What is the role of medications in treating substance abusing offenders?
Medications can be an important component of effective drug abuse treatment for offenders. By allowing the brain to function more normally, they enable the addicted person to leave behind a life of crime and drug abuse. Although some jurisdictions have found ways to successfully implement medication therapy, addiction medications are underused in the treatment of drug abusers within the criminal justice system, despite evidence of their effectiveness.
Effective medications have been developed for treating addiction to opiates/heroin and alcohol:
Opiates/Heroin. Long-term opiate abuse results in a desensitization of the brain’s opiate receptors to endorphins, the body’s natural opioids. Opioid agonist/partial agonist medications, which act at the same receptors as heroin, morphine, and endorphins, tend to be well tolerated and can help an individual remain in treatment. For example, methadone, an opiate agonist, reduces the craving that otherwise results in compulsive use of heroin or other illicit opiates. Methadone treatment has been shown to be effective in decreasing opiate use, drug-related criminal behavior, and HIV risk behavior. Buprenorphine is a partial agonist and acts on the same receptors as morphine (a full agonist), but without producing the same level of dependence or withdrawal symptoms. Suboxone is a unique formulation of buprenorphine that contains naloxone, an opioid antagonist that limits diversion by causing severe withdrawal symptoms in addicted users who inject it to get “high.” It has no adverse effects when taken orally, as prescribed.
An alternative approach, in previously detoxified opiate users, is to use an antagonist medication that blocks the effects of opiates. Naltrexone has been available for more than 2 decades, but poor compliance in the face of severe cravings and addiction has undermined its benefits. An extended-release injectable formulation of naltrexone (Vivitrol) was recently approved by the U.S. Food and Drug Administration (FDA) for treating opioid addiction. Vivitrol requires dosing every month rather than daily, which stands to improve treatment adherence.
- Alcohol. Disulfiram (also known as Antabuse) is an aversion therapy that induces nausea if alcohol is consumed. Acamprosate, a medication that helps reduce alcohol craving, works by restoring normal balance to the brain’s glutamate neurotransmitter system. Naltrexone (and now Vivitrol), which blocks some of alcohol’s pleasurable effects and alcohol craving, is also approved by the FDA for treatment of alcohol abuse.