Pharmacotherapy

What is Pharmacotherapy?

In the alcohol and other drug sector, pharmacotherapy is referred to as the use of medications to respond to drug abuse / dependence, including:

  • as replacement or substitution treatment for opioid (usually heroin) dependence
  • the management of withdrawal from opioids (heroin, morphine, pain medication)
  • the blocking of drug effects from heroin, other opioids or alcohol

Some of the more common pharmacotherapies used in Australia are:

  • Methadone: a withdrawal and substitution treatment for heroin dependence.
  • Buprenorphine: used in heroin dependence as a withdrawal and/or substitute treatment.  It is also available in combination with naloxone (suboxone), an injecting deterrent.
  • Naltrexone: used to treat alcohol dependence and for heroin withdrawal and dependence. 
  • Disulfiram: used to treat alcohol dependence and attempts to maintain abstinence by causing an unpleasant reaction if alcohol is consumed.
  • Acamprosate: used to treat alcohol dependence and maintain abstinence once withdrawal from alcohol is complete.  It may be combined with naltrexone.

It is important that young people who are dependent on substances are well-informed in relation to their treatment options and that they are given the best opportunities to achieve their treatment goals. 

The main objectives of using pharmacotherapy as part of treatment are:

  • to reduce dependence on substances
  • to reduce the harms and deaths caused by the use of substances or associated with their use; for example, BBVs, alcohol-related violence, liver damage, ABI, cancer
  • to improve physical and psychological health
  • to reduce criminal behaviour
  • to facilitate reintegration into the workforce and education system, and
  • to improve social functioning

It is useful if practitioners are able to recognise when young people may benefit from pharmacotherapy and then be able to instil hope by discussing options and supporting them through the process.

Pharmacotherapy Treatment

Pharmacotherapy for opioid dependence

In line with Australia’s harm reduction framework, opioid maintenance treatment is a practical and effective treatment for many opioid-dependent people who are unable to achieve abstinence at the time they seek help.

Individuals are able to receive a regular, known dose of a legally available opioid that is affordable and does not need to be injected.  This can subsequently result in improved health outcomes, improved social functioning, lower mortality rates and decreased criminal activity.

For those who wish to purse abstinence, naltrexone can be used in relapse prevention because it blocks the effects of heroin.

Objectives of treatment

  • to reduce or eliminate illicit opioid and other drug use by those in treatment
  • to improve the health and wellbeing of those in treatment
  • to facilitate the social rehabilitation of those in treatment
  • to reduce the spread of blood borne diseases associated with injecting drug use
  • to reduce the risk of death associated with opioid use
  • to reduce the level of crime associated with opioid use

Opioid maintenance / substitution pharmacotherapy

  • prescription of a long-acting synthetic opioid medication that acts as a substitute for heroin and other opioids
  • dosage is managed so as to prevent withdrawal symptoms without causing intoxication
  • best results are obtained when a sufficient dose of the drug is prescribed for 2-4 years
  • methadone & buprenorphine are the pharmacotherapies used in this way

Abstinence support pharmacotherapy

  • opioid antagonists (drugs that block the effects of other opioid drugs) are used for working towards abstinence
  • best results are obtained with motivated clients with relatively stable and supportive social environments and who are likely to experience clear consequences from continued opioid use
  • naltrexone is the pharmacotherapy used in this way

Pharmacotherapy for alcohol dependence

Three medications are licensed in Australia for the treatment of alcohol dependence. 

  1. Opioid antagonists: Naltrexone (Revia®)
  2. Acamprosate: Campral®
  3. Aversive agents: Disulfiram (Antabuse®)

The “Guidelines for the Treatment of Alcohol Problems” (DoHA, 2009) recommend that pharmacotherapy should be considered for all alcohol-dependent individuals following completion of alcohol withdrawal.  They are best used in conjunction with psychosocial supports as part of a post-withdrawal treatment plan. 

Naltrexone and Acamprosate have been shown to improve treatment outcomes in combination with psychosocial support and interventions.  For individuals who are motivated to take the medication, both are potential tools for reducing alcohol use and the core symptoms of alcohol dependence.

Disulfiram remains an option for relapse prevention in certain circumstances and as part of a comprehensive treatment plan however the evidence for its success is weaker.

For more details see Pharmacotherapy Information

Further Reading