Opioid abuse and dependence affects nearly 5 million people in the United States and leads to around 17,000 deaths every year. Opioid addiction can involve prescription drugs (oxycodone, hydrocodone) or illegal drugs like heroin, or a combination of these.
Treatment options to help addicts recover include the following medications:
- Methadone: methadone is an opioid also and is typically used to help addicts to stop using heroin. Methadone therapy is intended to reduce withdrawal symptoms and cravings, not to get the patient high or substitute one addiction for another. It replaces heroin with a pharmaceutical product, but with some clear advantages. It is longer acting and can be given once daily. This helps patients to have a more stable lifestyle, with less criminal activity, needle sharing and other behaviors that contribute to morbidity and mortality among addicts. Unlike street drugs, it is a standardized dose and does not contain adulterants or contaminants. Methadone is only available at specialized methadone clinics for the treatment of addiction. A retail pharmacy may stock methadone but can only dispense it for treatment of pain, not for opioid addiction.
- Buprenorphine/naloxone (Suboxone, others): Buprenorphine is an opioid also, but unlike other opioids, it is a partial agonist, meaning it causes less of a high, and has a ceiling effect so that taking larger doses will not have additional effects. This makes it a safer option than methadone, which can be lethal in an overdose. Buprenorphine stops withdrawal and cravings. Naloxone is an opioid antagonist (a.k.a. Narcan) and it blocks the effects of opioids. However, naloxone is very poorly absorbed when taken sublingually (as Suboxone) and has been added to these products to alleviate concerns that the tablets would be dissolved and injected intravenously. Since naloxone is highly effective when given intravenously, injection of Suboxone or these other products would not result in a “high” for the user, as the naloxone would block the effects. Products like Suboxone are not as highly restricted as methadone and can be dispensed at retail pharmacies. However, physicians have to be certified to prescribe Buprenorphine products and can only treat a limited number of patients. A once-monthly injection of Buprenorphine is available called Sublocade, and a Buprenorphine implant that lasts for 6 months is also available. Read more about that here.
- Naltrexone: Naltrexone is an opioid antagonist like naloxone but is longer acting. It blocks the effects of opioids. This type of medication is harder to initiate since it requires the patient to do a complete detoxification from opioids before use. If given to a patient who is still opioid dependent, it will cause withdrawal symptoms. This medication is a good option for patients who are off opioids and are at risk of relapse. It can be useful for patients who have tapered off of methadone or Buprenorphine. Naltrexone comes in a once daily tablet or a monthly injection. Naltrexone can also be used to treat alcohol dependence.
For more information:
To find a treatment program: https://www.hhs.gov/opioids/treatment/index.html