Which Opioid Replacement Treatments Give You the Best Odds for Long-Term Recovery?

More and more people are turning to opioid replacement treatments as an option for long-term recovery. Close to a million people in the United States suffer from some form of opioid use disorder – either heroin addiction or dependency on prescription painkillers.

With the epidemic on the rise, doctors and treatment centers alike have increasingly been using opioid replacement therapies to address the physical symptoms of opioid dependency in the United States. With so many different pharmacotherapies available for treatment, many patients are left asking: which opioid replacement treatment can give you the best odds for long-term recovery? There is no straightforward answer to this question.

What is Opiate Replacement Treatment?

In simple terms, opiate replacement treatment utilizes another form of prescription drug to mitigate the effects of withdrawing from either heroin or prescription painkillers. This approach has been shown to be effective for many people who struggle with addiction to heroin or prescription opioid drugs.

However, replacement therapies also have a set of limitations and risks. Addiction to opiates can be extremely pervasive, and it is crucial to implement other forms of addiction treatment even if replacement therapies are used. While Northpoint Recovery does not engage in medically managed treatment for drug rehab or detox, this post gives you all of the information you need to make an informed decision regarding replacement therapies.

“The development of effective treatments for opioid dependence is of great importance given the devastating consequences of the disease. Pharmacotherapies for opioid addiction include either detoxification or long-term agonist maintenance. Agonist maintenance therapy is currently the recommended treatment for opioid dependence due to its superior outcomes relative to detoxification. Detoxification protocols have limited long-term efficacy and patient discomfort remains a significant therapy challenge.”

~ Dr. Angela L. Stotts

Methadone Treatment for Opioid Addiction

One of the most common pharmacotherapies for treating opioid addiction is a methadone prescription. While controversial, methadone has been used for decades as a treatment for dependency on opiates (such as heroin) or prescription painkillers. Methadone is a common pharmacological option used in medication-assisted treatment for addiction, and is most commonly used in conjunction with both counseling and support groups during treatment. Methadone works in two primary ways:

  1. Methadone changes pain response in the brain and nervous system, therefore decreasing the symptoms associated with opiate withdrawal.
  2. Methadone blocks the euphoria caused by other opiate drugs (including heroin, morphine, codeine and oxycodone), therefore decreasing the addictive effects of these opioids.

How is Methadone Treatment Administered?

Methadone can be administered as a pill, a liquid, and even in wafers. It is only taken once every day, and usually administered in what are known as methadone clinics. More than that, most professional organizations recommend a long period of methadone treatment – the National Institute for Drug Abuse recommends a minimum of twelve months for methadone replacement therapy. Even then, the medication-assisted treatment should be stepped down gradually to avoid additional withdrawal symptoms associated with methadone use.

“Patients taking methadone to treat opioid addiction must receive the medication under the supervision of a physician. After a period of stability (based on progress and proven, consistent compliance with the medication dosage), patients may be allowed to take methadone at home between program visits. By law, methadone can only be dispensed through an opioid treatment program. Even if a patient feels that they are ready to stop methadone treatment, it must be stopped gradually to prevent withdrawal. Such a decision should be supervised by a doctor. Methadone can be addictive, so it must be used exactly as prescribed.”

~ Substance Abuse and Mental Health Services Administration

Is Methadone Treatment Effective for Opioid Dependence?

But what about the effectiveness of methadone treatment for opioid addiction? In reality, there is evidence both for and against the use of methadone in treating opioid addiction. For instance, a very recent academic study on methadone replacement therapy presented the arguments of two different doctors.

  • Doctor A makes the case that methadone as a replacement therapy for addiction treatment is well tested, cheap and acceptable in that it results in visible physical and psychological improvement during treatment.
  • Doctor B makes the case that methadone replacement treatment for opioid addiction is “philosophically ill-conceived”, ethically questionable, and very expensive. The same doctor also argues that methadone treatment can be harmful to patients in the long-run.

Clearly there is no consensus when it comes to the usefulness of methadone in treating opioid addiction. While many professionals argue that methadone can be extremely effective in helping people quit more dangerous drugs, like heroin, many others argue that methadone itself can be a dangerous replacement.

Despite the opposing opinions, research has shown that methadone maintenance therapy reduces drug injections and significantly reduces the death rate from opioid dependence. The effectiveness of methadone replacement treatment for long-term recovery, then, is a matter of perspective.

Buprenorphine Treatment for Opioid Addiction

Buprenorphine is another medication used in many opioid replacement treatments and long-term recovery, and is associated with many of the same benefits and drawbacks as both morphine and naltrexone. Because buprenorphine is both produced legally and used only with a prescription, there is very little risk of an overdose on the medication. Perhaps more importantly, there is no minimum length for using buprenorphine in managing withdrawal symptoms and cravings for drug addiction.

Unlike methadone, those in substance abuse treatment can come off buprenorphine treatment at any time – as long as they work with treatment providers to taper off of the effects of the medication.

“The person who takes buprenorphine feels normal, not high. However, the brain thinks it is receiving the problem opioid, so withdrawal symptoms stay away. Buprenorphine also reduces cravings. If cravings continue to be a problem, your doctor will adjust your medication or help you find other ways to reduce them. You are unlikely to overdose on buprenorphine if you take it properly. Buprenorphine is long acting. This means that after an initial period, your doctor may have you take the pill every other day rather than once a day.”

~ Substance Abuse and Mental Health Services Administration

How Should Buprenorphine Treatment be Used?

As with any replacement therapy, buprenorphine should only be used in conjunction with behavioral therapies and group support meetings, as well as consistent drug testing to ensure that the medication is not being abused. However, since buprenorphine cannot be used to get high, there is little chance that the drug will be abused. That said, the medication is associated with some side effects and should not be used at the same time as alcohol or illegal drugs.

Is Buprenorphine Effective in Opioid Replacement Therapy?

By way of effectiveness, multiple studies have shown that buprenorphine works to increase retention in long-term addiction treatment. This has been shown to be particularly true when buprenorphine is used only during the opioid withdrawal stage – that is, as a means of managing detoxification. Buprenorphine may therefore be most effective for those with a high risk of addiction to other forms of replacement medication.

Treating Opioid Addiction With Subutex

Subutex is a brand name for the drug, Buprenorphine. Subutex came out in October of 2002. It is given to patients in a pill form that is actually a sublingual tablet. Subutex is a mixed opioid agonist, which means it blocks the effects of opiates on the body.

Subutex comes in two different strengths. There is Subutex 2mg, and Subutex 8mg. Those with long-term addictions to opioid drugs might need a stronger form of this medication.

This drug works the best when it is given as soon as opioid withdrawal symptoms begin. It can be given as soon as 4 hours after the last dose of opioids has been taken.

Subutex Treatment and the Risk of Addiction

The main problem with Subutex is that it can lead to addiction in some cases. Most of the time, an addiction to Subutex doesn’t have the opportunity to occur. This is because the drug is usually stopped soon after is started. However, there may be some cases where keeping someone on Subutex long-term is preferable. In the event that this does occur, a Subutex addiction is possible.

Subutex addiction can occur when someone has been taking the drug for too long. It can also happen when Subutex is abused. Subutex abuse happens far too often. People can crush and snort the pills, or even dissolve them and inject them. Sometimes people simply take too many pills at one time to get high.

Even so, Subutex does seem to be a better alternative for opioid treatment than some other methods. This is why it has become so popular.

Suboxone Treatment for Opiate Addicts

One of the newest and most popular drugs on the market for opioid addiction is Suboxone. Suboxone is very similar to Subutex, but with one main difference. It also contains the drug, Naloxone in addition to buprenorphine.

Like Subutex, Suboxone was also released in October of 2002. This drug works by blocking the effects of opioids in the brain and body. It is quite effective. Suboxone comes in a few different forms. Suboxone 2mg and Suboxone 8mg are both available in a sublingual tablet. Even so, many doctors prefer to give their patients the sublingual film strips of Suboxone instead. The strips are believed to be more difficult to abuse.

Can People Form Addictions During Suboxone Treatment?

Unfortunately, many doctors choose to keep their patients on Suboxone long term. When they do, the risk of Suboxone addiction increases. Patients using this drug often don’t realize that addiction is possible. Those who take it long-term may experience some breakthrough symptoms of opioid withdrawal. This can cause them to take more of their medication than they should.

Of course, there are also individuals who abuse Suboxone by choice. They may hear that getting high with Suboxone is a possibility. Like Subutex, Suboxone can be dissolved and injected or crushed and snorted. It is also possible to dissolve the Suboxone film strips.

Naltrexone Treatment for Opioid Addiction

Naltrexone is another major medication utilized in medication-assisted treatment for opioid use disorders. In fact, the FDA has approved the medication to treat both opioid addiction and alcohol use disorders.

Naltrexone works differently than methadone and buprenorphine. Instead of suppressing cravings by activating opioid receptors in a limited way (as both former medications do), naltrexone simply blocks opioid receptors altogether. In this way, naltrexone has two primary effects:

  1. The medication reduces opioid cravings by binding with opioid receptors.
  2. The medication prevents getting high in cases of relapse, since naltrexone also blocks opioid receptors.

In other words, naltrexone can be used in the long-term to decrease cravings and to prevent getting high altogether. While methadone and buprenorphine can be used during detoxification, opioid detox should be completed at least a week before naltrexone is initiated into the system. Therefore, while naltrexone may be effective in decreasing cravings it is associated with at least one major danger: it can lead to an opioid overdose, since it heightens sensitivity to the drug.

“Patients who have been treated with extended-release injectable naltrexone may have reduced tolerance to opioids and may be unaware of their potential sensitivity to the same, or lower, doses of opioids that they used to take. Extended-release naltrexone should be part of a comprehensive management program that includes psychosocial support.”

~ Substance Abuse and Mental Health Services Administration

Everything in Moderation: Short-Term Use of Opioid Replacement Treatment

As the quote from SAMHSA highlights, pharmacotherapy options for opiate addiction treatment can be effective in getting someone started on the road to recovery. For instance, heroin rehab with medication can give those going through treatment the stability that they need to address the psychological and social impact of their addiction. It is crucial that any form of treatment for long-term recovery includes both counseling and support from family and friends, even if medication is used.

Medication alone should never be used as a primary form of treatment if long-term recovery is the goal – as it should be. Instead, medication-assisted treatment should be used in moderation and primarily as a short-term option for treatment. As the two opposing claims below highlight, opioid replacement treatment should be used in moderation. More specifically, three guidelines should be used when employing pharmacological options for opioid addiction treatment:

  • The goal should be to use medications on a short-term basis, since long-term use can lead to another form of dependency.
  • Medication like methadone, buprenorphine and naltrexone should be used in conjunction with behavioral therapies for addiction treatment.
  • Alternatives to opioid replacement treatments and long-term recovery should be explored before turning to this option.

Claim 1: Medication is Effective in Addiction Treatment

“If you are addicted, medication allows you to regain a normal state of mind, free of drug-induced highs and lows. It frees you from thinking all the time about the drug. It can reduce problems of withdrawal and craving. These changes can give you the chance you need to focus on the lifestyle changes that lead back to healthy living.”            

~ Substance Abuse and Mental Health Services Administration

Claim 2: Medication is not the Perfect Solution to Addiction Treatment

“So the opiate problem is not solved. There is no perfect drug or therapy, but it is still a certainty that the use of street heroin or synthetic opiates is extremely lethal. I have seen people use Narcotics Anonymous or Alcoholics Anonymous to get clean, and I have seen people use a combination of buprenorphine or methadone and [support groups] and live normal lives. The hope is change is still there.”

~ Dr. Joseph Troncale, writing for Psychology Today

So Which Treatment Gives You the Best Odds for Long-Term Recovery?

Based on this overview, it seems that buprenorphine may present the best odds for long-term recovery from heroin or prescription opioids. This might also be in the form of Subutex or Suboxone. This recommendation is based on two significant insights.

First, this form of opiate replacement therapy may prove most effective because buprenorphine is typically introduced as a short-term opioid replacement treatment, giving way to other rehab options for long-term recovery.

Second, patients are less likely to abuse and become dependent on buprenorphine because it acts as a partial agonist (rather than a full opioid agonist, such as methadone). This is a critical difference. Rather than introducing a new form of dependency for the long-term, as is the case with methadone and naltrexone, buprenorphine instead addresses the short-term cravings and withdrawal symptoms associated with an opioid use disorder.

The Best Way to Recover from Opioid Addiction

While the overview of each of the five pharmacotherapy options for opiate addiction treatment highlights buprenorphine treatment as one of the best options, this should not be the main takeaway from this post. Instead, the key insight gleaned from an overview of opiate replacement therapy is that this form of treatment for long-term recovery should be used selectively and carefully.

Opioid addiction treatment is complicated, and no one should rely primarily on medication replacement therapies for drug rehab. Instead, opioid use disorders and addiction should be treated with a combination of behavioral therapies, pharmacological options, and social support.

If you still have questions about opioid replacement treatments and the chances of long-term recovery, feel free to contact us today.

Sources:

Angela Stotts. (2010, August). Opioid Dependence Treatment: Options in Pharmacotherapy. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874458/

Joseph Troncale. (2014, May). Buprenorphine, Methadone and Opiate Replacement Therapy. Retrieved from: https://www.psychologytoday.com/blog/where-addiction-meets-your-brain/201405/buprenorphine-methadone-and-opiate-replacement-therapy

JR Robertson & AM Daniels. (2012, June). Methadone Replacement Therapy: Tried, Tested, Effective? Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/22693699

SAMHSA. (2015, September). Methadone. Retrieved from: https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone

SAMHSA. (2011). The Facts About Buprenorphine for Treatment of Opioid Addiction. Retrieved from: http://store.samhsa.gov/shin/content/SMA09-4442/SMA09-4442.pdf

SAMHSA. (2012). The Facts About Naltrexone for Treatment of Opioid Addiction. Retrieved from: https://store.samhsa.gov/shin/content/SMA12-4444/SMA12-4444.pdf

SAMHSA. (2016). Naltrexone. Retrieved from: https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone

Which Opioid Replacement Treatments Give You the Best Odds for Long-Term Recovery?
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By |2017-08-08T18:05:08+00:00July 5th, 2017|

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