There are safe and effective medications to treat an addiction to opioids, alcohol, and nicotine.
Opioids are strong painkillers. Some examples are morphine, hydromorphone (Dilaudid), oxycodone (Percocet, Oxycontin), heroin, and fentanyl. What To Do When Opioid Use Becomes a Problem explains the different treatment options for opioid use disorder. The most effective treatment is opioid agonist therapy (OAT), which means taking a safer, long-lasting opioid by prescription. OAT helps reduce cravings and withdrawal, and it also significantly lowers the risk of overdose. There are four medication options:
OAT Decision Aid is an excellent tool that can help a person and their health care provider decide which medication would be best for them.
Suboxone is available as a tablet or film. It dissolves under the tongue and shouldn’t be swallowed. At the right dose, it relieves cravings and withdrawal and won’t make a person high. It’s safer than methadone or Kadian. We used to think people had to be in opioid withdrawal before starting Suboxone to avoid very bad withdrawal (precipitated withdrawal), but there are now different ways to start it: standard, slow (microdosing), or fast (macrodosing). For more information, see:
With microdosing, people start with very small amounts of Suboxone while they can still be using other opioids and increase Suboxone gradually to lower the chance of withdrawal. With macrodosing, people in withdrawal take a high dose of Suboxone quickly to help their withdrawal and get to a full dose of Suboxone as fast as possible.
Sublocade is a monthly injection of buprenorphine. Sublocade Treatment: What to Know and Expect provides basic information on Sublocade. People used to have to wait to get Sublocade until they’d been taking Suboxone for a week. Now, some health care providers will start Sublocade sooner because waiting a week can be hard. Starting Sublocade describes when and how these quicker starts can be done. Some health care providers have also started giving Sublocade to people who use fentanyl without giving any Suboxone first (cold start) but this sometimes causes precipitated withdrawal.
Researchers and health care providers are finding new ways of using Sublocade to try to help people get stable on OAT as soon as possible because of the danger of using unregulated fentanyl. Recently, the US Food and Drug Administration approved:
Health Canada has only approved the last change regarding where the injection can be given.
Methadone is a long-acting opioid that is taken as a liquid mixed with juice. For people who use strong opioids often, methadone may be more helpful in managing withdrawal symptoms and cravings than Suboxone.
There are new guidelines for methadone prescribing to help health care providers meet the needs of their patients. The goal of these guidelines is to make sure that people can start methadone as quickly and safely as possible, get doses that are strong enough to help them feel better (usually 100 mg or more for people who use fentanyl), start getting take-home doses (carries) as soon as it’s safe, and help people who miss doses get back to their previous dose quickly. For more information, see…
Kadian is another OAT medication that reduces cravings and withdrawal. It’s sometimes prescribed with methadone, especially at the beginning of treatment when the methadone dose is still low and people are still having cravings and withdrawal. It can also be prescribed by itself, especially for people who have health issues that make methadone dangerous for them (like heart problems). For more information, see:
Some provinces have prescribed alternatives programs (previously known as safer supply programs), where people are prescribed hydromorphone tablets (Dilaudid) to help them use less toxic street drugs, which often have dangerous substances like carfentanil, benzos, xylazine, and harmful fillers.
Naltrexone works by blocking the pleasurable effects of alcohol. You can take it even if you are still drinking. People on opioids shouldn’t take naltrexone because it will cause opioid withdrawal.
Naltrexone is usually taken once daily. The Sinclair Method (TSM) is a way of using naltrexone by taking it before drinking. This Ted Talk by Claudia Christian describes how she stopped using alcohol using TSM.
Acamprosate works best for people whose goal is to stop drinking completely and who have already stopped drinking for even a day or two. It reduces symptoms like anxiety, insomnia, and alcohol cravings.
Gabapentin isn’t a medication for alcohol use disorder, but it’s sometimes used to manage withdrawal symptoms. It can be used with naltrexone or acamprosate.
See Medications for Alcohol Use Disorder for more information.
Stopping alcohol use suddenly can be life-threatening for people who get withdrawal. See Acute Alcohol Withdrawal for more information on how to stop drinking safely.
Nicotine Replacement Therapy (NRT) products are gum, patches, lozenges, and inhalers (sprays or vapes) with nicotine in them that people can use instead of cigarettes. All are available in Canada without a prescription.
Varenicline is a prescription medication that helps reduce cravings and makes smoking less enjoyable.
Bupropion is a prescription medication that helps reduce nicotine cravings and withdrawal.
Cytisine is a natural product that helps people quit smoking. It can be bought online or in some pharmacies without a prescription.
STOP is an online program available to people living in Ontario to help them stop smoking.
There are no approved medications to treat cannabis, cocaine, or methamphetamine (crystal meth) use disorders. However, sometimes health care providers prescribe medications that are used to treat other conditions that may also help reduce substance use (off-label use).
Families for Addiction Recovery (FAR) thanks the team at META:PHI for their assistance in ensuring the accuracy of the Medications section of our website.
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