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What drugs can I use (pharmacotherapies)?

A number of effective therapeutic drugs are now available for the treatment of dependence, primarily for alcohol, nicotine and opioids. Some pharmacotherapies also assist in reducing cravings in non-dependent individuals (e.g., naltrexone for binge drinking). It is likely that the use of pharmacotherapies will increase in the future.

Pharmacotherapies should not be considered as stand-alone treatments but should be used as part of a comprehensive treatment program, including

• supportive counselling
• other relevant therapies
• social support

Pharmacotherapies for Alcohol Dependence

Acamprosate (Campral®)

This is an anticraving agent which acts as a GABA-receptor agonist.

Randomised controlled trials have shown:

• reduced quantity and frequency of drinking in patients who do not achieve complete abstinence
• reduced rates of relapse (where relapse is defined as consumption of any alcohol)
• increased percentages of abstinent days during treatment
• increased rates of abstinence

Acamprosate is available on the Pharmaceutical Benefits Scheme (PBS) for use within a comprehensive treatment program.

Naltrexone (Revia®)

This anticraving agent is a competitive opioid antagonist which blocks the euphoric and reinforcing effects of alcohol.

Randomised controlled trials have shown:

• reductions in the amount and frequency of drinking overall
• reductions in the rate and relapse into heavy drinking (where relapse is defined as a return to > 5 drinks per day)
• increased rates of alcohol abstinence

Naltrexone is available on the Pharmaceutical Benefits Scheme (PBS) for use within a comprehensive treatment program.

Disulfiram (Antabuse®)

An alcohol-sensitising agent which inhibits aldehyde dehydrogenase causing a toxic build-up of acetaldehyde if alcohol is consumed. This results in unpleasant symptoms such as facial flushing, nausea, vomiting, sweating and palpitations.

Randomised controlled trials have shown:

• variable results
• only a modest effect in promoting abstinence

Disulfiram is not available on the PBS.

Pharmacotherapies for Opioid Dependence

Buprenorphine

A strong opioid analgesic with both partial agonist and partial antagonist properties. It is an alternative to methadone for withdrawal and maintenance treatment, and has a much lower risk of death from overdose than methadone.

Buprenorphine is listed on the PBS as S100 under Section 100 of the National Health Act 1953 and is approved by the Therapeutic Goods Administration (TGA).

Methadone

This is a long-acting synthetic opioid which can be used for both withdrawal and maintenance treatment. It decreases the need for heroin-dependent individuals to regularly use intravenous opioids. Methadone maintenance programs monitor drug use and should provide ongoing counselling and support.

Methadone is listed on the PBS as S100 under Section 100 of the National Health Act 1953 and is approved by the Therapeutic Goods Administration (TGA).

Levoalphaacetylmethadol (LAAM)

LAAM is a synthetic opioid analgesic which acts similarly to methadone. It is long-acting and only needs to be taken three times per week.

Overseas trials suggest that LAAM:

• is as safe as methadone
• has similar treatment outcomes and patient retention to methadone

This drug is not available for use in Australia.

Naltrexone (Revia®)

This is a competitive opioid antagonist, which completely blocks the effects of opioids for 24 to 72 hours. Maintenance therapy is suitable for highly motivated patients who wish to remain abstinent, are socially and psychologically stable and have good social support.

Naltrexone is not listed on the PBS for opioid dependence but is approved by the TGA as an adjunctive therapy. Clinical trials are also underway using naltrexone for rapid detoxification.