Drugs For Treating Drug Addiction - PowerPoint Presentation

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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

Disclosures 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!

Drugs 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?

3 Flavors of Outcomes

Traditional Abstinence Paradigm

Neurobiology of Addiction Paradigm

Harm Reduction Paradigm

What Would an Effective Medication Look Like From a Harm Reduction Point of View?

What 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

FDA 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

Other 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.: ?

Relevant 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

What 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