Giving Medications Another Look

First, an important disclaimer—Mark Publicker, MD, has no financial ties with the pharmaceutical industry. He makes sure his audience understands that as it tries to process what he just said about the antialcohol medication naltrexone. He calls the drug “the most effective medication not being prescribed in this country.”

Dr. Publicker, medical director at Mercy Recovery Center in Westbrook, Maine, and a former regional chief of addiction medicine at Kaiser Permanente, urged his listeners at the SECAD 2005 conference this past December to integrate medications and behavioral therapies into their work. His message was targeted to counselors, who he says play the pivotal role in determining whether the addiction field ultimately will embrace medication treatments.

“Counselor support for medications makes a huge difference,” Dr. Publicker told attendees at SECAD, which was celebrating its 30th anniversary. “If counselors argue for these medications, that gives them a lot more credibility than if doctors argue for them.”

And Dr. Publicker says counselors are being swayed by mounting evidence of medications' effectiveness in combating cravings associated with substance use. In his home state of Maine, which he says has the nation's highest per capita rate of opiate addiction, counselors are the health community's biggest believers in buprenorphine.

Still, Dr. Publicker acknowledges how conflicted the field remains about medications (readers can see evidence of this in this issue's Letters and feature sections). Despite the fact that most of the drugs Dr. Publicker touts do not promote depen-dence, he still hears some 12-Step advocates suggest that people in recovery who are on antiaddiction medication should start their own separate fellowship.

To those professionals who haven't looked into the potential of newly available medications such as buprenorphine for opiate addiction and acamprosate for alcohol dependence, Dr. Publicker says it's time to get ready, because even more compelling discoveries are coming. Among those that he anticipates most eagerly are a form of naltrexone injected monthly (which is a couple of procedural steps away from a market launch this spring) and a cocaine “vaccine” that is in phase III trials.

If addiction professionals truly want to translate the field's science into better service for their clients, then the science should clearly be telling them that medications merit a more prominent role in treatment.