Opioid is the broad category of drugs that are either derived from poppies (heroin, morphine, hydrocodone) or are synthetic, but have similar properties (fentanyl, Demerol). Medical treatment for opioid addiction takes two general tracks.
The first is replacement therapy. Methadone is a synthetic opioid that can be taken orally by those addicted to more serious forms of opiates, like injectable heroin. Although this creates an addiction to methadone, addicts are better able to manage their lives and the replacement allows them to function more normally than heroin would.
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In the U.S., replacement therapy followed long after Europe and this may be because of an unpleasant accident of history that tainted the idea. After the civil war, some soldiers developed an addiction to morphine – partly due to wartime treatment of injury and partially due to the new way to administer drugs – the hypodermic needle had been invented at about the same time. A new drug became available that was touted as a ‘cure’ for morphine addiction and it did allow patients to stop taking morphine. The drug? Heroin (named after ‘hero’). The cure in this case was just as bad as the original disease. This may be why methadone treatment (replacing one addiction for another) took so long to emerge.
The second type of medical therapy for opioid addiction is to administer a drug that blocks the effects of narcotics. One such is naltrexone. A related drug, naloxone, acts like an antidote to opioids and is used to save lives in those who have overdosed. Giving it to addicts means they will not achieve the desired effects of their drug.
One difficulty with naltrexone is getting patients to stay on it. It does little to stop cravings and an addict can once again abuse when it wears off. There are time-release forms that extend coverage, but many addicts decide to go off naltrexone because their cravings become so intense.
Naloxone has recently been available in combination with a mild replacement drug, buprenorphine. This combination of naloxone and buprenorphine is marketed as Suboxone.
Suboxone can be prescribed by a physician on an out-patient basis to those who are dependent on opioids. It is administered orally (sublingual) in a five-stage process of Intake, Induction, Stabilization, Maintenance, and Medically Supervised Withdrawal. The advantage is that the combination seems to lessen cravings and the series can be administered without someone being confined to a treatment facility.
Other considerations
The drugs mentioned above are generally reserved for those taking illegal narcotics, and even then, only the most powerful types. Others, who are using less or less harmful types might still use Suboxone, but would probably not be a candidate for methadone.
Many addicts still go the traditional route of withdrawal and abstinence with no adjunct medications at all. There is also a middle ground where patients receive medications to help them sleep or deal with anxiety and do not get the more powerful replacement or blocking drugs.
Each situation is unique enough that a competent addiction specialist is needed to diagnose both the severity, what medications might be helpful, and to seek out any underlying psychological problems that are contributing to an addiction.
photo by Martin Henkelmann
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