Medications that May Help for Quitting Toxic Substances
Author: Elizabeth Perry, Warren Alpert School of Medicine class of 2019
Medical content edited by Mark Clark, MD, Medical Director, Block Island Medical Center
BIHS Community Health Outreach Series 2018
A few weeks ago we provided an article discussing tips for quitting smoking. This follow up article is about medications that are now available to assist in quitting a variety of toxic substances, or, “Medication Assisted Treatment.”
Anyone who has tried to give up a bad habit knows how hard it can be. For substances like cigarettes, alcohol, and opioids, our bodies also get hooked on them, making them even harder to quit with will-power alone. If you are at the point of using any of these substances every day then your body has grown accustomed to them, and you may even get sick if you try to quit cold turkey. There are now a few different medications that can help you quit, either by preventing withdrawal, or by decreasing urges. If any of the medicines from this quick overview sounds like something you want to try, then the next step is to ask your doctor about it. We are ready and able to assist you at the Block Island Medical Center.
There are 3 main medications that have been shown to help people quit smoking. The first is actually a group of products, many of which are available over the counter, called nicotine replacement therapy. This includes patches, gum, and lozenges. Paying for these products out of pocket can get pretty expensive, but some insurances cover them, so ask your doctor about options for help covering the cost.
Two other prescription medications have also been shown to help. The first one is called bupropion or Wellbutrin, and the second one is called varenicline, popularly known as Chantix. Both of these medications have been shown to reduce the symptoms of nicotine withdrawal, making it easier to fight cigarette cravings. Patients taking varenicline are almost 3 times more likely to succeed at quitting smoking than patients who are not taking any medication.
While it is great to quit smoking by going cold-turkey, if this is not something that has worked for you in the past it is worth asking your doctor about medications that can help.
Alcoholism has touched almost everyone’s life either personally, or through watching friends and family struggle. This can be one of the hardest drugs to quit, but there are now a few medications out there that can help. However, if you develop symptoms when you do not have a drink, like anxiety, shaking, sweating, or hallucinations, then it is safer to quit in a detox program rather than on your own at home. Detoxification can sometimes be a very serious or life-threatening process and for that reason it sometimes needs to take place in the hospital. Your doctor can help you to decide which setting is correct for you.
Naltrexone is a medication that can be started before a person quits drinking. It can be administered as a daily pill or as a monthly shot, and it has been shown to decrease a person’s urges to drink. It actually blocks opioid receptors, so it will negate the effects of opioids too. This would not be a good choice for a person who requires opioids for pain control.
Disulfiram, also called Antabuse, must be started after a person has not had a drink for 24 hours. It can help deter a person from drinking again because when it is mixed with alcohol it causes negative side effects. These effects include flushing, nausea, vomiting, and dizziness, which make taking a drink a pretty unpleasant experience. If you are having trouble staying sober, but you want to, ask your doctor about these medications.
If you or someone close to you is using opioids every day then medications to keep withdrawal symptoms at bay can be really helpful. There are a few options available.
Methadone is a long acting opioid that has been used the longest as a treatment for opioid addiction. It is very effective, but often requires visiting special methadone clinics daily, especially in the beginning, in order to receive the daily dose of methadone. For some, this can be burdensome, but these specialized clinics also often have groups, social workers, and other supports to help with quitting.
Buprenorphine, or Suboxone, is a medication that can be taken at home, usually in a form that dissolves under the tongue. It partially stimulates opioid receptors in the body, while methadone fully stimulates them; as a result, some people find it less sedating than methadone. Buprenorphine is used by thousands of people to control the urge for opiods while avoiding the risks and side-effects of abusing opioids. These medications do not provide a “high,” however they do effectively reduce the physical urge to use opiod type drugs.
Naltrexone, the same medication used for alcohol urges, can also be used to help people quit opioids. It blocks opioid receptors completely. That means that if a person who is taking naltrexone takes an opioid, they will not feel the effects of it. Naltrexone must be started after a person has withdrawn from opioids, while methadone and Suboxone can be started before someone withdraws.
This has been a very brief summary of some of the medications available to help quit smoking, drinking, and taking opioids, but the first step is always feeling ready to make a change. You can get more information about any of these medications at your doctor’s office. We are ready and willing to confidentially discuss your substance use concerns with you at the Block Island Medical Center, in order to help you to make the best choices regarding treatment.
 Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013; 5:CD009329.