Opioid Replacement Therapy: Good or Bad?

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.

Vivitrol

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.

Suboxone

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.

Methadone

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.

Need Addiction Treatment?

If you or someone you love is battling an opioid dependence or addiction or an addiction to other substances, New Perspectives is here to help. Our recovery specialists have helped countless individuals with substance and behavioral addictions to begin the journey toward recovery. Don’t wait to start your new life—call us today at 855-463-0793 or connect with us online.

 

What are the Different Evidence-Based Addiction Treatment Approaches?

There is no one treatment program that works for everyone who struggles with addiction. The best treatment centers tailor programs for the individual based on a variety of options.

And the drug treatment industry has no shortage of choices when it comes to treatment approaches. Everything from outdoor therapy to the experimental use of powerful psychedelics like DMT is available in addiction recovery programs around the world. However, there are a few that are mainstays in the industry because of their proven track record in scientific studies. These approaches are called evidence-based addiction treatment approaches.

Evidence-based treatment is broken into two broad groups: pharmacotherapies and behavioral therapies. Usually, the effectiveness of these treatment options depends on the drug of abuse and the individual. The most effective treatment centers will individualize treatment by using many of the different approaches in conjunction with one another.

Pharmacotherapies

In addiction recovery, as with most other diseases, there are pharmacotherapy options available, which is the use of pharmaceutical drugs to promote healing. Prescription drugs are often used to curb the effects of withdrawal in detox but they can also be used as a substitute for the drug of abuse. Using replacement substances is a safer way to wean addicts off of a particular substance.

Opioid Addiction

Opioid addiction is a serious disease and can be difficult to recover from without treatment. However, there is an effective pharmaceutical that is commonly used to treat opioid addiction called methadone. Methadone is a synthetic opioid agonist that blocks withdrawal and reduces cravings. It’s widely available in the United States, with it being illegal in only three states. Methadone has been found to be more effective when paired with behavioral treatment.

Tobacco Addiction

Pharmaceutical treatments for tobacco addiction are probably the best-known forms of pharmacotherapy for addiction. Nicotine sprays, gum, and patches are all forms of nicotine replacement therapies (NRT). Nicotine replacement curbs withdrawal symptoms that may otherwise encourage continued smoking. It also introduces nicotine into the system in a way that avoids inhaling harmful smoke and tar into the lungs.

Another prescription that is used for smoking cessation is bupropion, sold under the name Zyban. It was originally sold as an antidepressant but it was found to have stop cigarette cravings. Because tobacco is an appetite suppressant, people who quit often gain weight. The similar appetite suppressing effects of bupropion also help smokers quit without gaining weight.

A drug called varenicline also can be used to treat tobacco addiction. The drug blocks the dopamine-releasing effects of nicotine which stops it from reinforcing addiction.

Alcohol Addiction

Several pharmaceutical drugs are used to treat alcohol dependence. Naltrexone is used to block opioid receptors that would otherwise cause alcohol rewarding effects. Other drugs, like acamprosate, are used to curb withdrawal symptoms and maintain abstinence. For alcoholics who are highly driven, Disulfiram is a drug that will impede your body’s process of breaking down alcohol, which causes nausea and palpitation if the user drinks alcohol.

Most pharmaceutical treatment options are made more effective when coupled with behavioral therapies. However, pharmacotherapies are often useful on their own.

Behavioral Therapies

Behavioral therapies are designed to work through addiction and other mental health issues psychologically. Different treatments may focus on providing motivation to persevere in abstinence, modifying attitudes and behaviors to avoid triggers, or working through deeper issues that may have led to addiction in the first place.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a treatment that was developed for alcohol addiction but later applied to marijuana, cocaine, methamphetamine, and nicotine. CBT focuses on changing thoughts and behaviors in anticipation of common pitfalls of addiction recovery. This often means identifying potential triggers and training your mind to handle them.

To effectively cope with cravings and stress, CBT helps people in recovery develop a strong sense of self-control. This helps them avoid or deal with high-risk situations and process cravings even after treatment is completed.

12-Step Programs

The 12-step program was developed and popularized by Alcoholics Anonymous (AA). Later it was also redesigned for stimulant and opiate abuse. The fundamentals remain the same across all addictions and are usually practiced in 12 steps that can be described in three basic principles:

  • Acceptance that drug addiction is chronic, it can’t be controlled with willpower alone, and that abstinence from the drug is the only way to combat it
  • Surrendering to a higher power and accepting help from fellow recovering addicts and the support structure of that community
  • Following the 12 steps and becoming involved in meetings and activities

Twelve-step programs are one of the most common treatment models across addiction treatment centers in the United States. Studies have examined the effectiveness of 12-step programs for alcohol and, to a lesser extent, drugs. Most agree that they are an effective, low-cost aftercare program.

Family Behavior Therapy

It’s often said that addiction is a family disease because of the effect it has on the people close to the addict. Because addiction hurts families as a whole, family behavioral therapy (FBT) aims to repair any damage done to relationships because of addiction. FBT involves talk sessions with the person in recovery and one or more family members or significant others. During sessions, behavioral goals are identified and reviewed in each subsequent session.

Do You Need Help?

Addiction is a serious disease, and the best treatment centers will offer a combination of evidence-based therapies as well as, other cutting-edge options. Call New Perspectives at 855-463-0793 today or contact us online to get in touch with an addiction specialist who can help you. Addiction can be scary, but treatment doesn’t have to be. We can help provide the right evidence-based treatment method for you.