Heroin and other opiates are known to be some of the most addictive drugs out there, and to produce some of the most aversive and painful withdrawal symptoms. They are also some of the most deadly, accounting for nearly 70,000 overdose deaths in 2020 in the US.
However, some medications can help patients to detox from heroin and to remain clean by ameliorating these harsh withdrawal symptoms and easing their cravings for the drug while not posing the same risk and not having such strong intoxicating and euphoric effects, thus normalizing patients’ brain chemistry and allowing to pursue the emotional and psychological aspects of recovery more freely.
This is known as medication-assisted treatment, or opioid replacement therapy. And despite the stigma around this form of treatment, as some laypeople and even practitioners erroneously assume that it is just substituting one medication for another, it has been shown to be enormously beneficial for the otherwise difficult to treat patients suffering from this insidious disorder.
40-65 percent of patients were able to maintain abstinence from other opioids while on the medication and 70-95 percent able to reduce their use significantly, which are significantly better outcomes than with non-drug approaches. One 2015 study found that patients on medication-assisted-treatment relapsed at a rate fifty percent lower than did a control group.
Medication assisted treatment also significantly reduces mortality rates, rates of new HIV and hepatitis infections, and crime rates among opioid users while significantly increasing their ability to function socially and become employed and increasing their likelihood of staying in treatment. Some patients are eventually able to taper off of these medications and achieve full sobriety. But for others, it could constitute an effective long term solution, much the way other psychiatric medications like antidepressants can be considered effective long term solutions to other mental health disorders.
Three different types of medication have been approved to treat opioid use disorder, all of which work in slightly different ways. Methadone is a synthetic opioid agonist, which means that it acts on the same opioid receptors in the brain that opioid drugs do, though it does so more slowly, allowing patients to maintain a more stable mental state. It is prescribed in one daily dose, and patients generally must report to a methadone clinic every day to receive this dose.
The next drug, buprenorphine, is a partial opioid agonist, meaning that it bonds to these opioid receptors as well, but not as strongly as full opioid agonists do. Since it does have some potential for abuse, this drug is also tightly regulated, with a special waiver being required for prescribing physicians and patients subject to regular urine screenings to ensure they are not diverting their prescriptions.
Then there’s naltrexone, which has a different mechanism of action entirely, which works by blocking activation of opioid receptors. Instead of substituting for the opioids, it works by reducing cravings and preventing other opioid drugs from having euphoric effects, thereby virtually eliminating the motivation to use them. Since this drug has no abuse potential, it is subject to less restrictions in prescription, but should only be prescribed to a patient who has already completed a detox period to avoid worsening a patient’s withdrawal symptoms.
Naltrexone and buprenorphine are combined in the drug Suboxone, which reduces some of the latter’s abuse potential by inhibiting the euphoric effects. Buprenorphine and naltrexone are both also available in long-acting injections, which reduces the potential for a patient to skip or forget a dose.
Naltrexone is also sometimes used to treat alcohol use disorders as well, as it has a similar effect of reducing the euphoria associated with alcohol consumption, and other drugs like acamprosate, which works to reduce the aversive symptoms associated with alcohol withdrawal, or disulfiram, which makes alcohol consumption extremely aversive, are also sometimes prescribed to treat alcohol use disorders.
Though they are not perfect, with all of these medications coming with some risk of side effects, in combination with the right accompanying psychological treatment, any of them medications could be an extremely useful aid to patients who are motivated to recover from an addiction. In fact, given the incredible potential these medications have in aiding recovery, many believe that making these options less stigmatized and more widely available could be a way to save countless lives.
Medication assisted treatment is just one of the countless ways that someone can get sober and go on to live a happy, addiction-free life. To learn more about addiction, withdrawal, and how our team of experts can help you or a loved one through their recovery, call (833) 489-5577 today.