Substance use disorder (SUD) is a chronic health condition characterized by the use of a substance/drug that causes negative impacts on a person’s functioning, and social, physical, or mental health. There is a loss of control, and drug use is continued despite harm to the user. Substance use disorder can apply to many drugs or substances, including alcohol, nicotine, opioids/narcotics, cannabis/marijuana, stimulants, sedatives/anti-anxiety medications, inhalants, hallucinogens, and other illegal “recreational” drugs. In South Africa, is it estimated that 13% of people have symptoms and behaviours that meet the criteria for SUD diagnosis. People of any age, sex, religion, race, and social class can develop SUD, and it significantly affects work, school, and home life. Although there is no cure for addiction and SUD, it is treatable, and there are several treatment options, including medications that can help you stay drug or alcohol-free. The medications most commonly used for substance use disorder are described below. Some are specific to treating SUD associated with one substance/drug, and some can treat SUD associated with multiple types of drugs/substances.
Medications that are used to treat SUD help treat withdrawal symptoms and decrease cravings for the substance. There are several medications that may be used to treat immediate (acute) withdrawal symptoms in the setting of drug detoxification. The medications discussed here are for chronic, longer-term treatment of substance use disorder, except for naloxone.
*Naloxone is used to reverse opioid effects when an overdose is known or suspected to have occurred. Examples of opioids include hydrocodone, oxycodone, morphine, and heroin. It is very effective at preventing death from opioid overdose when used correctly. There are education and distribution programs available for the public to obtain and use naloxone. If you or someone you know is on high-dose opioids or abuses opioids, it may be wise to seek out one of these programs.
Acamprosate is used to treat alcohol abuse disorder. It affects chemicals in the brain that lessen the desire for alcohol, and it decreases the pleasurable response in response to drinking alcohol. It may also help with withdrawal symptoms.
Disulfiram is used to treat alcohol use disorder. It makes it harder for the body to break down and digest alcohol and will cause nausea, vomiting, palpitations, headache if alcohol is consumed while taking it. This discourages the patient from drinking alcohol to avoid the very unpleasant side effects.
Naltrexone is used to treat both opioid use disorder and alcohol use disorder. It blocks the “high”/positive effects that alcohol and opioids have on the brain.
Methadone is used to treat opioid use disorder. It is an opioid itself, but because it is so long acting, it blunts the “high” experienced when taking other opioids. It can be used to taper patients off of high doses of opioids.
Buprenorphine is used to treat opioid use disorder. It works like an opioid but to a lesser degree, so the euphoric effect experienced by taking opioids is less. It is often used in a combination medication with naloxone.
Bupropion is an antidepressant that is used to help people quit smoking. It decreases cravings for nicotine and has also been found to be effective in reducing cravings for cocaine and methamphetamine.
Topiramate is a seizure medication that has been found to be effective in reducing alcohol cravings in alcohol use disorder.
Nicotine replacement products, such as the nicotine patch, gum, and lozenge are used to help quit smoking cigarettes. They are used to reduce cravings and are supposed to be decreased in dose as cravings decrease.
The most common side effects associated with these medications are listed below:
-Nausea/vomiting -Sweating
-Headache -Itchy skin
-Diarrhoea -Cold-like symptoms
-Drowsiness
-Dizziness
-Insomnia
-Muscle aches
Rare, but serious side effects that require medical attention are respiratory distress, overdose, seizures, allergic reaction, and liver damage (signs include yellowing of skin and whites of eyes, swollen belly, stomach pain, dark urine, and tiredness).
Some of these medications used to treat SUD may also be addictive, so it is important to take them exactly as prescribed and follow up with your health care provider regularly. Substance use disorder requires treatment other than medication, including counselling or other mental health services, treatment of any accompanying mental illness, group therapy, and making healthy lifestyle changes.