How to Treat Opioid Addiction
Prescription opioid and heroin addiction is one of the biggest public health problems currently facing the United Sates.1 In 2019, more than 1.6 million people struggled with an opioid use disorder, with an estimated 526,000 having a heroin-related opioid use disorder.2 That same year, close to 50,000 people died from opioid-related overdoses.3 In the 20 years spanning 1999 to 2019, close to half a million people died from opioid overdoses.
The consequences of opioid abuse and addiction are devastating. Fortunately, there are several effective treatment strategies and medications that are used to treat opioid addiction, giving people an opportunity to turn their lives around and enjoy fulfilling and long-term recovery.
How Do You Treat Opioid Addiction?
Opioid addiction is a chronic but treatable illness. There is no single “one size fits all” approach treatment. Moderate to severe opioid use disorder often requires continuing care for effective treatment. There are several forms of treatment for opioid use disorder, each with a strong evidence base.4 hey include: 4,5,6,7,8
- Medications: There are three FDA-approved medicines—methadone, buprenorphine and extended-release naltrexone—that were each found to be more effective in reducing illicit opioid use vs. no medication in randomized clinical trials. Treatment with methadone and buprenorphine have also been associated with reduced risk of overdose death, and a person can be started on either medication during inpatient or outpatient medical detox and may utilize them for as long as is appropriate to prevent relapse.
- Medical detox. This is a period of medically supervised withdrawal management that aims to minimize intense, uncomfortable symptoms and drug cravings typically experienced during withdrawal from heroin or prescription opioids. Detox and medication for opioid use disorder serves as a good entry point to further addiction treatment, and it is generally advised that medication is successfully integrated into further treatment.
- Residential rehab. A structured, drug-free social living environment combined with individual and group counseling services and round-the-clock support, residential programs set a solid foundation for addiction recovery.
- Outpatient programs. Different levels of care exist within the outpatient treatment spectrum to provide the appropriate level of care for an individual’s particular needs. These programs generally consist of individual and may also include group therapy. Outpatient programs vary in intensity; some programs require attendance in therapy many hours of the day most days per week while others require attendance only 1-2 hours of therapy per week.
- Mutual help groups. Active engagement in a mutual help group, such as 12-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), as well as groups like SMART recovery, offer peer and sponsor support and can teach and reinforce skills that help prevent relapse or a return to opioid use. They may be used to augment treatment or as “aftercare” to support continuing care after formal treatment.
- Sober living. These substance-free and recovery-focused living environments for those working to overcome addiction offer a supportive transition out of treatment and into daily life.
Greenhouse Treatment Center provides each of the above levels of care, as well as medications. Call us to learn more about our treatment programs at .
What Medications Treat Opioid Addiction?
The American Society for Addiction Medicine (ASAM) describes addiction as a chronic, treatable medical disease that involves “complex interactions among brain circuits, genetics, the environment and an individual’s life experiences.”10
Acknowledging this, the Substance Abuse and Mental Health Services Administration (SAMHSA) and ASAM both recommend evidence-based patient-centered care consisting of medication that’s been proven to be effective supplemented with necessary mental health services, addiction counseling and recovery support services.4,11
There are three FDA-approved medications for treating opioid use disorder: methadone, buprenorphine, and naltrexone.4
How Do Opioid Treatment Drugs Work?
Each of these drugs interact with the body’s opioid receptors in different ways:4,12
- Methadone is an opioid agonist that binds to the same receptors as other opioid drugs; however, it does so more slowly and will not produce euphoria in someone who is dependent on opioids. Methadone can effectively help to reduce or eliminate withdrawal symptoms and cravings to use opioids.
- Buprenorphine is a partial opioid agonist that binds to opioid receptors but activates them less strongly than a full agonist. It has a ceiling effect that limits feelings of euphoria but is still effective in reducing cravings and reducing the severity of withdrawal symptoms.
- Naltrexone is an opioid antagonist that works by blocking the activation of opioid receptors. This prevents the ability for an opioid to produce a high, but unlike methadone and buprenorphine, it also doesn’t help to control withdrawal or cravings to use opioids.
The use of naltrexone, which blocks the activation of opioid receptors, is typically not used during opioid withdrawal as it does not help to lessen the severity of withdrawal symptoms or reduce cravings to use opioids.4, 11 Naltrexone’s typically used to prevent relapse but only after complete detoxification.9 Naltrexone, unlike methadone or buprenorphine, has no abuse potential.13
Are Opioid Treatment Medications Safe?
Although it may seem counterproductive for someone addicted to an opioid to take another opioid-based medication, studies show that individuals with an opioid use disorder who undergo medical detoxification followed by complete abstinence are very likely to relapse or return to using opioids.12
Methadone, buprenorphine, and naltrexone have all been shown to increase the likelihood a person will remain in treatment, which in turn lowers risk of overdose, reduces risk of bloodborne disease such as HIV, and improves the likelihood of employment.14
Despite some risks (discussed below), long-term buprenorphine or methadone treatment is considered a critical part of successful opioid addiction treatment, and both medications have been proven to be safe and effective when combined with psychosocial treatment such as individual and group therapy, addiction counseling and referrals to mutual-help groups and other community services. 11
Methadone Use and Risks
When it comes to treating an opioid addiction, the traditional first-line of attack is methadone, an opioid agonist that’s been used since 1947 to reduce opioid use in individuals with an opioid use disorder.14
Methadone is recommended for individuals in a supervised treatment environment where daily dosing can be closely monitored. 11 Opioid treatment programs are required to monitor methadone administration to avoid misuse or illegal diversion.11
Methadone is not without its risks. As a full agonist, it can induce some of the same side effects as other opioids, and dosage must be carefully monitored by treatment programs to avoid over-sedation or overdose.11
Buprenorphine Use and Risks
As a partial agonist, buprenorphine causes fewer effects traditionally associated with opioids and at a lower intensity. 12 The risk of harms, such as a fatal overdose, are significantly lower than those of full agonist opioids (e.g., oxycodone, hydrocodone, heroin, etc.). 12
Like methadone, buprenorphine is closely regulated and requires federal approval to dispense. However, buprenorphine doses do not require supervised administration, and many programs and providers have been granted waivers by the federal government, which gives individuals the freedom to self-administer the medication at home. 12
As a long acting opioid with a high affinity for the body’s opioid receptors, buprenorphine interferes with the effects of full opioid agonists, such as heroin, by blocking their ability to bond with opioid receptors.15 Diversion of buprenorphine does occur, but it’s unlikely someone who has developed a dependence to full opioid agonists would choose to switch to buprenorphine in an effort to get or maintain a high. In fact, survey data shows that illicit buprenorphine use is often used to reduce withdrawal symptoms as well as reduce illicit heroin use. 15
Buprenorphine is sometimes combined with naloxone in a film that’s administered by dissolving it under the tongue. The naloxone has no effect when administered via this route, but should a person dissolve the film in water and try to inject it intravenously, the naloxone—an opioid antagonist—is activated and begins reversing the effects of any opioids in the system, which then precipitates withdrawal symptoms. 15
Buprenorphine is also available as a 6-month subdermal implant and a once-monthly injection that eliminates the need for daily dosing.12