Receiving Prescription Medication while in Addiction Treatment

Both domestic and international media outlets have branded America as having a pill culture, and many would argue rightly so. According to the Washington Post, as of 2015, almost 60 percent of Americans take a prescription pill, and this is the highest proportion of the population ever to do so. On the one hand, Americans may be benefitting from exceptional pharmaceutical advancements. On the other hand, Americans may be using prescription medications as a shortcut to making important lifestyle changes. Arguments about the pros and cons of taking medications abound, but one thing is clear: For some, prescription medications may be instrumental to the addiction recovery process.

At present, there are three drugs of abuse for which addiction medication is used in treatment: opioids and opiates, alcohol, and benzodiazepines. It is important to note that one of the strongest arguments in favor of using medication for addiction to these drugs is that they are associated with potentially severe withdrawal symptoms. Medication can serve as a bridge from addiction to stabilization to eventual full detoxification, if desired; some individuals opt to use addiction treatment medications for months, years, or a lifetime.

The key is to know that there are research-based pharmacological options available. The best practice is to know about these medications and to speak with a doctor about whether they’re potentially a good fit for one’s recovery program. In addition to these addiction treatment medications, other medications may be used to address specific symptoms during withdrawal and for co-occurring medical or mental health issues.

Prescription Medication for Opioid Addiction Recovery

• Methadone was approved in 1947 for the treatment of opioid abuse, and it remains a commonly used pharmacologically based addiction treatment. But starting in 2002, methadone was no longer alone on the opioid treatment landscape. That year, the US Food and Drug Administration approved two prescription addiction medications: Suboxone and Subutex. Both medications are indicated as a replacement therapy for opioids, and both include buprenorphine as an active ingredient.Buprenorphine is a semisynthetic opioid, and as such, it can mimic the effects of opioids in the brain. This means that someone who takes buprenorphine while addicted to a prescription pain reliever or heroin will typically not go into intense withdrawal. In other words, buprenorphine can safely replace opioids in the brain without conferring a high (provided the medication is not abused) and without causing severe withdrawal symptoms to emerge. Subutex has only buprenorphine as its active ingredient. Suboxone has both buprenorphine and naloxone as active ingredients. Subutex and Suboxone carry abuse potential because they contain a semisynthetic opioid. As an article on Mental Health Daily explains, the naloxone in Suboxone lessens the abuse potential of this drug as compared to Subutex. If Suboxone is snorted or injected, the naloxone feature will cause a person to go into withdrawal rather than get the high desired. In other words, naloxone has an anti-abuse function.
• Subutex and Suboxone have continued to grow in popularity, in part because they can be prescribed to recovering individuals who are eligible for their use. By one estimate, in 2013, there were 9.3 million Suboxone prescriptions provided to recovering patients. Methadone, on the other hand, cannot be provided by prescription. Every 24-36 hours individuals in methadone programs must return to the dispensing clinic or other facility in order to obtain their next dose.The US Substance Abuse and Mental Health Services Administration speaks for the addiction treatment community when it advises the public that buprenorphine is safe for narcotic abuse recovery. Per the Drug Addiction Treatment Act of 2000 (DATA 2000), physicians who have been approved to prescribe and dispense buprenorphine may do so in various settings, including drug rehab programs. It is important to highlight that addiction treatment with buprenorphine occurs as part of a medically supervised recovery process. Medical management is a critical safeguard to have in place because it helps to ensure that any side effects can be effectively treated as soon as they emerge.Individuals can be maintained on buprenorphine even after rehab ends. A person may opt to remain on buprenorphine for months, years, and possibly for life. But should a person want to taper off this medication, a doctor can supervise the process to ensure that severe withdrawal symptoms do not emerge. Over time, a person who desires to achieve full detoxification may do so.
• Narcan: This drug has naloxone as its active ingredient (also contained in Suboxone). Naloxone binds to opioid receptors and can reverse an opioid overdose when administered properly and immediately. The effects are temporary, so emergency services should still be contacted in the event of an overdose.

Medication for Alcohol Addiction Recovery
As WebMD discusses, there are different prescription medication options for the treatment of alcohol addiction, such as:

• Antabuse: Approved over 50 years ago for alcohol addiction recovery, Antabuse stops the body from making an enzyme that breaks down alcohol. As a result, even a small amount of alcohol in the body will cause a buildup and lead to unpleasant feelings, such as nausea, flushing, and palpitations.
• Campral: This drug reduces withdrawal symptoms.
• At least two drugs have been used off-label to treat alcohol addiction: Topamax (an epilepsy drug) and Baclofen (a muscle relaxant).

In an interview with WebMD, Dr. Roger D. Weiss, MD, professor of psychiatry at Harvard Medical School points out that alcohol addiction medications can curb the desire to drink, weaken the response a person has to alcohol, reduce the severity of withdrawal symptoms, and serve as a chemical safeguard against relapse. As a general recommendation, anyone who is taking an alcohol addiction recovery medication should also be in a therapy program and engage in supportive or self-help groups, such as Alcoholics Anonymous. As a general rule, alcohol addiction recovery medications tend to be most effective when used in combination with other recovery methodologies.

Medication for Benzo Addiction Recovery
As the National Institute on Drug Abuse (NIDA) explains, it is always advisable to taper off benzodiazepines when dependence or addiction is present. NIDA describes research in this area as sparse, but it is clear that a cold-turkey detoxification includes significant risks. In some instances, benzodiazepine withdrawal can lead to seizures, coma, and even fatality.

To achieve a benzodiazepine taper, a doctor will initiate a patient into the process with a dose of a prescription benzodiazepine. The benzodiazepine may be the same one that was abused but in a lesser amount and at different intervals. In other instances, the attending doctor may use a different benzodiazepine. An effective taper may involve some (safe) trial and error on the part of the doctor and patient. The doctor’s goal will be to avoid the onset of severe withdrawal symptoms and ensure the process is comfortable for the patient.

The taper is, of course, a critical part of the treatment plan, but it’s still only a component of the overall process. A client’s response to the taper can also depend on environmental and psychological factors. For this reason, psychological support should be made available, such as therapy. In addition, the treating rehab center (whether inpatient or outpatient) should make efforts to help the recovering person to minimize any stress (e.g., providing case management services as necessary).

Drug addiction results in certain biological realities, including that of withdrawal. It may come as a surprise, but recovery is not always synonymous with a full detoxification, at least not right away. The body’s natural and gradual process of physical dependence is part of its effort to maintain survival. It makes good sense, therefore, that the body may need time to adjust to the absence of drugs. Prescription medications can be seen as safely supporting the body’s transition from drug dependence to freedom from drugs.

Any use of prescription medication while in addiction treatment should be determined on a case-by-case basis by supervising physicians. Those in recovery should never take any medications or other substance without direct oversight from their doctor.