The problem is that, while these drugs are statistically successful, they aren't necessarily instant sobriety in a pill. Some patients will still need counseling and group therapy to stay sober. Others won't find certain pills useful at all. "One thing that's clear is that some of these medications don't work in everyone," says Dr. Frank Vocci, director of the Division of Pharmacotherapies at the National Institute on Drug Abuse. "Doctors have to work with each patient on an individual basis and see what works for them."
That means managing both effectiveness and side effects, which also vary from person to person. Chantix is a great example of this. According to the Mayo Clinic, clinical trials of Chantix showed a 14 percent to 25 percent success rate over the course of a year. Miller, however, has seen a far higher rate of success in his practice—about 40 percent. The length of time patients have to take the meds can also differ. According to Miller, some patients could need to be on meds for their entire lives. Others will take a pill for several years and then wean off. Still others will only need a few months before they feel confident avoiding the addictive drug without medical help.
Side effects also seem to vary, particularly with Chantix. The main ones are nausea, vomiting, and headache—similar to what a young, first-time smoker might experience. But over the past few months, there have been reports of far more troubling problems: horrific nightmares, suicidal thoughts and irrational, erratic behavior. In September 2007, Texas musician Carter Albrecht was accidentally shot to death after showing up on his neighbor's porch in the middle of the night, ranting and demanding to be let in. His family blames Chantix for Albrecht’s behavior that night. In January of 2008, Pfizer, Chantix's maker, changed the med's labeling to caution doctors to monitor patients for severe mental side effects.
Who can prescribe them?
Some anti-addiction meds, usually the ones used to treat opiate addiction, can also be difficult to get. Suboxone, the pill "Kyle" credits with saving his life, can only be prescribed by doctors who have taken a special eight-hour training course or who've been certified by the American Board of Psychiatry and Neurology in Addiction Psychiatry, the American Society of Addiction Medicine, or the American Osteopathic Association. It can be hard to find these doctors and the best way to track them down is through the Federal Substance Abuse and Mental Health Services Administration. Part of the reason these drugs are so closely regulated is that they can cause withdrawal symptoms in some patients. Getting off a drug like Suboxone usually involves gradually scaling back the dose over several months or years.
Weighing the benefits
Experts in the field say the benefits Chantix outweigh its risks for most people and it shouldn't be taken off the market or avoided. "It does seem like in a minority of folks there is an issue, particularly people with current or previous psychiatric disorders,” Vocci says. “But for the majority, it's probably beneficial."
Miller agrees. "I'm concerned these reports will end up with people staying away from medicine that can really help them," he says. "If people don't recover from nicotine addiction it has a good chance of killing them. Not treating the addiction is a dangerous thing."
Instead, both doctors advise patients on any kind of anti-addiction medication to look at their meds as a tool that might need to be adjusted or changed. They say to report any odd or uncomfortable symptoms immediately and work with doctors to find a med that best balances health, quality of life, and the ability to stay clean and sober.
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