Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment. Preventing relapse is necessary for maintaining its effects. However, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen addressing all aspects of the life of a patient with addition, including medical and mental health services and follow up options like community or family-based recovery support systems, is crucial to the success of a patient in recovery because it helps the patient achieve and maintain a life free of drugs.

Buprenorphine

Buprenorphine is a partial agonist of opioid receptors that carries a low risk of overdose. Buprenorphine reduces or eliminates withdrawal symptoms associated with opioid dependence but does not produce the euphoria and sedation caused by heroin or other opioids. In 2000, Congress passed the Drug Addiction Treatment Act, allowing qualified physicians to prescribe Schedule III, IV and V medications for the treatment of opioid addiction. This bill created a major paradigm shift that allowed access to opioid treatment in general medical settings, such as primary care offices, rather than limiting it to specialized treatment clinics. Buprenorphine was the first medication approved under the Drug Addiction Treatment Act and is available in two formulations: Subutex®, which is a pure form of buprenorphine and the more commonly prescribed Suboxone®, which is a combination of buprenorphine and the opioid antagonist naloxone. Suboxone is a unique formulation with naloxone that causes severe withdrawal symptoms when addicted individuals inject it to get high. Physicians who provide buprenorphine treatment for detoxification and or maintenance treatment in office must have special accreditation. The government requires these physicians to have the capacity to provide counseling to patients when indicated or to refer patients to those who do. Treatment of opioid addiction in an office can be cost-effective approach that increases the reach of treatment and the options available to patients. Many patients have life circumstances that make treatment in the office of a physician a better option for than specialty clinics. For example, a recovering addict may live far away from a treatment center or have working hours incompatible with the clinic hours. Addiction treatment is available in the office of a primary care physician, psychiatrist and other specialists, such as internists and pediatricians. Patients stabilized on adequate, sustained dosages of methadone or buprenorphine can function normally. Recovering addicts can hold jobs, avoid the crime and violence of the street culture and reduce exposure to HIV by stopping or decreasing injection drug use and other risky sexual behavior. Patients stabilized on medications can also engage more readily in counseling and other behavioral interventions essential to recovery and rehabilitation.

Isotretinoin

A daily oral intake of vitamin A derivative isotretinoin (marketed as Accutane, Amnesteem, Sotret, Claravis, Clarus) over a period of four to six months can cause long-term resolution or reduction of acne. Doctors believe that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin research shows it to be very effective in treating severe acne and can either improve or clear well over 80 percent of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects (many of which can be severe). About 25 percent of patients may relapse after one treatment. In those cases, patients require a second treatment for another four to six months to obtain desired results. Doctors recommend that one allow a few months pass between the two treatments, because acne can actually improve somewhat over time. Occasionally a third or even a fourth course is used, but the benefits are often less substantial. The most common side effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa). Oral retinoids also often cause an initial flare up of acne within a month or so, which can be severe. There are reports that the drug has damaged the liver of patients. For this reason, doctors recommend that patients have blood samples taken and examined before and during treatment. In some cases, doctors terminate or reduce treatment due to elevated liver enzymes in the blood of the patient, which suggest a link to liver damage. Other dermatologists claim that the reports of permanent damage to the liver are unsubstantiated, and deem routine testing unnecessary. A doctor must also monitor the blood triglycerides. However, routine testing is part of the official guidelines for the use of the drug in many countries. Some press reports suggest that isotretinoin may cause depression but as of September 2005, there is no agreement in the medical literature as to this risk. The drug also causes birth defects if a woman becomes pregnant while taking it or takes it while pregnant. For this reason, female patients are required to use two separate forms of birth control or vow abstinence while on the drug. Many doctors only supply isotretinoin to women as a last resort after milder treatments have proven insufficient. The USA put into effect restrictive usage rules (see iPledge program) beginning in March 2006 to prevent misuse, causing occasioned widespread editorial comment.

Physical Medicine

Physical medicine and rehabilitation involves the management of disorders that alter the function and performance of the patient. Emphasis is on the optimization of function through the combined use of medications, physical modalities, physical training with therapeutic exercise, movement and activities modification, adaptive equipment and assistive device, orthotics, prosthesis, and experiential training approaches. Physical Medicine & Rehabilitation physicians may use electro-diagnostics, which are to provide nervous system functional information for diagnosis and prognosis for various neuromuscular disorders. The common electro diagnostic tests performed by physiatrists are nerve conduction studies and needle electromyographies. The nerve conduction study involves electrical stimulation to peripheral nerves, and the nerves' responses including such things as onset latency, amplitude, and conduction velocity. Needle electromyography requires needle electrode insertion into the muscles to detect the electrical potential generated from muscle fibers. Abnormal electrical potentials, such as fibrillation potential or positive sharp waves, detected by needles indicate the presence of muscle fibers that have abnormal nerve supplies. Common conditions that are by physiciaans include amputation, spinal cord injury, sports injury, and stroke, musculoskeletal pain syndromes such as low back pain, fibromyalgia, and traumatic brain injury. Cardiopulmonary rehabilitation involves optimizing function in those afflicted with heart or lung disease. Chronic pain management is through a multidisciplinary approach involving psychologists, physical therapists, occupational therapists, chiropractors, and interventional procedures when indicated. In addition to the previous methodology, stroke treatment is often with the help of a speech therapist and recreational therapist when possible.