A Guide to Opioid Replacement Therapy

Opioid addiction is currently a public health emergency. Approximately 2.1 million American’s are suffering from some form of opiate addiction. Many of these are prescribed medications by their doctors. Addiction can set it quickly and many don’t even realize that they’re addicted.

Opioid addiction doesn’t just include the addict sitting on a street corner. It includes the housewife that may have a prescription for back pain. The businessman who may have a prescription for a sports-related injury. It may be you, or me, or someone you know well, and you may not even realize it.

Prescription pain medications can be as addicting as heroin. They may take over your life in the same fashion that street drugs do. If your prescription medications aren’t locked up, you may risk someone stealing them to use them as substitutes to their drug of choice.

Opioid replacement therapy can help with opioids addiction. On this article, we go into detail.

What Is Opioid Replacement Therapy?

Using opioid replacement therapy for replacing the use of opioids is frequently done to help treat addiction to opioid use such as heroin and other opioids. Addiction to opioids is quite strong and can change how the brain functions. Treating the addiction to opioid replacement therapy is done under medical supervision.

As the addict goes through the withdrawal from the use of opioids, the craving for the drug is overwhelming and this makes it very difficult to stop using opioids. It can be quite uncomfortable and very painful to stop the use of opioids, by using opioid replacement therapy the addict will have fewer symptoms and the ones that they do have will be far more manageable. This allows the addict to focus on their recovery.

opiods addiction

What medications are used in Opioid Replacement Therapy?

There are typically four different medications that may be used in opioid Replacement Therapy.

Doctors will choose which particular medication to use based on personal experience, how long the addict has been addicted, the level of addiction that the addict has and the particular medication that they feel will work best for the particular opioid that the addict was using.

These are the four medications that are typically used in opioid replacement therapy:

Suboxone

The medication suboxone has both naloxone and buprenorphine in the medication. The naloxone works as a deterrent to drug abuse and the buprenorphine works on the withdrawal symptoms that the addict is struggling with.

Suboxone for Opiate Replacement Therapy

Naloxone is classified as an antagonist which means that it can reverse the effects of an overdose on opiates. Thus, if an addict decides to get high on an opioid, and they’ve been taking their suboxone, the drug will have virtually no effect on them. Of course, some will attempt to inject the suboxone in lieu of taking their suboxone orally.

In which case, the addict will suffer from a variety of unpleasant withdrawal symptoms.

What Makes Suboxone So Special?

Since naloxone is antagonist, it works very well to deter the use of drugs. While some addicts will try to abuse suboxone, it does block the addict from getting high and can quell the cravings that they are struggling with. As long as the addict is following their regimen for taking their suboxone, they tend to do very well on suboxone. However, a few addicts have learned that if they wait long enough between doses, they can still sneak a high in.

The Downside of Suboxone

According to NIH.gov, a study with 600 prescription painkiller addicts used suboxone for 12 weeks. At the end of the study, approximately half of them decreased their drug use. Unfortunately, when the suboxone was stopped, less than 10 percent of the addicts refrained from further drug use.

Naltrexone

Naltrexone is another medication that is used in opioid replacement therapy. It is used in conjunction with counseling and behavioral contracts as well as lifestyle changes. It’s not used for addicts who are still using opiates or for those who are taking methadone. This would cause too sudden of a withdrawal.

How Naltrexone Works

Naltrexone is in the drug classification of opioid antagonists as well. It works directly on the brain to stop the sensation of euphoria or well-being in the addict. It also reduces the desire or drive to use opiates.

Other Benefits of Naltrexone

Naltrexone is also used in the treatment of alcoholism. It helps the alcoholic or addict to use less alcohol or even stop drinking entirely. Since it can be used for co addictions it’s often used for those who are struggling with opioid addictions as well as for alcoholism.

What to Watch Out for With Naltrexone

It reduces their desire when it’s used in conjunction with a treatment program that will offer counseling and lifestyle changes as well as support groups. Unfortunately, many addicts don’t want to make the right lifestyle changes to make Naltrexone work properly.

Methadone

Perhaps the most well known opioid antagonist, methadone is used often as an opioid replacement therapy. Methadone is a synthetic opioid and it’s very long-lasting. It works to reduce the cravings in the addict and to keep them from suffering from withdrawal symptoms. Methadone is frequently used in heroin withdrawal as well as some other opiates.

What is Methadone Replacement Therapy?

Taken as prescribed, it is effective and safe according to the SAMHSA or Substance Abuse and Mental Health Services Administration. Methadone blocks the painful withdrawal symptoms of opioid addiction and it doesn’t give any euphoric effects. It’s taken as a pill with water or it can also be in a liquid form. It’s taken once per day.

What Makes Methadone Different?

Methadone, as an opioid replacement therapy, is only dispersed when an addict is in a treatment program. A regular physician cannot distribute methadone. The treatment protocol is typically one year. Many addicts remain on methadone for several years. They will be tapered off of the methadone gradually until they no longer carve or desire any opioids.

Cons of Methadone

The use of methadone as an opioid replacement therapy has a success rate of approximately 60 to 90 percent per the California Society of Addiction Medication. Unfortunately, many addicts will misuse methadone in an effort to get high and wind up with an overdose of methadone in their system as it won’t ever give them the sensation of euphoria that they are seeking. Methadone is also only available when an addict is in a treatment facility and a regular doctor cannot prescribe methadone.

Buprenorphine

The other medication that is used in opioid replacement therapy is buprenorphine. It hasn’t been on the market as long as methadone. There are many differences in the way that buprenorphine is distributed and used. It can be given out as a prescription by a physician that has been specially trained. It’s more readily available than methadone and it also works to stop the cravings for opioids.

Buprenorphine for Opiate Replacement Therapy

Buprenorphine does give the addict a few effects like their opiates did, however, these effects are greatly reduced in comparison to the opiates that they were using. Buprenorphine has what is called a “ceiling effect” wherein even if the dose is increased, the effects will not change.

What Makes Buprenorphine So Special?

For this reason, buprenorphine is far less likely to be abused even though there are a few addicts who will abuse it.

The Downside of Buprenorphine

The effects are very mild when it’s given orally, however, if the addict were to mix it with water and inject it will become far more potent. If this is found to be happening the physician will have to change the type of opioid replacement therapy medication.

Cognitive Behavioral Therapy Or CBT

Cognitive Behavioral Therapy is a very effective means of dealing with opioid addiction. It works by helping the addict to connect their feelings, thoughts, and behaviors and when they are able to change these, they are able to learn how to anticipate cravings and triggers and avoid them.

Cognitive Behavioral Therapy gives the addict new tools for coping and dealing with their issues that triggered drug use in the first place. It’s frequently used in conjunction with opioid Replacement Therapy.

Group Therapy Sessions

Group Therapy Sessions

When considering opioid replacement therapy, group therapy sessions also come into play.

In group therapy, a group of addicts meets and work together to share their issues and struggles and glean helpful tips from others in the group. These are supervised, in most cases, by a licensed drug addiction counselor. It helps to know that they’re not alone on their journey to sobriety.

Group therapy may also include music and other complementary forms of treatment that work together to help relieve the anxiety and stress of addiction. Addicts will work closely with licensed therapists to learn how to change habits, make the right life choices, make the right lifestyle changes and find new ways to cope with stress and the desire to use drugs.

Benefits Of Opioid Replacement Therapy

Clearly, what works well for one addict may not work at all for another addict when it comes to opioid replacement therapy. Just as no two patients on pharmaceuticals will react the same way to medication, no two addicts will react the same way to medications used in opioid replacement therapy.

Medication-Assisted Treatment

Addicts who are determined to lead a clean and sober life are far more likely to be successful when using opioid replacement therapy.

By using medication for recovery, addicts are far less likely to overdose. They will have a decreased craving for the opioids and they will be far less likely to relapse to relieve their withdrawal symptoms.

Pros and Cons of Opioid Replacement Therapy

Due to the very nature of using an opioid replacement, some addicts become addicted to the opioid replacement medications. For this reason, they are always given under the direct supervision of a rehab center or in the case of some, a specially licensed physician.

Wrapping things up

Addiction is a complicated condition and many addicts themselves don’t understand addiction. It can rear its ugly head in any family regardless of socioeconomic status, regardless of how educated the person is and regardless of gender.

Choosing which Opioid Replacement Therapy to use will be a matter to discuss with the care team.

Making the choice to lead a clean and sober life is the first step to gaining freedom from drug addiction. Following the treatment plan and attending the therapy sessions as well as taking the proper medications at the proper times will go far in helping the addict to remain clean and sober.

After care should also be a consideration when considering the treatment plan. Without an after care plan many addicts find that they’re not getting the emotional support that they require to continue leading their life clean and sober after going through a treatment program.