Opiate Addiction Treatment

Opiate addiction treatment can help people stop using, or misusing, pain medications or heroin. Generally, prescription opioids are safe to use for short periods of time to relieve pain. But longer-term use, misuse, and abuse can lead to addiction or overdose. Many people begin using heroin as a replacement when their prescription for pain medication runs out. Heroin is a highly addictive and illegal drug. Even though opioid addiction can be a serious condition, it is highly treatable.

Opioids are a class of drugs that interact with the brain to provide pain relief. The interaction also causes a euphoric effect in the user, which can lead to misuse and abuse as he or she begins using the drug for the euphoric, rather than medical, effect.

In 2015, about 2 million people suffered from a substance abuse disorder associated with prescription opioids, 591,000 abused heroin, and more than 33,000 died from opioid overdose. Currently, approximately 115 people a day die as a result of opioid overdose. As a result, opioid misuse and addiction is considered a serious national crisis. Of people who have been prescribed opioids to treat chronic pain, it is estimated that:

  • 21 to 29 percent misuse them
  • 8 to 12 percent later develop an opioid use disorder
  • 4 to 6 percent switch to heroin after misusing their prescription
  • 80 percent of heroin users misused prescription opiates first

One of the main goals of the U.S. Department of Health and Human Services is to improve access to opiate addiction treatment and recovery programs for people who are struggling with addiction to prescription or illegal opioids. Effective treatment programs generally include a combination of psychotherapy and medications.

Psychotherapy to Treat Opiate Addiction

Several types of psychotherapy and behavioral counseling can be effective when treating people with opioid addiction. Addiction affects many parts of a person’s life and thus the treatment should also address affected areas. People who are addicted to opioids also often suffer from chronic physical pain. Because chronic pain can be difficult to manage emotionally as well as physiologically, strategies that deal with managing moderate pain and functioning despite the pain, can be very helpful.

  • Cognitive behavioral therapy (CBT) focuses on teaching strategies to identify and manage patterns of negative, unhelpful thoughts and beliefs that might be contributing to drug misuse. After identifying negative thoughts, the goal is to change those thoughts and beliefs to form new helpful behaviors, and discard unhelpful behaviors.
  • Motivational interviewing uses non-confrontational interviews between therapists and people suffering from opioid addiction, to discuss their addiction in a comfortable environment, without judgment. The goal is to help individuals deal with anxieties and doubt in order to find motivation to want to change. It is often used to help people who are suffering from both addiction and a chronic medical health condition. This type of therapy can be helpful in moving a person through the stages of change to find their inspiration to change.
  • Mindfulness-based stress reduction (MBSR) is designed to help people with addiction focus on the present and calm the mind and body in order to manage pain, illness and stress. The idea is to pay careful attention to environment, emotions, thoughts, and how the body feels, without judgement. The theory is that judgements could cause a person to dwell on, or get stuck in, negative thoughts, feelings or situations, which is considered an unhelpful behavior.
  • Contingency Management Interventions/Motivational Incentives is a form of therapy that is based in a system of learning that occurs through rewarding and/or punishing specific behaviors. It is often used in injunction with CBT or motivational interviewing, but can be used alone. The idea is that behaviors that are rewarded are likely to continue and those that are ignored or punished are likely to be reduced or eliminated. And if substance abuse is indeed affected by a sense of reward when using, the goal is to remove the reward and even replace it with some sort of undesirable consequence. Then next step would be to then reward the helpful, desired behavior, such as not using and attending treatment.

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Medication to Treat Opiate Addiction

There are three medications typically used in opiate addiction treatment: Methadone, Buprenorphine, and Naltrexone.

Methadone is one of the oldest and most effective medications used to treat addiction to opioids. It is a long-acting drug that works by changing how the brain responds to pain, and also reduces the euphoric effect of opioids. Methadone can be very helpful in reducing symptoms of withdrawal. When used to assist with withdrawal, it should only be administered by a medical health professional in a treatment program to monitor the individual and prevent emergency situations. While methadone is generally safe to use, it can be addictive. Side effects can be serious and may indicate a medical emergency. Side effects include:

  • Difficulty breathing
  • Chest pain
  • Rapid heart rate
  • Lightheadedness
  • Hives or rash and swelling of the face, lips, and mouth

Buprenorphine (Suboxone, Subutex) is a long-acting drug approved by the Food and Drug Administration in 2002 to treat opiate addiction. It works similarly to methadone but is shorter acting, further reduces the effects of euphoria, and is less addictive. Naltrexone can be combined with buprenorphine to decrease the likelihood of misuse. Buprenorphine is commonly used as a first-line medication during opioid withdrawal. And later it’s used in combination with behavioral change therapies. Buprenorphine is regulated but not as controlled as methadone, so it is easier to obtain and thus more convenient to use for many people.

Generally, buprenorphine is administered in three phases:

  1. Induction – Initial use is administered after a period of abstinence of 12 to 24 hours and during opioid withdrawal, which is medically monitored by a qualified specialist.
  2. Stabilization – When use or misuse has significantly diminished or stopped. Cravings and side effects have also ceased.
  3. Maintenance – When a fixed dosage of buprenorphine is sufficient to maintain the desired abstinence and elimination of cravings or side effects.

Common side effects of buprenorphine are:

  • Insomnia
  • Irritability
  • Muscle aches and cramps
  • Fever
  • Nausea and vomiting
  • Constipation

Naltrexone, extended release (Vivitrol) works by blocking opiate receptors to prevent the euphoria associated with opioids. It is used to help people maintain abstinence from opioid use. Unlike methadone and buprenorphine, naltrexone cannot reduce the symptoms of withdrawal.

In fact, people starting naltrexone must first be free of opioid dependence. Naltrexone tends to be most effective when used in combination with behavioral change therapies. Naltrexone can be combined with buprenorphine to enhance its effects. Most side effects do not warrant medical attention and will subside over time. But a physician can answer questions about them if needed. Common side effects include:

  • Anxiety
  • Abdominal pain
  • Fatigue
  • Headache
  • Joint or muscle pain
  • Nausea or vomiting

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a combination of behavioral counseling programs and medication therapy designed to treat the whole person and his or her individual concerns. Research has shown that MAT has the potential to be a particularly effective opiate addiction and withdrawal treatment. It can also potentially decrease opiate use, increase treatment retention and the ability to obtain and retain subsequent employment, and improve outcomes and survival rates. Medications used in MAT for opiate addiction treatment can only be obtained from a SAMSHA-certified Opioid Treatment Program (OTP).

Even though MAT appears to be a highly effective treatment, the Substance Abuse and Mental Health Services Administration (SAMSHA) reported that MAT therapy plan usage dropped from 35 percent in 2002 to 28 percent in 2010. Researchers believe one cause for the resistance to using MAT is the notion that it substitutes one form of addiction for another. In other words, critics believe that the opioid of choice is replaced by the therapeutic use of methadone or buprenorphine during treatment.

Opioid Addiction Relapse Prevention

The most effective treatment plans often have a component that addresses relapse prevention during recovery. Recovery can be a vulnerable time for people who once were dependent on opioids. Most relapse prevention plans are designed to include peer assistance and support services to help maintain sobriety.

Opioid addiction relapse plans generally include strategies to build a strong support system that can help with identifying and managing emotions, cravings, and stressors, and reinforce newly acquired problem-solving skills.

Opioid addiction can be a difficult condition to overcome. But with treatment, support, and a strong relapse prevention plan, individual outcomes, survival rates, and quality of life can be improved.