Living with a Replacement Drug

Because some addictive substances are more powerful than others, certain addictions – usually to opiates, alcohol, and tobacco – are sometimes treated with replacement drugs. These drugs mimic the original substance (and, in some cases, delay withdrawal symptoms) but are not as addictive, in some cases actually blocking the potential for a high from the original substance. Although researchers are still attempting to find a replacement drug for cocaine addiction, this article will focus on the personal and social benefits of replacement drugs as well as how to live with the replacement drugs used to treat opiate, alcohol, and tobacco addictions.

Why use a replacement drug instead of quitting? Isn’t it still “drug abuse”? Some substances cause stronger addictions or more dangerous withdrawal symptoms than others. Replacement drugs offer a way to fulfill the body’s craving for the original substance without the devastating physical, financial, and emotional consequences that are associated with the other substance. They also stop the user from going through withdrawal because they give the body a similar version of the addictive substance. Although the body remains dependent on a substance, replacement drugs eliminate highs and lows, thereby creating a stable environment to allow the addict to function in everyday life again. According to the Office of National Drug Control Policy, some of the social benefits of methadone maintenance treatment (MMT), for example, include decreased costs associated with the criminal justice system (methadone treatment is only about $13/day), a benefit-cost ratio of 4:1 (every $1 spent on MMT results in $4 of economic benefits), and a reduction in the risk of transmission of such diseases as HIV/AIDS, STDs, tuberculosis, and Hepatitis B and C among participants in MMT programs.

What replacement drugs are used to treat opiate, alcohol, and tobacco addictions?

• Methadone (opiates)
• Suboxone (opiates)
• Campral (alcohol dependence)
• Zyban (tobacco)
• Chantix (tobacco)

How do these drugs work and what are common side effects? For opiate or opioid replacement drugs (like Methadone and Suboxone), most users do not report severe side effects. Depending on which drug is being used, minor side effects, such as headaches, mood swings, trouble sleeping, nausea, rashes, sweating, drowsiness, and/or libido changes, may occur. Sweating, in particular, can be problematic for patients taking methadone, even at the correct dosage. Patients may be advised to make lifestyle changes like wearing different types of clothing or using a different antiperspirant. Although the mechanisms that make Campral effective in treating alcohol dependence are not fully understood, it is believed that the drug restores certain aspects of brain chemistry that have been disrupted by alcoholism. The most common side effects, as reported by the drug’s website, are diarrhea, fatigue, itching, gas, and nausea. Addiction to nicotine, the active ingredient in tobacco products, can be treated with Zyban or Chantix. Zyban does not actually contain nicotine, and its effectiveness was discovered somewhat by accident when patients who were using the anti-depressant Wellbutrin reported a decrease in desire to smoke. The drug manufacturer repackaged it as Zyban. Common side effects include change in appetite, headaches, dry mouth, agitation, and problems sleeping. Chantix, like Zyban, contains no nicotine. It attaches to nicotine receptors in the brain so the nicotine is unable to attach to them. Common side effects of Chantix include nausea, constipation, vomiting, gas, and difficulty sleeping.

Do I still need to go to rehab or be in a support group if I take one of these medicines? These medicines are intended to be used in combination with rehabilitation programs and/or support groups, as determined by your physician. Addiction is a complicated disease that affects all areas of the addicted person’s life. Rehab programs teach new life skills and help heal the past and present through counseling; support groups provide a social environment that reinforces a recovering addict’s commitment to a sober life. Clearly, these components are invaluable to recovery, and medication should be used as a complement to them.

What if I would like to get pregnant? If you are sexually active and using one of these drugs or an addictive substance, you should consult your doctor, even if you are not necessarily planning to become pregnant. For example, sometimes opiate use can stop or delay a woman’s period, but this does not mean that you can’t get pregnant. According to SAMHSA, there is no evidence to suggest that methadone causes birth defects, but an infant may experience withdrawal after birth. Your baby’s withdrawal should be managed by a doctor. The effects of Suboxone are not fully understood. Animal studies of Campral suggest that it may be dangerous to take this drug during pregnancy. One study of Zyban did not suggest that infants who had been exposed to it in the first trimester were at any greater risk for cardiovascular or other malformations than others who had been exposed to a different type of anti-depressant; however, these results have not been confirmed. The effects of Chantix on pregnant women have not been studied. In general, these medicines may be less damaging to a fetus than the original substances (Read Substance Abuse and Pregnancy); however, you should ALWAYS consult your doctor because responses to medication can vary based on many individualized factors (Read Why People Respond Differently to Substances).