6.8 Psychoactive Substances and Medications to Treat Substance Use and Withdrawal
Information about the effects of substances such alcohol, cannabis, and illicit drugs is discussed in the “Substances: Use, Intoxication, and Overdose” section of the “Substance Use Disorders” chapter.
Medications to treat alcohol use disorder and opioid disorder include buprenorphine-naloxone, methadone, naltrexone, acamprosate, and disulfiram. These medications are further discussed in the “Treatment and Recovery Services” subsection of the “Substance Use Disorders” chapter.
See Table 6.8 for a list of medications commonly used to treat alcohol and opioid use disorders.
Table 6.8 Common Medications Used to Treat Alcohol and Opioid Use Disorders[1]
| Medication | Use | DEA Schedule | Application |
|---|---|---|---|
| Buprenorphine-naloxone | Opioid use disorder | CIII | Used for detoxification or maintenance of abstinence. |
| Methadone | Opioid use disorder | CII | Used for withdrawal and long-term maintenance of abstinence of opioid addiction. Dispersed only at opioid treatment centers certified by SAMHSA and approved by state authority. |
| Naltrexone | Opioid use disorder and alcohol use disorder | Not scheduled under the Controlled Substances Act | Block opioid receptors, reduce cravings, and diminish rewarding effects of opioids and alcohol. Extended-release injections are recommended to prevent relapse. |
| Acamprosate | Alcohol use disorder | Not scheduled under the Controlled Substances Act | Used for maintenance of alcohol abstinence. |
| Disulfiram | Alcohol use disorder | Not scheduled under the Controlled Substances Act | Causes severe physical reactions when alcohol is ingested, such as nausea, flushing, and heart palpitations. The knowledge that the reaction will occur acts as a deterrent to drinking alcohol. |
Medications used to manage symptoms of substance withdrawal/detoxification include buprenorphine, methadone, and Alpha-2 adrenergic agonists (such as clonidine and lofexidine). In the case of alcohol withdrawal, benzodiazepines (such as lorazepam or diazepam) remain the first-line treatment, particularly for preventing seizures and delirium tremens. In certain cases—especially in ICU-level care—dexmedetomidine (Precedex) may be used as an adjunct for sympathetic overactivity, though it does not treat seizures and must be used with close monitoring. Read more about these medications in the “Withdrawal Management/Detoxification” section of the “Substance Use Disorders” chapter.
- Substance Abuse and Mental Health Services Administration, & Office of the Surgeon General. (2016). Facing addiction in America: The surgeon general's report on alcohol, drugs, and health. United States Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK424857/ ↵
