Addiction Medicine: Closing the Gap between Science and Practice

trazadone to treat insomnia.^63 Detoxification
also can be achieved using specific medically-
prescribed opioids that have less potential for
misuse (methadone or buprenorphine) and then
tapering the patient off these medications when
possible.^64

The prescription of methadone for addiction
treatment is restricted by federal regulations;* it
only can be prescribed for detoxification from
opioids in licensed facilities.† 65 Buprenorphine
can be dispensed or prescribed for illicit or
prescription opioid withdrawal in any outpatient
setting by qualified physicians who have the
required waiver from the Drug Enforcement
Administration (DEA).‡ 66 While use of these
medically-prescribed opioids can result in
physical dependence, they are considered less
dangerous because they have less potential for
misuse and addiction than other opioids;§ 67 they
also are prescribed to patients by a licensed
physician in a medical care setting. They work
by occupying the opioid receptors in the brain,
blocking or minimizing the effects of more
addicting opioid drugs; therefore, a patient on
methadone or buprenorphine maintenance
largely is protected from inadvertent overdose.^68

CNS** Stimulant Detoxification. Cessation of
CNS stimulant (cocaine, amphetamine) use may
result in withdrawal symptoms if the user

• It is not restricted when prescribed for pain

management.
† Unless a patient has been hospitalized for another

medical condition.
‡ Becoming qualified to prescribe and distribute

buprenorphine involves an eight-hour approved
program in treating addiction involving opioids, an
agreement that the physician/medical practice will
not treat more than 30 patients for addiction
involving opioids with buprenorphine at any one time
within the first year and up to 100 thereafter, and
assurance that the trained physician will refer patients
to necessary supplemental psychosocial services.
Physicians who meet the qualifications are issued a
waiver by the Substance Abuse and Mental Health
Services Administration (SAMHSA) and a special
identification number by the DEA.
§ Methadone and buprenorphine also are used for

stabilization and maintenance of addiction involving
opioids.
** Central Nervous System.

develops addiction involving these drugs; these

symptoms are not life-threatening and generally

are less severe than those associated with

withdrawal from alcohol or opioids.†† 69

Symptoms of stimulant withdrawal commonly

include decreased energy, insomnia, agitation,

increased appetite, depressed mood, anxiety and

drug craving.^70

Evidence for the effectiveness of pharmaceutical

detoxification to assist in stimulant withdrawal

is limited.^71 A vaccine to treat addiction

involving cocaine and ease withdrawal

symptoms currently is being tested.‡‡ 72 But

more research is needed to determine the

vaccine’s place in the cocaine detoxification

process and how it can be implemented safely.^73

Although there are no available medications

proven to be effective in mitigating the

symptoms of amphetamine withdrawal,^74 several

medications currently being researched may

prove useful in alleviating the symptoms.§§ 75

CNS Depressant Detoxification. Withdrawal

from CNS depressants may produce

complications and, in some circumstances, can

be life-threatening.^76 Symptoms of withdrawal

from certain prescription CNS depressants, such

as benzodiazepines, are similar to those for

alcohol withdrawal, with seizures and delirium

being the most serious. In the elderly, there is a

risk of falls and myocardial infarctions during

benzodiazepine withdrawal.^77 Benzodiazepine

withdrawal symptoms more specifically include

seizure, hypersensitivity, impaired perception of

movement, nausea and tension.*** 78 It is

common for people detoxifying from

†† During withdrawal from stimulants, there is a risk

of depression or negative thoughts and feelings that

may lead to suicidal thoughts or attempts.

‡‡ See page 98 for a discussion of vaccines under

development for addiction treatment.

§§ Drugs under investigation for this purpose include

modafinil, propranolol and bupropion; these

investigations are of off-label uses of approved drugs.

*** Symptoms of withdrawal from benzodiazepines

often mimic the conditions for which those drugs

initially were prescribed--mood and anxiety

disorders. As such, it sometimes is unclear if the

patient is presenting with withdrawal symptoms or

with symptoms of the underlying condition.