Heroin is considered one of the most powerful addictive substances and treatment for heroin dependence has only recently made progress from the traditional abstinence-only methodology. It is thought that the fear of withdrawal has as much an effect on keeping someone addicted as the cravings that come from not having the drug.
In 2000 the Federal Government addressed medications that are helpful for treating heroin addiction as part of the Drug Addiction Treatment Act (DATA). This new legislation clarified the role physicians may take in treating substance abuse patients.
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Old and new ideas about heroin treatment
The traditional medical treatments for addiction centered around getting patients through the initial withdrawal period and then relying on counseling to help them maintain abstinence. The success rate has always been very poor for heroin. Users would kick the habit and then, weeks or months later, return to using. Often, several cycles of withdrawal and treatment were needed to see any improvement in behavior.
Newer models add tools for physicians and treatment centers. One such is the ‘rapid detox’ where addicts are placed under anesthesia and given a narcotic antagonist. Their body undergoes the first stages of withdrawal while the patient is unconscious. This does eliminate initial withdrawal symptoms, at least from a patients experience, but it hasn’t been shown to improve overall recovery.
A second option is replacement therapy. The strategy is to give a related compound that is less addictive than heroin. Either methadone or buprenorphine will act on opioid receptor sites and mimic some of the effects of heroin.
Neither medication gives the ‘high’ that users get from heroin, but both can lessen withdrawal symptoms and help patients function in a more normal fashion. The idea is to allow patients to repair their lives while being maintained on a less addictive substance. Eventually, patients may be weaned off the replacement drugs.
Suboxone is gaining popularity with physicians and treatment centers. It is a combination of buprenorphine and naloxone. The buprenorphine helps reduce cravings (heroin replacement) and the naloxone inhibits the effects of narcotics (narcotic antagonist). The reason it is gaining popularity is that patients can safely use it as a ‘take home’ medication. It is not as addictive as methadone and taking it actually ruins the ‘high’ from heroin.
Suboxone requires special licensing to prescribe.1 This is because the DATA legislation linked its use with other treatment requirements.
photo by Rodrigo Valladares
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