Barry Zevin MD Tom Waddell Health Center San Francisco Department of Public Health Homeless Programs Board Certified Internal Medicine Board Certified Addiction Medicine BarryZevinsfdphorg Disclosures And Disclaimer ID: 775845
Download Presentation The PPT/PDF document " Drugs For Treating Drug Addiction" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Drugs For Treating Drug Addiction
Barry Zevin MD
Tom Waddell Health Center
San Francisco Department of Public Health Homeless Programs
Board Certified Internal Medicine
Board Certified Addiction Medicine
Barry_Zevin@sfdph.org
Slide2Disclosures And Disclaimer
Barry Zevin accepts no payments, samples, or gifts from any pharmaceutical companies
The opinions expressed here are those of the presenter
All information regarding medications expressed here should be
checked out!
Slide3Drugs for Treating Drug Addiction?
What’s the difference between a drug and a medication anyway?
If a medication could treat addiction, how would we know it was working?
Why have the results of this been “disappointing” so far? Disappointing to who?
Slide43 Flavors of Outcomes
Traditional Abstinence Paradigm
Neurobiology of Addiction Paradigm
Harm Reduction Paradigm
Slide5What Would an Effective Medication Look Like From a Harm Reduction Point of View?
Slide6What is FDA Approved For Treating Addiction?
Tobacco: nicotine replacement, bupropion,
verenicline
Alcohol:
chlordiazapoxide
(specific regimen for withdrawal),
diazapam
(specific regimen
regimen
for withdrawal),
oxazapam
(specific regimen
regimen
for withdrawal),
disulfiram
,
acamprosate
, naltrexone
Opioids – heroin: naltrexone, methadone only in NTP, buprenorphine
Opioids – prescription opioids: naltrexone, methadone only in NTP, buprenorphine
Stimulants – methamphetamine: none
Stimulants – cocaine: none
Benzodiazepine,
carisoprodol
, GHB, Other sedative-hypnotics: none
Marijuana: none
Process Addictions – gambling, porno, shopping, etc.: none
Slide7FDA Approved For Indications Other Than Addiction
Tobacco: clonidine,
nortryptaline
Alcohol: benzodiazepines,
topiramate
,
ondansetron
, valproate, other
aeds
, baclofen,
Opioids – heroin: clonidine, other prescription opioids
Opioids – prescription opioids: clonidine, other prescription opioids
Stimulants – methamphetamine: baclofen, other
psychostimulants
, mirtazapine, bupropion, venlafaxine,
topiramate
, other
aeds
Stimulants – cocaine: baclofen, naltrexone,
topiramate
, other
aeds
Marijuana: gabapentin,
pregabalin
Process Addictions – gambling, porno, shopping, etc.: naltrexone
Slide8Other Non FDA Approved Substances Used to Treat Addiction
Tobacco: Herbs (lobelia, St. Johns wort, oat straw, valerian, ginseng)
Alcohol: cannabis
Opioids – heroin: heroin, ibogaine
Opioids – prescription opioids: ibogaine
Stimulants – methamphetamine: cannabis
Stimulants – cocaine: cannabis
Marijuana: ?
Process Addictions – gambling, porno, shopping, etc.: ?
Slide9Relevant Outcomes
Safe / comfortable withdrawal
Abstinence / relapse prevention
Controlled use
Reduced heavy use / Less using days / Less use overall
Reduce harm related to mode of use, impurity of substance
Prevent overdose
Better mental health
Better quality of life
Reduce
mortality
Retention in treatment
Reduce craving
Anti-depressant
Better cognition / Maintain cognitive function
Reset tolerance
Turn on or off effects of drug as needed
Reduce criminal activity
Slide10
Slide11
Slide12
Slide13
Slide14
Slide15What Doesn’t Work?
Anti-depressants for stimulant dependence when depression is not present
Dopamine agonists (
eg
bromocriptine
, amantadine,
pergolide
) or most
aed’s
for stimulant dependence
Disulfiram
for alcohol dependence in settings in which daily dosing cannot be assured
Naltrexone for opioid dependence in “less motivated” patients
SSRI’s in type II (early onset – strong family history) alcoholism
Worse outcomes than placebo
Ultra-rapid opioid detox
Slide16Slide17