Naltrexone
This long-acting opioid antagonist was developed to block the effects of opioid narcotics such as heroin. It binds to the brain's opioid receptors, completely blocking the effects of narcotic opioid drugs. It has been found useful as part of the treatment of health professionals recovering from opiate addiction. It was found also to block some of the craving, reward, and loss of control in alcoholics when they drink alcohol. Alcoholics taking naltrexone and receiving counseling were more likely to be sober at three months than a comparison group receiving counseling plus a placebo.
Clonidine
Clonidine is a blood pressure medication that blocks sympathetic or adrenaline-like activity in the parts of the brain (locus ceruleus) responsible for panic, fear, or the fight-flight reaction. During withdrawal from some types of drugs, most notably opioids such as codeine or heroin, the sympathetic and parasympathetic nervous systems are overactive, causing extremely uncomfortable emotional, gastrointestinal, and musculoskeletal symptoms. Clonidine alleviates, at least partially, many of these symptoms.
Methadone (methadone maintenance therapy or MMT)
Due to a combination of myths, lack of information, and exposure to poorly administered methadone maintenance programs, methadone is unpopular with many lay persons and some health professionals. However, for this particular medical therapeutic modality, scientific evidence is probably stronger than for most other pharmacotherapies used by physicians: for properly selected opiate-dependent individuals, methadone maintenance therapy (MMT) is the most effective therapeutic intervention available. MMT results in significant reductions in mortality and morbidity, decreases the spread of infectious diseases such as HIV and hepatitis C, and provides social benefits to individuals, their families, and the community.
Ray Baker, MD