Although all drugs come with a certain risk of addiction, some are found to be more addictive compared to others. Among the most addictive substances are alcohol, tobacco, cocaine and crack cocaine, crystal methamphetamine, and heroin. Due to the severity of addiction that stems most notably from opiates like heroin, the opioid epidemic has called for drastic treatment measures.
In recent years, opioid replacement therapy, also known as medication-assisted treatment, or MAT, has become increasingly prevalent. The key to deciding for what kind of treatment to choose comes from first understanding opioid addiction, then understanding available options, and finally weighing the pros and cons of each.
Classic Treatment Model
The preferred means of treating addiction, including opiate addiction, is typically an inpatient program at a residential treatment facility, beginning with a period of medically supervised detox and followed by aftercare and possibly a period in a halfway house or sober living facility.
However, while inpatient and intensive outpatient programs have proven to be effective for many who suffer from dependency and substance abuse disorders, no single treatment works best for every person who in active addiction. As such, it’s necessary for there to be a variety of addiction recovery treatments available to account for the diverse needs and preferences of the numerous individuals that are in need of treatment.
Opioid replacement therapy is considered an alternative to more traditional treatment programs, such as inpatient and outpatient recovery treatment, for treating opioid addiction and has remained very controversial. There are some who advocate very strongly for its efficacy while others tend to be adamantly against replacement therapy.
The Severity of Opioid Addiction
Arguably, the most addictive mind-altering substance around, heroin has been well-documented in its ability to rapidly hook people on it and being so notoriously difficult for people to quit once dependence has developed. In fact, opioids in general and heroin, in particular, are so highly addictive as to be classified as its own affliction called opioid use disorder, characterized by the compulsive and uncontrollable use of opioids—heroin and pharmaceutical opioids such as morphine, hydrocodone, oxycodone, and so on.
Heroin addiction and opioid use disorder are the results of developing both physical and psychological dependence on the drug. This is sometimes referred to as dependence withdrawal syndrome.
It’s often the fear and severity of withdrawal symptoms that keeps many who are addicted to opiates from seeking and participating in rehabilitative treatment. The onset of withdrawal symptoms can occur in as little as a few hours after the last dose and includes hot and/or cold flashes, anxiety, sudden increase or decrease in libido, muscle aches, teary eyes, mental fog and confusion, runny nose, sweating, insomnia, restless legs, yawning, and dehydration.
While these early withdrawal symptoms are unpleasant, it’s when they’re combined with the severity of advanced stage withdrawal that includes diarrhea, nausea, abdominal cramping, vomiting, and a marked increase in muscle and joint pain, that it becomes worse.
Not only is the withdrawal unpleasant, but to a person who’s detoxing from opiates, it can seem to last forever. Although various factors determine how long a person with heroin addiction will experience withdrawal symptoms—length of opiate/opioid addiction, opiate/opioid tolerance, the number of opiates that was being administered daily, and so on—it’s generally accepted that withdrawal symptoms will peak after a few days and remain severe for about a week or possibly longer.
Additionally, it can take as much as a few weeks for the symptoms to subside or for the person to transition into much more manageable post-acute withdrawal.
What Is Opioid Replacement Therapy?
Opioid replacement therapy, or medication-assisted treatment, has emerged as a treatment option for individuals with heroin addiction and other opiates. By definition, replacement therapy refers to treatment in which the individual replaces an illicit opioid like heroin or painkillers bought on the street with a non-euphoric, longer-acting opioid. The addict is administered the opioid substitution while under medical supervision.
These medications used in opioid replacement therapy have various effects on the patients, some inhibiting a euphoric response to opioids while others will act as a replacement of the opioid of choice completely.
The first drug on the list for opioid replacement therapy is Vivitrol. Vivitrol is considered an opioid-blocking medication, meaning it prevents any euphoria or pain-relieving feelings to result when using opioids. It can be administered as an injectable via intramuscular gluteal injection or taken daily as an oral medication. It is also extremely effective in treating alcoholism by reducing the urge to drink. With the craving for alcohol removed, many have found cessation of drinking far easier to do with Vivitrol.
While Vivitrol removes the rewarding feelings from using opioids and alcohol, it does not counteract their effects. This means if you use opioids or alcohol while taking Vivitrol, you can still overdose.
Your chance for overdose is actually increased because you cannot feel the effects of the substances you’ve ingested, which can make knowing when to stop impossible.
This is why a person seeking Vivitrol treatment is required to be free of drugs and alcohol for at least two weeks before starting the treatment. This may be a problem for a person who is struggling with a severe addiction. The patient will also not get off scot-free as far as this being an “easy fix” for addiction. Additional counseling and monitoring are required by the health care provider during treatment. The shot itself is an integrated portion of the treatment program.
Perhaps one of the more recognizable methods for opioid replacement therapy, Suboxone, is another option for people in addiction recovery. Suboxone has long been used in medical detoxes at inpatient treatment facilities around the world as a sort of step-down method when getting off opioids. Many people in recovery are slowly weaned off opioids with a Suboxone taper.
Suboxone itself is a combination of buprenorphine and naloxone. The prescription medication also acts as an opioid blocker, which negates the use of any opiate. Suboxone maintenance is one of the more popular treatments in the opioid replacement therapy family, as its long-term use does not damage one’s internal organs. It also traditionally does not give the patient a feeling of euphoria or a “high” when administered in the correct dosage. Under the careful supervision of a health care provider, the appropriate dose is determined, and it will regulate the opioid dependency of the patient.
It is important to note, however, that the patient can develop a dependency on the medication. It is an opioid replacement. That means the patient will have to remain on the medication for an extended period. If the patient would ever want to stop using Suboxone, a taper much like the ones used in a medical detox would be required. There is no going “cold turkey” when on Suboxone and despite the taper, withdrawal symptoms likely will be present.
Of all the techniques, methadone (brand name Dolophine and Methadose) has been under the most scrutiny for its various side effects.
Methadone is available as a tablet, liquid, or an injectable. It is an opioid blocker, and it reduces drug cravings and withdrawal symptoms. It is required to be taken once a day, and it works for 24- to 36-hour increments. Methadone is only administered by a licensed medical health professional at designated dispensaries known as “methadone clinics.” Since it is a man-made opiate, much like morphine, much care and caution are used when providing methadone maintenance services.
When applying for this type of opioid replacement therapy, a sort of vetting process is performed. You will not be administered the medication on your first visit. An initial screening by the attending health care practitioner is required. This determines the appropriate dosage required as well as if the patient is a good candidate for treatment.
Since the dispensement of the medication is almost always required to be on-site, by undergoing methadone maintenance, you will need to visit the clinic on a daily basis. After some time, the doctor may allow you to occasionally take a small number of doses home with you, but that is not always the case. It is a very big commitment as you cannot miss even one dose.
There also are a multitude of risks associated with methadone use. If taken incorrectly, overdose can occur. In the past 10 years, methadone overdose has increased by 5.5 times. Physical dependence on the medication is also inevitable, and should treatment ever need to stop, an intense withdrawal process may abruptly start.
The Pros and Cons of Opioid Replacement Therapy
As mentioned previously, replacement therapy has been a very controversial treatment for opioid addiction. Those who are against replacement therapy often argue that replacement therapy is simply substituting one dependency for another and doesn’t help people with an addiction to become independent from chemical substances. However, some arguments support replacement therapy, and they suggest that it’s more a means of harm reduction than of recovery.
Opioid replacement therapy is a faster and less painful means of reducing some of the more serious risks associated with being in active addiction, such as contracting infectious diseases or committing crimes.
While opioid replacement therapy might help those with a severe addiction to begin living a safer and healthier life, the biggest drawback to replacement therapy is that addicted people remain physically dependent on a substance, albeit a substance that’s not illicit and one that reduces much of the risk associated with addiction rather than actually recovering from dependency.
There’s growing evidence that replacement therapy can be used in the initial stages of inpatient treatment as a means of tapering the severity of opioid withdrawal, but this isn’t yet a common practice and will require ongoing study to determine how this may be beneficial to patients. There may be instances in which replacement therapy is an ideal option for some individuals with opioid addiction, but it remains that the best journey from addiction will always be to recover from chemical dependency altogether.
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