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What are the medications used for Substitutive Therapy?
These include methadone and buprenorphine (Suboxone, Subutex). Both can be used for either long term maintenance or short term tapering of a patient from illicit drugs. Both medications relieve withdrawal symptoms, decrease drug craving and if person should use they decrease the effect of the illicit opiates.
Another medical treatment option is Naltrexone which is an opiate antagonist and will block the effects of any ingested opioid. If a person has not used opioids for a period of time (usually four or more days) they may start on Naltrexone. If started sooner, withdrawal may suddenly occur. Therefore this medication is most frequently used after a patient has completed a several week inpatient detoxification.
No medication is a magic bullet by itself. Counseling is a necessary and integral part of any type of drug treatment. Relapse to substance abuse is a part of the disease; however these should become more infrequent as treatment progresses.
Buprenorphine was recently approved for use in drug treatment. Unlike methadone which must be dispensed in a restrictive treatment clinic setting, buprenorphine may be prescribed by a qualified physician in the privacy of their office.
- Patients dependent on opioids who do not need a highly structured environment find this mode of treatment more acceptable and do well.
- Patients who cannot attain and maintain abstinence may need a more structured environment such as an inpatient treatment stay or methadone program.
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What is Substitutive Therapy?
One theory of addiction is that an alteration of the brain’s receptors sensitivity to endogenous and synthetic neurotransmitters exists and drives a patient to continue drug use.
The idea behind substitutive treatment involves stimulating the receptors to ameliorate or abrogate withdrawal symptoms, decrease craving and allow time for counseling to become effective.
Currently two medications are approved for substitutive therapy.
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