From the Guidelines
The treatment for illicit drug use should involve a comprehensive approach combining behavioral therapy and, when appropriate, medication, with a focus on individualized care and addressing co-occurring mental health conditions, as recommended by the American College of Physicians 1. The most effective treatment approaches for illicit drug use are those that are tailored to the individual's specific needs and circumstances. This may involve a range of interventions, including:
- Behavioral therapies, such as Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy, and Contingency Management, to help patients modify drug-related thoughts and behaviors
- Medications, such as methadone, buprenorphine, or naltrexone, for opioid use disorder, and naltrexone, acamprosate, or disulfiram for alcohol use disorder
- Recovery support services, including peer support groups like Narcotics Anonymous, to provide ongoing support and promote long-term sobriety
- Comprehensive care that addresses physical health, social needs, and relapse prevention strategies According to a study published in the American Family Physician, a primary care approach to substance misuse can be effective in identifying and managing substance use disorders, and promoting behavior change 1. The study highlights the importance of using brief validated screening tools to identify problematic drug use, and providing brief counseling and ongoing follow-up and reevaluation as needed. Key considerations in treating illicit drug use include:
- Addressing co-occurring mental health conditions, such as depression or anxiety, which are common among individuals with substance use disorders
- Providing individualized care that takes into account the patient's unique needs and circumstances
- Fostering a supportive and non-judgmental therapeutic relationship to promote patient engagement and motivation
- Encouraging patients to participate in peer support groups and other recovery-oriented activities to promote long-term sobriety and overall well-being.
From the FDA Drug Label
Patients in maintenance treatment should be titrated to a dose at which opioid symptoms are prevented for 24 hours, drug hunger or craving is reduced, the euphoric effects of self-administered opioids are blocked or attenuated, and the patient is tolerant to the sedative effects of methadone. Patients seeking to discontinue treatment should be apprised of the high risk of relapse to illicit drug use associated with discontinuation of methadone maintenance treatment
The treatment for illicit drug use involves methadone maintenance treatment, where patients are titrated to a dose that prevents opioid symptoms and reduces drug hunger or craving. The goal is to achieve clinical stability at doses between 80 to 120 mg/day. However, patients should be aware of the high risk of relapse to illicit drug use when discontinuing methadone maintenance treatment 2.
From the Research
Treatment for Illicit Drug Use
The treatment for illicit drug use typically involves a combination of medication and behavioral therapies. Some of the key treatment options include:
- Medication-assisted treatment (MAT) with methadone, buprenorphine, or naltrexone to help manage withdrawal symptoms and reduce cravings 3
- Cognitive-behavioral therapy (CBT) to help individuals identify and change negative thought patterns and behaviors associated with drug use 4
- Non-individual CBT, which has been shown to be effective in adding benefit to buprenorphine therapy for opioid use disorder 4
Medications Used in Treatment
Some of the medications used in the treatment of illicit drug use include:
- Buprenorphine, which has been shown to be effective in reducing extra-medical opioid use and improving treatment retention 3
- Methadone, which has been shown to be effective in improving treatment retention and reducing cocaine use, cravings, anxiety, and cardiac dysfunction 3
- Naltrexone, which can be used to help block the effects of opioids and reduce cravings 5
Importance of Treatment
Treatment for illicit drug use is crucial in reducing the risks associated with drug use, including overdose, HIV/AIDS, and other health problems. According to a study published in 2008, drug abuse is responsible for decreased job productivity and attendance, increased health care costs, and escalations of domestic violence and violent crimes 6. Another study published in 2011 found that the number of Americans aged 50+ years with a substance use disorder is projected to double from 2.8 million in 2002-2006 to 5.7 million in 2020, highlighting the need for effective treatment options 7.
Geographic and Demographic Considerations
The treatment for illicit drug use can vary depending on geographic and demographic factors. For example, a study published in 2017 found that the prevalence of past-month use of illicit drugs was highest in large metropolitan areas compared to small metropolitan or nonmetropolitan areas 5. Another study published in 2008 found that heroin is the most widely abused drug in Bangladesh, and that the country is an important transit route for internationally trafficked illicit drugs 6.