Background: Substance use disorders (SUDs) are an increasing problem worldwide.
In the United States, there is currently an “opioid epidemic,” primarily initiated by the
over-prescription of opioid medications, barriers to continued access to those same medications,
and the eventual procurement of illegal opioids to prevent withdrawal. In addition to
the diversion of prescription opioids (especially oxycodone and fentanyl), other, more powerful
opioids (e.g., carfentanil) have found their way to the street. Of especial concern is the
number of adolescents who have access to legal- but diverted- or illegal drugs, as they are at
risk for developing SUDs. Clinicians in various treatment settings (such as primary care offices,
emergency departments, and mental health clinics) may lack the knowledge and training
to safely and effectively treat patients who have SUDs. Fortunately, there are several
pharmacologic agents that are approved for the treatment of opioid, alcohol and nicotine use
disorders in adults and several agents have been explored to treat cannabis use disorder. To
date, none of these medications have been approved for those indications in adolescents, although
they can be-and are- used off-label in that patient population. All medications can be
associated with adverse events, which are of particular concern in younger patients.
Objective: To address the most common adverse effects from medications used to treat substance
use disorders, and to offer suggestions regarding management of those unwanted effects.
Method: The method utilized was PubMed search, from January 1, 2002 through November
1, 2017, with cross-referencing medications used to treat SUDs, adverse events and their
Results: The substances addressed in this article (opioids, alcohol, tobacco and cannabis) are
the most commonly abused in the general population, and are the most likely to be associated
with adverse medical, psychiatric, social, financial and legal consequences. Medications used
to treat opioid, alcohol, tobacco and cannabis use disorders are described, along with important
adverse effects and their treatment.
Conclusion: Given that there is no “drug of choice” to treat any given SUD, the selection of
agent will depend on the patient’s personal characteristics (e.g., age, gender, medical status,
degree of social support, etc.) and preferences, and the prescriber’s knowledge, comfort, and
experience regarding the available medications. The pharmacotherapy of SUDs should always
be accompanied by psychosocial therapies.