Medications for Treatment of Substance Use Disorders (SUDs)

Medications for Treatment of Substance Use Disorders (SUDs)
David Willey MD Substance Use Unit Director Cottonwood Springs Hospital Original Presentation and multiple slides courtesy of: Karen Drexler, MD Deputy National Mental Health Program Director- Addictive Disorders Office of Patient Care Services Department of Veterans Affairs

Learning objectives The participant will be able to:
Understand the rationale for using medications to treat substance use disorders Understand the risks and benefits of different medications for treatment of withdrawal from: Alcohol Opioids Understand the risks and benefits of different medications for treatment of: Alcohol use disorder Opioid use disorder Reversal of opioid overdose Tobacco use disorder

Overview Why medications? Withdrawal management: Alcohol Opioids
Relapse prevention: Tobacco

Why Medications? SUDs are chronic brain diseases
Multifactorial, like other chronic diseases Respond best to comprehensive treatment Require long-term treatment Medications improve treatment outcome over psychosocial interventions alone Prevent medical complications of alcohol and opioid withdrawal Facilitate engagement in psychosocial treatment Reduce craving and risk of relapse Protect against opioid overdose

Substance Use Disorders are Chronic Brain Diseases
Known pathophysiology Treatment response similar to other chronic diseases Respond best to a combination of psychosocial interventions and medications (when available).

Interconnected Networks Mediating Motivation and Decision-making
Neurophysiology of addiction – There is a growing literature increasing our understanding of the effects of addicting drugs on the brain such that even a cursory overview could take the entire time allotted. As we learn more about these drugs we understand better how they gradually undermine one’s decision-making capacity through gradually increasing their own incentive salience (the more you use them, the more you want them) and by compromising executive functioning (rational thinking and ability to inhibit impulses to use the drugs) George Koob, PhD (2013)

Compliance and Relapse in Chronic Medical Disorders
Insulin-dependent diabetes Compliance with medication <50% Compliance with diet and foot care <30% Retreated within 12 months 30 – 50% Medication-dependent hypertension Compliance with medication <30% Compliance with diet <30% Retreated within 12 months 50 – 60% Substance use disorders Compliance with treatment attendance <40% Retreated within 12 months 10 – 40% O’Brien CP, McLellan AT. Lancet, 347: McLellan T, Lewis D, O’Brien C, Kleber H: Drug dependence, a chronic medical illness, implications for treatment, insurance and outcomes evaluation. JAMA 2000;284: O’Brien CP, McLellan AT. Lancet. 1996;347:

Relapse prevention: (Cocaine) Tobacco

Mild-to-Moderate Alcohol Withdrawal
Time course Begins 6 to 8 hours after last drink Peaks at 24 to 48 hours after last drink Symptoms may include some or all of the following: Anxiety and/or irritability Insomnia Tremor Headache Gastrointestinal disturbance Perceptual disturbances Diaphoresis Hypertension Increased heart rate Myrick H, Anton R. CNS Spectrums. 2000;5:22-32.

Severe Alcohol Withdrawal
Alcohol withdrawal seizures Usually occur 6 to 48 hours from last drink Delirium tremens Gradual onset 2 to 3 days from last drink, peaks at 4 to 5 days Includes altered mental status and some or all of the following: Disorientation Perceptual disturbances and/or hallucinations Fluctuating mental status Tremor Diaphoresis Hypertension Increased heart rate Fever Gastrointestinal disturbance Myrick H, Anton R. CNS Spectrums. 2000;5:22-32.

Alcohol Withdrawal Treatment
Assess withdrawal risk using standardized scale (e.g. CIWA-Ar, AUDIT-PC, etc.) Based on and using shared decision-making, determine treatment setting- acute inpatient or ouwithdrawal risk tpatient Stabilize with medication (e.g. benzodiazepine, anticonvulsant) Gradually withdraw medication (e.g. reduce 20% daily over 5 days) Supplemental vitamins and minerals Thiamine Folic acid Multivitamin Supportive treatment Decrease stimulation, increase fluid and caloric intake Myrick H, Anton R. CNS Spectrums. 2000;5:22-32.

Inpatient Medically Managed Withdrawal
Recommended for patients with: Suggested for patients with at least moderate alcohol withdrawal (CIWA >/= 10) and: History of delirium tremens or withdrawal seizures Inability to tolerate oral medication Co-occurring medical conditions that would pose serious risk for ambulatory withdrawal management (e.g., severe coronary artery disease, congestive heart failure, liver cirrhosis) Severe alcohol withdrawal (i.e., Clinical Institute Withdrawal Assessment for Alcohol [revised version] [CIWA-Ar] score >/= 20) Risk of withdrawal from other substances in addition to alcohol (e.g., sedative hypnotics) Recurrent unsuccessful attempts at ambulatory withdrawal management Reasonable likelihood that the patient will not complete ambulatory withdrawal management (e.g., due to homelessness) Active psychosis or severe cognitive impairment Medical conditions that could make ambulatory withdrawal management problematic (e.g., pregnancy, nephrotic syndrome, cardiovascular disease, or lack of medical support system)

Alcohol Withdrawal Medications
Anticonvulsants (i.e. Carbamazepine, Gabapentin, Valproic Acid) Benzodiazepines (e.g. Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam, Oxazepam) Efficacy in relieving mild to moderate alcohol withdrawal symptoms. Efficacy in preventing withdrawal seizures Potential for addiction and misuse May induce incoordination and increase risk of falls. Efficacy in relieving mild to moderate alcohol withdrawal symptoms. Insufficient evidence for preventing alcohol withdrawal seizures. Less potential for misuse Less potential for incoordination and falls.

Withdrawal Management: Opioids
Withdrawal management alone is not recommended. Lack of evidence of efficacy for psychosocial intervention without medication. Risk of overdose (greatest in first few months after discharge from inpatient) When opioid agonist maintenance treatment is not an option, Recommend withdrawal using opioid agonist medication: Buprenorphine Methadone- in an OTP or when patient is hospitalized for treatment of a medical condition other than narcotic addiction If opioid agonist medication is contraindicated, not preferred, or not available, recommend: Clonidine Plus adjunctive medications such as benzodiazepine, antiemetic, antidiarrheal, NSAIDs.

Relapse prevention: Tobacco Overdose reversal: Naloxone

Medications for SUDs Alcohol use disorder: Opioid use disorder:
Acamprosate (Campral®) Disulfiram (Antabuse®) Naltrexone (Revia®, Vivitrol®) Topiramate (Topamax®) Gabapentin (Neurontin) Opioid use disorder: Methadone Buprenorphine/naloxone (Suboxone®, Subzolv®, Bunavail®) Naltrexone (Vivitrol®) Tobacco use disorder: Nicotine replacement (transdermal, gum, spray) Bupropion (Zyban®, Wellbutrin®) Varenicline (Chantix®) Opioid overdose reversal Naloxone rescue kits and Evzio®

Naltrexone (ReVia®, Vivitrol®)
Mechanism of action: Mu opioid antagonist Craving reduction Decreased euphoria (may enhance extinction) Reduces risk of opioid overdose if slip occurs Usual dose: Oral - 50 to 100 mg once daily, Intramuscular mg/month Nota bene: Pretreatment abstinence from alcohol improves response (48 hours or more). Some patients experience dramatic craving reduction, some none. Adverse events: Nausea, abdominal cramps, muscle aches Opioid withdrawal (in patients with recent opioid use) Renders opioid pain medications ineffective Injection site reactions for extended-release injectable naltrexone

Oral Naltrexone in the treatment of alcohol dependence
Volpicelli et al: 1992 Arch Gen Psych 49(11):876-80

Oral Naltrexone Reduces Relapse to Heavy Drinking
Source Duration in weeks Bias Risk Tx Group Event/ No event Control Risk Difference Favors treatment Favors control % weight

Oral Naltrexone Supports Abstinence from Alcohol
Source Duration in weeks Bias Risk Tx Group Event/ No event Control Risk Difference Favors tx Favors control % weight Jonas et al: 2014, JAMA

Oral Naltrexone

Injectable Naltrexone (Vivitrol)

Extended Release Naltrexone Injection Associated with Reduced Mortality and Hospital Readmissions
Outcome measure Odds Ratio for NTX-XR/control 1 year mortality 0.30 (p < 0.001) In subset with detox in prior year Subsequent detox episodes 0.80 (p < 0.001) 0.78 (p < 0.001) Case-Control design 387 veterans with AUD received NTX-XR 3759 controls Propensity score weighted, mixed-effects logistic regression model for 1-year mortality. For subset with at least one detox episode in previous year, # detox episodes in following year. Harris et al Alcohol Clin Exp Res-39:79–83 Extended release naltrexone is associated with improved mortality and reduced need for detoxification services.

Naltrexone Precautions
Contraindications Precautions Drug interactions Use of opioids Acute opioid withdrawal Anticipated need for opioid analgesics Acute hepatitis or liver failure Liver disease Depression History of suicide attempts Injection site reactions Pregnancy Cat C Opioid analgesics (blocks action) Thioridazine (increased somnolence)

Acamprosate (Campral®)
Mechanism of action: Modifies glutamate NMDA receptor function Reduces withdrawal relief craving Eliminated through the kidney Note: Alcohol abstinence at treatment initiation improves results. Usual dose: 333mg: 2 tablets 3 times daily Adverse events: Rare: suicidal ideation and behavior Common: diarrhea, sleepiness

Acamprosate (Campral)

Acamprosate Supports Abstinence in Alcohol Use Disorder
Jonas et. al

Acamprosate Precautions
Contraindications Precautions Drug interactions Severe kidney disease (CrCl <30mL/min) Moderate kidney disease Depression History of suicide attempts Pregnancy Cat C None known

Acamprosate vs. Naltrexone
Maisel et al. (2012) meta-analysis examined when naltrexone & acamprosate are most helpful by testing relative efficacy & whether implementation strategies moderate its effects. Findings support: Acamprosate larger effect size on abstinence maintenance Naltrexone larger effect size on reduction of heavy drinking & craving Detoxification before tx or a longer period of abstinence associated with larger medication effects for acamprosate

Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings----A Systematic Review and Meta-analysis Most comprehensive, systematic review and meta-analysis of the comparative effectiveness of naltrexone and acamprosate across 135 studies concluded that: “Acamprosate and oral naltrexone have the best evidence for improving alcohol consumption outcomes for patients with alcohol use disorders. Head-to-head trials have not consistently established the superiority of one medication. Thus, other factors may guide medication choices, such as frequency of administration, potential adverse events, coexisting symptoms, and availability of treatments…Evidence from well-controlled trials does not support efficacy of disulfiram, except possibly for patients with excellent adherence.” Jonas et al. (2014)

Disulfiram (Antabuse®)
Inhibits aldehyde dehydrogenase  build-up of toxin (acetaldehyde) Active for up to 2 weeks. Usual dose: 250 mg once daily Adverse reactions: Serious: Alcohol-disulfiram reaction Hepatitis Neuropathy Psychosis Common: Metallic or garlicky taste Drowsiness Rash Dose range 125 mg- 500 mg once daily Chick et al: Br J Psychiatry. To assess the efficacy of supervised disulfiram as an adjunct to out-patient treatment of alcoholics, a randomised, partially blind, six-month follow-up study was conducted in which 126 patients received 200 mg disulfiram or 100 mg vitamin C under the supervision of a nominated informant. In the opinion of the (blinded) independent assessor, patients on disulfiram increased average total abstinent days by 100 and patients on vitamin C by 69, thus enhancing by one-third this measure of treatment outcome. Karen Drexler, M.D.

Disulfram (Antabuse)

Disulfiram Precautions
Contraindications Precautions Drug interactions Recent alcohol use Cardiovascular disease Allergy to rubber (thiuram) derivatives Liver disease Psychosis Epilepsy Hypothyroidism Diabetes mellitus Kidney disease Carry wallet card Alcohol (cough syrups, mouthwash, wine sauce, etc.) Anticoagulants (Coumadin) Isoniazid Metronidazole Phenytoin

Opioid Use Disorder High mortality1 – 581 male admits to California Civil Addict Program (CAP) Average age at entry = 25 years 10-year mortality = 14% 20-year mortality = 28% 30-year mortality = 49% Insufficient evidence that counseling alone is effective Medications: Opioid Agonist Therapy (OAT) is recommended as first-line: Methadone (in an OTP) Buprenorphine/naloxone If OAT is contraindicated, unavailable, unacceptable, or discontinued: Extended-release injectable naltrexone Insufficient evidence to recommend for or against oral naltrexone for OUD. 1Hser (2001) Arch Gen Psych 58:

Methadone Mu opioid agonist Usual dose: 60 - 120 mg once daily
Efficacy: 1.72 (high dose vs low dose (<60 mg) Must be administered through Federally Regulated Opioid Treatment Program Methadone can be continued for patients hospitalized for treatment of a medical condition other than narcotic addiction (including alcohol use disorders). Adverse reactions: Dose range 125 mg- 500 mg once daily Common: Constipation Drowsiness Low testosterone Hyperalgesia Serious: Cardiac arrhythmias Sudden cardiac death Karen Drexler, M.D.

Methadone Precautions
Contraindications Precautions Drug interactions Allergy to methadone Respiratory, renal or liver impairment Prolonged QTc or arrhythmias Concurrent opioids (e.g. enrollment in another OTP) Partial opioid agonists or antagonists Head injury Concurrent benzodiazepines, alcohol, or other CNS depressants CYP3A4 inhibitors may  levels- ketoconazole, erythromycin, HIV protease inhibitors

Buprenorphine (Suboxone®)
Partial  opioid agonist Usual dose: mg once daily Efficacy: >8mg daily similar to methadone Adverse reactions: Common: Drowsiness Constipation May precipitate opioid withdrawal Serious: Cytolytic hepatitis Dose range 125 mg- 500 mg once daily Karen Drexler, M.D.

Buprenorphine Precautions
Contraindications Precautions Drug interactions Allergies to buprenorphine or naloxone May precipitate opioid withdrawal Patients with liver, renal or respiratory impairment CNS depression- Caution in operating heavy machinery Head injury Alcohol, benzodiazepines, and other CNS depressants CYP3A4 inhibitors may  levels- ketoconazole, erythromycin, HIV protease inhibitors Buprenorphine (Subutex) and Buprenorphine/Naloxone (Suboxone): Contraindications: 1. Suboxone and Subutex should not be administred to patients who have been shown to be sensitive to buprenorphine. 2. Suboxone should not be administred to patients who have been shown to be sensitive to Naloxone. Precautions: 1. Respiratory depression: A number of death have occurred when addicts have intravenously misused buprenorphine with benzodiazepines concomitantly. 2. CNS depression; Paetient receiving buprenorphine in the presence of other narcotics, general anesthetics, benzodiazepines, phenothiazines, other tranquilizers, sedative/hypnotics(including alcohol) may exhibit increased CNS depression. 3.Dependence: Chronic administration produces physiologic dependence. 4. Hepatitis and Hepatic events: Cases of cytolytic hepatitis and hepatitis with jaundice have been observed in addict population receiving buprenorphine both in clinical trials and in post marketing reports. 5. Allergic reactions; Cases of acute and chronic hypersensitivty to Suboxone and subutex have been reported both in clinical trials and in post marketing experiences. 6. Increased intracranial pressure: Like other opioids buprenorphine may increase CSF pressure and should be used with caution in patients with head injury. 7. For ambulatory patients: buprenorphine may impair mental or physical ability required for the performance of potentially dangerous task such as driving a caror operating machinery especially induction or dose adjustment. Drug interaction: Buprenorphine is metabolized by cytochrome CYP3A4. CYP3A4 inhibitors may increase plasma concentration of buprenorphine. Patients on medication such as azole antifungal (Ketoconazole), macrolide antiboitics (erythromycin) and HIV protease inhibitors (ritonavir, indinavir and saquinavir) should have their dose of buprnorphine adjusted. Karen Drexler, M.D.

Short Buprenorphine Taper versus Extended Buprenorphine
Multisite randomized trial- 2-phase adaptive treatment research design 653 treatment-seeking outpatients dependent on prescription opioids Randomized to Standard Medical Management (SMM) or SMM plus counseling Phase 1: Two week stabilization, 2-week taper, 8-week post-medication follow-up Successful patients exited study; thoMethodsse who returned to opioid use entered Phase 2 Phase 2: Twelve week treatment, 4-week taper, 8-week post-medication follow-up Results: Phase 1: 43 of 653 (6.6%) had successful outcomes Phase 2: 177 of 360 (49%) achieved success at week 12, no group differences 31 of 360 (8.6%) maintained success 8 weeks post-medication Chronic pain did not affect outcome History of heroin use predicted poorer outcome during Phase 2 medication. Weiss R et al: Arch Gen Psychiatry

Naltrexone (Revia/Vivitrol)
Opioid antagonist with high affinity for mu-opioid receptors and lower affinity at kappa- and delta-opioid receptors Effectively blocks the effects of heroin and other opioids Long half-life can be administered 3x week in doses of mg Generally well tolerated, side effects can include: GI distress, headaches, rare liver toxicity Poor adherence suggest use of injectable formulation Only given when acute withdrawal has been completed 47

Improved Abstinence from Opioids and Reduced Craving with Extended-Release Naltrexone (XR-NTX) vs Placebo 2011-Krupitsky et al-Lancet- 377:1506

Overview Why medications? Withdrawal management: Relapse prevention:
Alcohol Opioids Relapse prevention: Tobacco Overdose reversal: Naloxone

Opioid Prescribing Increased 1991 - 2011
Source: April 2, Nora Volkow testimony to House Committee of Appropriations Subcommittee on Commerce, Justice, Science, and Related Agencies Volkow – 04/02/ Testimony

18,893 deaths from prescription opioid pain relievers in 2014
10,574 deaths from heroin in 2014

One strategy to mitigate opioid drug overdose deaths includes increasing the accessibility and utilizing of Naloxone Naloxone is a safe and effective antidote for opioid-related overdose that has been used for more than 40 years. Naloxone has no abuse potential and can reverse a life-threatening overdose by blocking the opioids effects, restoring breathing and preventing death.

Opioid overdose prevention programs
In 1996, Community-based programs began distributing naloxone directly to patients at high risk for overdose Programs have since expanded to provide overdose training and naloxone kits to laypersons who might witness an opioid overdose in efforts to reduce opioid overdose mortality in these areas These programs have since shown to be safe and cost-effective by providing naloxone kits to 152,283 laypersons and received reports of 26,463 overdose reversals

Naloxone Rescue Kit Contents
Naloxone Rescue Kit IM Naloxone Rescue Kit Nasal

Naloxone Autoinjector- Evzio
Video available at Evzio website:

Ongoing Efforts to Increase the Accessibility of Naloxone
Legislation and Government Policy – Laws being amended or enacted to increase accessibility to Naloxone and Encourage persons to summon medical assistance in case of an overdose Naloxone Access Laws provide civil immunity to prescribers, permit third-party prescribing or permit prescribing via standing order Good Samaritan Laws – aim to protect persons who provide assistance during an overdose from prosecution or criminal repercussions

Prevention Strategies to Address the Opioid Epidemic Include:
Clinical guidelines to educate physicians Mandatory addiction education in medical, nursing and pharmacy schools Continued development of use prescription-drug monitoring programs Providing safe and efficient ways to dispose of medication Abuse-deterrent formulations Enforcement policies to discourage diversion

Treatment Strategies Include:
Efforts to de-stigmatize addiction and treatment Education and public awareness Increasing access to evidence based treatment Reimbursement, insurance coverage, number of treatment programs Expanding medication assisted treatment (suboxone, naltrexone, methadone) Number of providers willing to treat and provide these medications Increased psychosocial and recovery support Counseling, mental health, family involvement, monitoring services for extended periods of treatment Ongoing research to evaluate current treatment strategies and help direct future care Increased availability and utilization of Naloxone to reduce the number of opioid related overdose deaths

Tobacco Use Disorders (TUD)
Leading preventable cause of premature death in the United States. Patients with alcohol use disorder (AUD) more likely to die of TUD than AUD. Treatment works: Brief counseling Counseling plus medication most effective Combined medication may be more effective than a single agent Nicotine patch and gum Nicotine patch and bupropion

Pharmacotherapy Nicotine replacement Gum Transdermal patch Nasal spray
Inhaler Bupropion (Zyban®, Wellbutrin®) Varenicline (Chantix®) The cigarette is the fastest, most efficient nicotine delivery system available. Nicotine is the component of tobacco that is addicting. Karen Drexler, M.D.

Nicotine Gum Available OTC Usual dose: 10 – 15 pieces per day
4 mg and 2 mg Usual dose: 10 – 15 pieces per day Proper chewing technique is key: Chew until “tingling” or “pepper” taste Park between cheek and gums No food or drink while chewing Side effects: Nausea, indigestion Efficacy: OR = 1.4 – 1.6 Side effects are minimized with proper chewing technique Advantage relief for intermittent urges. Disadvantage, fluctuating blood levels may contribute to intermittent withdrawal symptoms and urges to smoke. Karen Drexler, M.D.

Transdermal Nicotine Patch
Available OTC 22, 21, 14, 11, 7 mg over 24 hours 15 mg over 16 hours Usual dose 21/22 mg/day x 4 – 8 weeks Dose reduction every 2 – 4 weeks Abstinence in first two weeks is key Side effects Local skin irritation, ? Insomnia Efficacy- O.R. = 2.1 Abstinence in the first two weeks is highly predictive of success. If patient smokes during first two weeks, NRT dose may be too low. Consider increasing the dose based on the following tables. Karen Drexler, M.D.

Transdermal Nicotine Dose Based on Reported Smoking
Cigarettes per day Initial Patch Dose < 10 7 – 14 mg/day 10 – 20 14 – 22 mg/day 21- 40 22 – 44 mg/day >40 >44 mg/day If you do not have cotinine levels available, then you can estimate patch dose based on reported numbers of cigarettes per day Karen Drexler, M.D.

Bupropion (Zyban®, Wellbutrin®)
Monocyclic antidepressant available by prescription Inhibits reuptake of NE and DA Antagonist at nAChr Usual dose 150 mg/day x 3, then 150 mg twice daily Adverse events Seizure risk (0.1%) Insomnia, dry mouth, hypertension Efficacy- O.R. = 1.4 – 2.35

Varenicline (Chantix®)
Partial agonist at alpha4beta2 nicotinic cholinergic receptor Usual dose: 1 mg twice daily Adverse events: nausea (30%), insomnia (18%), headache (15%), abnormal dreams (13%) Efficacy: OR = Varenicline is supplied orally in 2 strengths: 0.5 mg (a white tablet containing 0.85 mg of varenicline tartrate equivalent to 0.5 mg of varenicline base) and 1.0 mg (a blue tablet containing 1.71 mg of varenicline tartrate equivalent to 1 mg of varenicline base).16,17 Varenicline treatment should be initiated one week prior to a quit attempt or stop date.16,17 The titration schedule consists of a one week lead-in phase followed by a dose of 1 mg twice daily after eating and a full glass of water to reduce associated nausea.16 The gradual increase in titration is recommended to limit the occurrence of nausea.16,17,21 A 12 week course of treatment is recommended, with an additional 12 weeks included to ensure long-term abstinence. Successive attempts are recommended for those who relapse or fail therapy. The titration schedule is as follows: days 1–3, 0.5 mg daily; days 4–7, 0.5 mg twice daily; and, starting on day 8, 1.0 mg twice daily. A maximum dosage of 0.5 mg daily is recommended for patients undergoing hemodialysis for end-stage renal disease. Varenicline is packaged in an initial package of one blister pack (0.5 mg, with 11 tablets in each pack) and 3 blister packs (1 mg, with 14 tablets in each pack).16,17 Refills are provided as 4 blister packs (1 mg with 14 tablets in each pack). Alternatively, bottles of 56 tablets are available for both strengths. Tablets should be stored at room temperature (25 °C), with an acceptable range of 15–30 °C. The literature reviewed here suggests that varenicline shows efficacy comparable to that of bupropion SR and superior to that of placebo. This agent is only approved for individuals above the age of 18 and should not be used in pregnant or lactating women. Varenicline may be prescribed for patients who have a contraindication to bupropion (eg, already on selective serotonin-reuptake inhibitors, seizure disorder, eating disorder). Safety and efficacy of varenicline in combination with other smoking cessation therapies has not been well studied. Preliminary kinetic data involving combination therapy with the transdermal patch illustrate an increased incidence of adverse events. Varenicline has FDA approval as monotherapy, with further studies needed evaluating combination therapy in the future. Seena L Zierler-Brown PharmD FAACP, Associate Professor of Pharmacy Practice, Department of Pharmacy Practice, Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL Jeffrey A Kyle PharmD, Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, Gregory School of Pharmacy, Palm Beach Atlantic University Reprints: Dr. Zierler-Brown, 901 S. Flagler Dr., PO Box 24708, West Palm Beach, FL 33416, fax 561/ , pba.edu References Karen Drexler, M.D.

Varenicline versus Bupropion or Placebo for Smoking Cessation
Gonzalez et al: JAMA 2006;296:47-55

Conclusions Counseling plus medication more effective than counseling alone Medications save lives compared to counseling alone Imminent risk of opioid overdose death after detoxification Significantly reduced risk of mortality for alcohol Significantly improved success in quitting tobacco over counseling alone Persons with alcohol, opioid, and tobacco use disorders should receive medication as part of comprehensive treatment for a complex, multifactorial illness. Part of the functional analysis of relapse should include assessment of medication or lack of medication as part of treatment at the time of relapse.

Resources MHS SUD SharePoint: Academic Detailing AUD Campaign:
Academic Detailing AUD Campaign: Pharmacy Benefits Management- Recommendations for Use VA DoD Clinical Practice Guidelines for Management of SUD

Medications for Treatment of Substance Use Disorders (SUDs)

Similar presentations

Presentation on theme: "Medications for Treatment of Substance Use Disorders (SUDs)"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Medications for Treatment of Substance Use Disorders (SUDs)

Similar presentations

Presentation on theme: "Medications for Treatment of Substance Use Disorders (SUDs)"— Presentation transcript:

Similar presentations

About project

Feedback