Withdrawing from powerful opioids like fentanyl, oxycodone, hydrocodone, or heroine is hard. Opioid withdrawal symptoms can be both harshly unpleasant and long-lasting, and those withdrawal symptoms are often because of relapse.
Most addiction specialists agree that people in opioid recovery need medication-assisted therapy (MAT), specifically opioid-replacement therapy (ORT), that allows them to stay clean and sober so they can progress in their recovery and live safer, more productive lives.
The Benefits of Opioid Replacement Therapy
ORT provides opioid addicts with the ability to slowly wean from their drug while avoiding the worst withdrawal symptoms. It is referred to as a “harm reduction” strategy:
- Up to 65% of opioid abusers receiving ORT are able to completely abstain from illicit opioid use.
- Between 70% and 95% are able to significantly cut down their opioid use.
- IV drug users can immediately stop using needles, limiting the spread of such illnesses like HIV and Hepatitis.
- Guaranteed dosage, quality, and purity
- Encourages addicts to seek professional drug treatment.
- Having to check-in daily gives addicts much-needed structure, which in turn can help keep them clean and sober.
- Decreased rates of crime and incarceration.
- Increased ability to maintain personal relationships and keep a job.
Methadone Is the Traditional Choice
Since 1947, methadone has been approved for use in the United States as a treatment for opioid addiction. Methadone is the most commonly prescribed first-line treatment for ORT, and maintenance clinics around the country dispense dosages to many thousands of suffering and opioid addicts, giving them a fighting chance to recover.
But as important medication as methadone is, it is not without its problems:
Even though methadone is dispensed as a way to reduce the harm associated with addiction to other opioids, it is itself a highly-addictive and powerful opioid –up to five times stronger than morphine.
- In 2011, 4418 people died in the United States because of methadone poisoning.
- That number represents 26% of ALL opioid poisoning deaths.
- In 1999, the number of methadone deaths was only 790.
- In 2006, the FDA released a caution about the medication, saying, “Methadone use for pain control may result in death“.
Methadone Is Associated with Many Negatives
As with any medication, the positives of methadone – harm reduction – must be weighed against the negatives:
- Methadone has a high potential for abuse. This is why ORT dosages are so highly regulated and dispensed by clinics.
- It is possible to become dependent upon and addicted to methadone.
- Methadone is dispensed over the long-term. It is not unusual for a person to be on a methadone maintenance plan for over a year, and some individuals must take methadone for an even longer, indefinite period.
- A person can take methadone and still continue to use illicit opioids.
- While structure IS important to addicts, the rigid protocol of some methadone clinics can cause patients to feel that they have no control over their own lives and no input about their own treatment.
- Methadone will show up on employment drug screens, making it difficult for methadone patients to get or keep a job.
- Having to travel to the methadone clinic every day can be problematic for those patients who either have jobs or do not have a car.
- Require daily attendance at the methadone clinic can prohibit overnight travel.
- The clinical environment can result in lowered self-esteem.
- Methadone can interact dangerously with several other medications, particularly with benzodiazepines such as Klonopin, Xanax, or Valium.
- Drinking alcohol after taking methadone can be potentially fatal.
Methadone Is Associated with Many Negative Side Effects
For many people, the adverse side effects of methadone can be unpleasant enough to spur them into discontinuing the maintenance program:
- Breathing Difficulties
- Low Blood Pressure
- Chest Pain
- Constipation/Urinary Problems
- Nausea/Vomiting/Diarrhea/Stomach Pains
- Profuse Sweating/Intolerance to Heat
- Red, Flushed Appearance
- Exhaustion/Chronic Fatigue
- Sleep disturbances – Extreme Insomnia or Difficulty Staying Asleep
- Swelling of the Extremities
- Mood Swings – Anxiety, Agitation, Disorientation
- Blurred Vision
- Loss of Appetite/Anorexia
- Itching/Skin Rash
- Menstrual Problems
- Decreased Libido/Impotence/Difficulty in Achieving Orgasm
Is There an Alternative ORT Medication to Methadone?
In 2002, another medication was approved for ORT – the synthetic opioid Suboxone. Since that time, Suboxone has shown to be equally effective as a treatment for opioid dependence and is increasingly being used as a first-line option.
Suboxone has several advantages over methadone:
- Less potential for abuse – Suboxone’s unique formulation creates a “ceiling effect” on any high produced. It even limits the euphoria experienced by any other opioids that the patient may take. Less abuse potential also equates to less risk of overdose.
- Other uses – Suboxone can be used to treat depression and neonatal abstinence syndrome.
- Convenience – Because it has such a low potential for abuse, Suboxone can be prescribed for home use.
- Special populations – Suboxone is recommended over methadone whenever there is a risk of toxicity – the elderly, adolescents, or benzodiazepine users.
- Cognitive affect – Individuals taking Suboxone to achieve higher scores on attention tests then methadone patients.
- Physician preference – It is the opinion of most medical professionals that Suboxone is a safer choice than methadone. Consequently, the number of Suboxone prescriptions for ORT is increasing dramatically.
So Which Is the Right Option for YOU – Methadone or Suboxone?
The decision to take any medication always has to be the result of waiting for the potential benefits against the potential harm. The ORT medication that is best for you depends on your situation as an individual – your acceptance of the need for change, the severity of your drug problem, the support system that is available to you, etc.
If you are severely addicted to opioids and you are unlikely to stick to a program that requires you to take medication on your own, then methadone might be your best choice. Having to physically check-in at the methadone clinic on a daily basis may give you structure that can help keep you clean.
But if your opioid addiction is less severe, your support system is strong, and you are motivated to adhere to stay in treatment, then Suboxone is probably a better choice for you, primarily because it has lower abuse potential.
Whatever you decide, ORT should be combined with professional drug rehab that also addresses the other factors – social, emotional, psychological, medical, and spiritual – that contributed to the development of your addiction.