Office based substance use disorder treatment

Office based substance use disorder treatment

Medication for Opioid Use Disorders

Medication-assisted treatment with buprenorphine, or extended-release injectable naltrexone (Vivitrol) plays a critical role in the treatment of opioid use disorders. Opioid agonist therapies with buprenorphine reduce the effects of opioid withdrawal and reduce cravings.

They have been shown to increase retention in treatment and reduce risk behaviors that lead to transmission of HIV and viral hepatitis such as using opioids by injection. Medication-assisted treatment with extended-release injectable naltrexone reduces the risk of relapse to opioid use and helps control cravings.

Extended-release injectable naltrexone is particularly useful for people exiting a controlled setting where abstinence has been enforced such as jail or residential rehabilitation or in situations where maintenance with an opioid agonist is not available or appropriate. People who misuse prescription opioids benefit from medication assisted treatment as much as people abusing heroin.

Medications for Alcohol Use Disorders

Medications also exist that can assist in the treatment of alcohol use disorder. Acamprosate is a medication that reduces symptoms of protracted withdrawal and has been shown to help individuals with alcohol use disorders who have achieved abstinence go on to maintain abstinence for several weeks to months.

Naltrexone, a medication used to block the effects of opioids, has also been used to reduce craving in those with alcohol use disorders. Disulfiram is another medication which changes the way the body metabolizes alcohol, resulting in an unpleasant reaction that includes flushing, nausea, and other unpleasant symptoms if a person takes the medication and then consumes alcohol.

Medications for Tobacco Use Disorders

There are three medications approved by the Food and Drug Administration (FDA) to treat tobacco use disorders (cigarette smoking). Nicotine replacement medications assist with reducing nicotine withdrawal symptoms including anger and irritability, depression, anxiety, and decreased concentration. Because nicotine delivered through chewing of gum containing nicotine, via a transdermal patch, or in lozenges has a slower onset of action than does the systemic delivery of nicotine through smoked tobacco; these medications have little effect on craving for cigarettes.

These medications are available over-the-counter. However, the nicotine inhaler and nasal spray deliver nicotine more rapidly to the brain and so are available only by prescription. Bupropion is a medication originally developed and approved as an antidepressant that was also found to help people to quit smoking.

This medication can be used 2/4 at the same dose for either cigarette smoking or depression treatment (or both). Varenicline is a nicotine partial agonist that reduces craving for cigarettes and has been helpful in smoking cessation for many. Bupropion and varenicline are prescription medications.

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