Evidence-based pharmacological interventions for the treatment of drug use disorders – Not one size

Drug use disorder has been conceptualized as a biopsychosocial disorder that often takes the course of chronic and relapsing disease. The risk for relapse is heightened because the neurobiological changes in brain pathways created by many years of drug use do not completely revert to normal when stopping to take drugs or after the detoxification alone. The use of medications in the treatment of drug use disorder can play a major role in overdose management, withdrawal management and in preventing relapse and facilitating longer periods of abstinence. More effective medications have been developed over the past 30 years, and subsequently, pharmacotherapy has progressively played a more important role in the treatment of drug use disorders, especially opioid use disorders.

 

Pharmacological agents have three broad objectives: management of acute withdrawal symptoms during detoxification, attenuation of cravings and urges to use drugs (initial recovery), and prevention of relapse to compulsive drug use. Treatment retention and the reduction of the negative health and social consequences of drug use can also be enhanced by the use of agonist therapies such as methadone and buprenorphine for the treatment of opioid use disorders.

 

Medications can be very helpful in managing and/or treating a variety of disorders due to drug use, such as intoxication, overdose, withdrawal, dependence and drug-induced or drug-related psychiatric disorders. Pharmacological interventions should be administered alongside psychosocial interventions. Medications can help alleviate the withdrawal manifestations to help patients feel more comfortable during the early stages of treatment after stopping alcohol or drug use. Reducing withdrawal symptoms can, in turn, help the patient to stay abstinent and remain in treatment rather than being caught into a vicious cycle of using drugs to relieve withdrawal symptoms, thereby, continuing drug dependence. Psychostimulant and cannabis use disorders are mainly treated through evidence-based psychosocial interventions however, there are promising medications that might become available in the future.

 

 

Pharmacological interventions are available in Tanzania. Currently, Medication-Assisted Treatment (MAT) centres for opioid dependence in Tanzania are situated in Dar es Salaam and Tanga with ongoing plans of extension to other regions; they have helped several people recover and become free of compulsive use of drugs. Further, naloxone is available in many health facilities for the treatment of opioid overdose.

 

If you are concerned about your substance use or that of a family member or a friend, you can visit https://www.huruapp.org/services/ to see treatment centres and contacts that you can reach for additional help, guidance as well as medical and social support.

 

 

 

Sources:

1.      Douaihy AB, Kelly TM, Sullivan C. Medications for substance use disorders. Soc Work Public Health. 2013;28(3-4):264-278. doi:10.1080/19371918.2013.759031

2.     McLellan AT, Lewis DC, O’Brien CP, Kieber HD. Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. Journal of the American Medical Association. 2000;284(13):1689–1695

3.     Barber WS, O’Brien CP. Pharmacotherapies. In: McCrady BS, Epstein EE, editors. Addictions: A comprehensive guidebook. New York, NY: Oxford University Press; 1999. pp. 347–369.

4.     International standards for the treatment of drug use disorders: revised edition incorporating results of field-testing. Geneva: World Health Organization and United Nations Office on Drugs and Crime; 2020