Top Medications for Addiction Treatment

Medically reviewed by Dr. Richard A. Marasa, MD, MBA — Board Certified in Addiction Medicine, Emergency Medicine, and Internal Medicine. Over 40 years of clinical experience and 21 years of personal recovery.

Understanding FDA-Approved Medications for Addiction Treatment

Medication-assisted treatment (MAT) combines FDA-approved medications with counseling and behavioral therapies to treat substance use disorders. According to the National Institute on Drug Abuse (NIDA), MAT is clinically proven to reduce opioid use, overdose deaths, criminal activity, and infectious disease transmission while increasing treatment retention.

"At Clear Steps Recovery, we use medication-assisted treatment as one component of a comprehensive, individualized recovery plan," says Dr. Richard A. Marasa, MD, MBA, Medical Director at Clear Steps Recovery. "These FDA-approved medications address the neurobiological changes caused by addiction, giving patients the stability they need to fully engage in therapy and rebuild their lives."

The U.S. Food and Drug Administration (FDA) has approved specific medications for treating opioid use disorder (OUD) and alcohol use disorder (AUD). Below, we break down each medication, how it works, and what the clinical evidence shows.

FDA-Approved Medications for Opioid Addiction

The FDA has approved three primary medications for the treatment of opioid use disorder. According to NIDA research, all three have been demonstrated to reduce opioid use, improve treatment retention, and decrease mortality risk.

Buprenorphine (Suboxone, Sublocade)

Buprenorphine is an FDA-approved partial opioid agonist, meaning it activates opioid receptors at a lower intensity than full agonists like heroin or oxycodone. According to NIDA, buprenorphine at doses of 16 mg per day or higher makes patients 1.82 times more likely to remain in treatment compared to placebo.

How it works: Buprenorphine binds to mu-opioid receptors, reducing cravings and withdrawal symptoms without producing significant euphoria. It has a "ceiling effect" — beyond a certain dose, its effects plateau, which lowers the risk of misuse and respiratory depression.

Key clinical facts (per NIDA):

• Patients on adequate buprenorphine doses showed significantly fewer opioid-positive drug tests than placebo groups
• Available as sublingual tablets/films (Suboxone), long-acting injectable (Sublocade), and implants (Probuphine)
• Can be prescribed by certified physicians, nurse practitioners, and physician assistants in office-based settings — no specialized clinic required
• Often combined with naloxone (as Suboxone) to deter misuse via injection

Methadone

Methadone is an FDA-approved synthetic full opioid agonist that has been used to treat opioid addiction since 1947. According to NIDA, patients on methadone maintenance had 33% fewer opioid-positive drug tests and were 4.44 times more likely to remain in treatment compared to controls.

How it works: Methadone acts on mu-opioid receptors to prevent withdrawal symptoms and relieve cravings. Its long half-life (24-36 hours) allows once-daily dosing, providing stable opioid receptor occupancy throughout the day.

Key clinical facts (per NIDA and SAMHSA):

• Reduces opioid use, overdose risk, infectious disease transmission, and criminal behavior
• Must be dispensed through SAMHSA-certified opioid treatment programs (OTPs) — not available by standard prescription
• NIDA research shows methadone and buprenorphine are equally effective at reducing opioid use when dosed at medium-to-high levels
• Requires careful medical supervision due to risk of respiratory depression, especially during induction

Naltrexone (Vivitrol)

Naltrexone is an FDA-approved opioid antagonist — it completely blocks opioid receptors rather than activating them. Unlike buprenorphine and methadone, naltrexone carries no risk of physical dependence and is not a controlled substance.

How it works: Naltrexone binds to opioid receptors and blocks the rewarding effects of opioids. If a person uses opioids while on naltrexone, they will not experience euphoria, effectively removing the reinforcement cycle.

Key clinical facts (per NIDA and FDA):

• Available as a daily oral tablet or extended-release monthly injection (Vivitrol)
• The injectable form is particularly effective for patients who struggle with daily medication adherence
• Patients must be fully detoxed from opioids (typically 7-10 days) before starting naltrexone to avoid precipitated withdrawal
• NIDA research confirms naltrexone reduces opioid use and prevents relapse when patients remain adherent

Ready to explore medication-assisted treatment? Our medical team, led by Dr. Richard A. Marasa, MD, MBA, creates individualized MAT plans at both of our locations. Call our New Hampshire center at (603) 769-8981 or our Massachusetts center at (781) 765-0001.

Clinical Effectiveness: What the Research Shows

The evidence for medication-assisted treatment is substantial. According to NIDA's comprehensive research report on medications for opioid use disorder, MAT consistently outperforms non-medication approaches across multiple outcome measures.

Treatment Retention and Opioid Use Reduction

NIDA's analysis of clinical trials found:

• Methadone maintenance: Patients were 4.44 times more likely to stay in treatment and had 33% fewer opioid-positive drug tests than controls
• Buprenorphine (16+ mg/day): Patients were 1.82 times more likely to remain in treatment compared to placebo
• Methadone vs. buprenorphine: Head-to-head studies showed no significant difference in opioid-positive drug tests or self-reported heroin use at medium-to-high doses — both are equally effective

Why Treatment Retention Matters

According to NIDA, remaining in treatment is directly associated with:

• Lower risk of overdose mortality
• Reduced risk of HIV and hepatitis C transmission
• Decreased criminal justice involvement
• Greater likelihood of stable employment
• Improved family and social functioning

"The data is clear — patients who stay in medication-assisted treatment have dramatically better outcomes across every measure we track," notes Dr. Marasa. "That is why we focus on creating treatment plans that patients can sustain long-term."

FDA-Approved Medications for Alcohol Use Disorder

The FDA has approved three medications specifically for treating alcohol use disorder (AUD). According to SAMHSA, these medications are most effective when combined with behavioral therapies and mutual support programs.

Acamprosate (Campral)

Acamprosate was FDA-approved in 2004 for relapse prevention in alcohol dependence. It works by modulating glutamate and GABA neurotransmitter systems that become dysregulated during chronic alcohol use.

How it works: Acamprosate helps restore the neurochemical balance disrupted by prolonged alcohol exposure. It reduces the physical and emotional distress of post-acute withdrawal — the persistent discomfort that often triggers relapse in early sobriety.

Key clinical facts:

• FDA-approved specifically for maintaining abstinence in patients who have already stopped drinking
• Does not prevent withdrawal symptoms — patients should be detoxed before starting
• Taken three times daily as an oral tablet
• Most effective when combined with counseling and psychosocial support

Disulfiram (Antabuse)

Disulfiram was the first FDA-approved medication for alcohol dependence and has been in clinical use for over 50 years. Rather than reducing cravings, it works as an aversive deterrent.

How it works: Disulfiram inhibits the enzyme aldehyde dehydrogenase. If alcohol is consumed while taking disulfiram, acetaldehyde accumulates in the body, causing intense nausea, vomiting, flushing, and headache — creating a strong physical deterrent to drinking.

Key clinical facts:

• Most effective when taken under supervised conditions (e.g., at a clinic, by a family member, or as part of a structured program)
• Patients must avoid all sources of alcohol, including certain medications, mouthwashes, and cooking wines
• The aversive reaction can occur up to two weeks after the last dose
• Not recommended for patients with severe heart disease, psychosis, or certain liver conditions

Naltrexone for Alcohol Use Disorder

Naltrexone is FDA-approved for both opioid use disorder and alcohol use disorder. For AUD, it reduces the rewarding effects of alcohol, making it easier to maintain abstinence or reduce heavy drinking days.

How it works: Naltrexone blocks opioid receptors in the brain that are activated by alcohol consumption. By blocking the pleasurable "buzz" from drinking, it reduces the reinforcement loop that drives compulsive alcohol use.

Key clinical facts:

• Available as a daily oral tablet (ReVia) or monthly extended-release injection (Vivitrol)
• Clinical trials show naltrexone reduces heavy drinking days and increases the percentage of abstinent days
• Should not be used in patients currently taking opioids or with acute hepatitis or liver failure
• The injectable form (Vivitrol) eliminates daily adherence challenges

Overdose Reversal Medications

Overdose reversal medications are critical, life-saving tools. According to the FDA and the World Health Organization (WHO), naloxone is considered an essential medicine for any functioning healthcare system.

Naloxone (Narcan)

Naloxone is an FDA-approved opioid antagonist that rapidly reverses opioid overdose by displacing opioids from receptors in the brain and restoring normal respiration.

Key facts:

• Available as a nasal spray (Narcan), auto-injector (Evzio), and injectable formulation
• The FDA approved over-the-counter (OTC) naloxone nasal spray in March 2023, making it available without a prescription
• Takes effect within 2-5 minutes when administered intranasally
• May require multiple doses if synthetic opioids like fentanyl are involved, as fentanyl binds more tightly to receptors
• NIDA recommends that anyone at risk of opioid overdose — and their family members — should have naloxone readily accessible

Nalmefene (Opvee)

Nalmefene is an FDA-approved opioid antagonist with a longer duration of action than naloxone. The FDA approved Opvee (nalmefene nasal spray) in May 2023 specifically for emergency treatment of known or suspected opioid overdose.

Key facts:

• Longer half-life than naloxone — may be particularly useful for overdoses involving long-acting opioids
• Available as a nasal spray (Opvee), approved for OTC use
• Administered the same way as naloxone nasal spray
• Provides an important alternative when naloxone is not available

If you or a loved one is struggling with opioid or alcohol addiction, our clinical team provides comprehensive medication-assisted treatment with ongoing medical monitoring. Contact our New Hampshire center at (603) 769-8981 or our Massachusetts center at (781) 765-0001 for a confidential assessment.

Safe Medication Practices in MAT Programs

Proper medication management is essential for the safety and effectiveness of any MAT program. At Clear Steps Recovery, Dr. Marasa oversees medication protocols that follow FDA guidelines and SAMHSA best practices.

Storage and Safety at Home

The FDA and SAMHSA recommend the following safety measures for patients taking MAT medications:

• Store all medications in a locked location out of the reach of children — liquid methadone can be mistaken for juice by young children
• Keep medications in their original containers with child-resistant caps
• Never share your prescription medications with anyone else
• Dispose of unused or expired medications through FDA-recommended drug take-back programs or by following FDA disposal guidelines

Medication Safety During Treatment

• Take medications exactly as prescribed by your treatment provider
• Inform your doctor of all other medications, supplements, and substances you are using — dangerous interactions can occur
• Do not stop MAT medications abruptly without medical guidance, as this can trigger withdrawal and increase relapse risk
• Keep naloxone available at home if you or anyone in the household is at risk of opioid exposure
• Report any side effects to your prescribing physician promptly

How Clear Steps Recovery Uses Medication-Assisted Treatment

At Clear Steps Recovery, MAT is integrated into a comprehensive treatment program that includes individual therapy, group counseling, family programming, and aftercare planning. Under the medical direction of Dr. Richard A. Marasa, MD, MBA, each patient receives an individualized medication plan based on:

• The specific substance(s) involved
• Medical history and co-occurring conditions
• Previous treatment attempts and outcomes
• Patient preference and lifestyle factors

Our MAT programs are available at both locations:

• New Hampshire: Clear Steps Recovery — Londonderry, NH — Call (603) 769-8981
• Massachusetts: Clear Steps Recovery — Needham, MA — Call (781) 765-0001

Learn more about our approach to medication-assisted treatment:

• Benefits of Medication-Assisted Treatment
• How MAT Transformed My Recovery
• Guide to Successful MAT Programs

Sources

• National Institute on Drug Abuse (NIDA). Medications to Treat Opioid Addiction Research Report.
• National Institute on Drug Abuse (NIDA). Efficacy of Medications for Opioid Use Disorder.
• Substance Abuse and Mental Health Services Administration (SAMHSA). Medications for Substance Use Disorders.
• U.S. Food and Drug Administration (FDA). Information About Medication-Assisted Treatment (MAT).
• National Institute on Drug Abuse (NIDA). How Can Prescription Drug Addiction Be Treated?
• World Health Organization (WHO). Community Management of Opioid Overdose.