Medication Assisted Recovery (MAR)

Medications can be a useful tool in the journey of recovery. Although many people recovery from addiction without choosing to take medication, many have benefitted. Medications can be useful in recovery from mental and physical health issues in your overall recovery and these will be prescribed by your GP or mental health provider. If we are going to prescribe anything for you it is important that we know about all of the medications that you are currently taking. Please bring your medication with you to your appointment with the doctor here, if you are going to have one. The medications that you may be offered here are those that are prescribed by addiction specialists. These types of medications tend to work on the brain to readjust changes that have occurred during the addictive phase. Medications are used to help you in your journey towards recovery, rather than treatment in their own right. There are a number of different medications, used in different situations which are described in general terms here.

Medications that are used in detox

Medications can be helpful when a person is choosing to stop using a substance that they have become dependent on. We can use medications to make the experience more comfortable, safe and to improve chances of success. Medication-assisted detox in the community can be provided to suitable individuals who are physically dependent on alcohol and opiates (heroin, codeine, methadone, dihydrocodeine, buprenorphine). Medications are sometimes used to support the withdrawal from other substances including GBL, stimulants and “legal highs”.

Alcohol Detox

If you are dependent on alcohol is important that you get medical assessment and guidance when you are planning to stop. Without this help there are risks to your physical and mental health. The evidence-based medical guidance can be found at https://www.nice.org.uk/guidance/cg115

Three types of medications are used during alcohol detox:

Librium (chlordiazepoxide)

This medicine acts on the same receptor in the brain as alcohol. It is used to safely manage the alcohol withdrawal process. Not everyone who is drinking alcohol every day will need this medication but if you do the dose and number of days of medication will be decided according to your individual situation. If you do need this medicine it will be given to you by a nurse during a consultation each day which will review your progress.

If your liver is not working well you may be given a medication that does not last so long in the body (often clonazepam).

Remember to tell the nurse if there is any difficulty with this medicine (for example, you are too shaky or sleepy during detox).

Vitamins

During heavy alcohol use the body can become low vitamins that are essential to the healthy working of the body. Alcohol particularly affects B vitamins and it is important that these are supplemented during detox. B vitamins are necessary for the healthy functioning of nerves in the body and in the brain and a number of complications can arise if they become low. Vitamins are usually given by the oral route here as it is more convenient but B vitamins are absorbed much better by injection so this might be offered to you if you are particularly at risk.

Acamprosate

This is the ‘relapse prevention medication’ that tends to be the safest and most convenient to take. There is some evidence that it might also protect the brain a little during detox and when taken for a longer period (not like a painkiller) might reduce cravings. It is best to start from the start of detox and continued for a time in early recovery.

Opiate Detox

Four medications are used during detox from opiates:

Buprenorphine

This is a long-acting opiate medication and can be used in a reducing dose to help manage any withdrawal from opiate dependence (heroin, codeine, methadone addiction (read here for more information).

Methadone (Physeptone)

This is an alternative to buprenorphine. The medications are similar but there are some important differences and the choice of medication will be made by you and your doctor (read here for more information).

Lofexidine

This is a non-opiate medication that can help with some of the symptoms of withdrawal from opiates. It can have an effect on blood pressure so this may be monitored during your treatment. (read here for more information).

Symptomatic medication

A number of prescribed and over-the counter medications can be useful in coping with the symptoms of opiate withdrawal including anti-diarrhoeal mediations (like loperamide), anti-nausea medication (metoclopramide), medicines for muscle cramps and simple painkillers (paracetamol and aspirin).

Medications used to reduce the risks of opiate addiction

Methadone (physeptone) and buprenorphine (subutex) have been used in this country for decades. They are valuable medications and their use is supported by national guidance (https://www.nice.org.uk/guidance/ta114). These longer-acting opiates are used to replace the shorter acting opiates (like heroin, codeine, fentanyl) to enable the individual to rebuild their life. Medication is part of a wider-process of recovery. Many people will reduce the dose with time and may become abstinent from all medications. It is important to remember that whilst this medication isn’t the whole answer you can be doing well while you taking it.

Medications that are a ‘helping hand’ in preventing relapse

There are several medications that can help an individual to sustain their recovery. They are not medications that are a cure or quick fix but they can certainly boost recovery in some situations. Three difference medications are recommended for relapse prevention in alcohol use (read here for more information):

Acamprosate (Campral)

See above.

Disulfiram (Antabuse)

This is a medication that stops alcohol being broken down. There is a severe and potentially dangerous reaction if this medication and alcohol are combined so it is important to avoid anything containing alcohol (including food, perfumes and medicines that contain alcohol).  This mediation  is not safe to take in some situations (for example liver failure and heart disease) and blood monitoring is needed regularly through treatment (read here for further information).

Naltrexone

Naltrexone helps a little with relapse prevention by acting on the opioid system in the brain. Like Antabuse it is not safe in some situations and regular blood monitoring is required. Naltrexone can also be used for relapse prevention in opiate dependence (read here for more information).