slow release medications, so each injection will last for the entire week or month depending on the formulation. Clinical trials have found them to be as effective as the oral formulations of buprenorphine and methadone, which typically require daily dosing.
Injectable buprenorphine is a great option for people who would like to manage their heroin or other opioid use but find it hard to stay on methadone or oral forms of buprenorphine. It is however important to remember that different things work for different people - so if you are interested in trying injectable buprenorphine please speak to your doctor for individualised advice. Also remember that medication is just one option in a whole range of treatments available for opioid use disorder to help people recover from addiction.
Pharmacotherapy for Gambling Addiction
In some instances, medication may be considered to manage gambling. Naltrexone is one medication that has shown encouraging results for people experiencing problem gambling in clinical trials. Your doctor may consider this but usually with input from an addiction medicine specialist, as naltrexone is not registered as a medication for gambling in Australia and has to be prescribed ‘off-label’.
Medication is usually not the only answer however and it is important to understand that naltrexone may not work for everyone. Even when medication works it is good to remember that addiction is a complex disease, and recovery works best when any medication used is combined with support and other treatments.