Medications to treat opioid and alcohol use disorders can be integrated into primary care settings effectively and play an important role in helping patients recover from addiction.

Medications to treat alcohol use disorder

Medication (Brand name)	Route	Effect	Most common adverse effects	Notes
Acamprosate (Campral)	Oral	Can decrease the craving for alcohol.	Anxiety Diarrhea Vomiting	Non habit-forming. Safe to take with alcohol and opiates. In event of relapse, will not cause an adverse reaction or exacerbate withdrawal symptoms.
Naltrexone (Vivitrol)	Oral, injection	Can decrease the craving for alcohol.	Dizziness Nausea Vomiting	Non habit-forming. May reduce the feeling of intoxication and the desire to drink more, but it will not cause a severe physical response to drinking.
Disulfiram (Antabuse)	Oral	Can discourage alcohol use by producing adverse reactions when alcohol is consumed, such as nausea, dizziness, headache, flushing.	Drowsiness	Non habit-forming. Should not be administered until patient has abstained from alcohol for at least 12 hours. If discontinued it can be restarted, even briefly, to ensure success in high-risk relapse situations.
Topiramate (Topamax)	Oral	Can decrease the craving for alcohol.	Loss of appetite Drowsiness Hair loss	Non habit-forming. An anti-seizure medication used off-label for the treatment of alcohol use disorders (not FDA approved for this purpose).

More information: Pharmacotherapy for Adults With AUD in Outpatient Settings – AHRQ

Medications to treat opioid use disorder

Medication (Brand name)	Route	Effect	Most common adverse effects	Notes
Methadone	Oral	An opioid agonist that eliminates withdrawal symptoms and relieves drug cravings.	Constipation, hyperhidrosis, respiratory depression, sedation	Only federally certified, accredited opioid treatment programs can dispense methadone.
Buprenorphine (Suboxone)	Tablet, Injection, implant	A partial opioid agonist that reduces cravings and withdrawal symptoms without producing euphoria.	Constipation, nausea, withdrawal, excessive sweating, insomnia	Only physicians (MDs); nurse practitioners; physician assistants; clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives can prescribe buprenorphine. They must get a federal waiver to do so, but are not required to complete the previous eight-hour training.
Naltrexone (Vivitrol)	Oral, injection	Blocks the euphoric and sedative effects, prevents feelings of euphoria	Nausea, anxiety, insomnia, depression, dizziness	Any prescriber can offer naltrexone.

More information: Treatment Improvement Protocol 63, SAMHSA