Treating an Addiction to Painkillers

Opioid addiction isn't a moral or mental weakness. It's a chronic medical condition that results from changes in the brain in susceptible people. Once narcotic addiction has developed, escaping the cycle of detox and relapse is typically a long-term process.

Breaking free of prescription drug abuse takes much more than willpower. Fortunately, medications and counseling can improve the chances of success. Newer drugs like buprenorphine (sometimes combined with naloxone, a combination called Suboxone), naltrexone (given by mouth as the drug Revia or by a monthly injection called Vivitrol), and traditional therapies like methadone along with12-step programs are helping thousands of people stay on the road to recovery.

Physical Dependence and Detoxification

Narcotic addiction leads to real changes in certain areas of the brain. Prescription drug addiction alters the circuits responsible for mood and "reward" behaviors.

In addition, long-term prescription drug abuse affects virtually all the systems in the body. Cutting off the supply abruptly leads to opioid withdrawal symptoms.

Symptoms of opioid withdrawal include:

But for someone with an established narcotic addiction, a list of symptoms doesn't capture the agony of opioid withdrawal. The syndrome is intensely unpleasant, and people will do almost anything to avoid it.

Opioid withdrawal lasts from hours to several days -- and sometimes weeks -- depending on how long and how much a person has used their drug of choice. After the intense initial symptoms subside, some physical and mental discomfort may persist for weeks.

Medications for Opioid Withdrawal

Opioid withdrawal is difficult to endure, and is a major reason for relapse and continued prescription drug abuse. Medications are used to prevent symptoms of opioid withdrawal during detox, easing the person out of physical dependence:

Methadone is a long-acting opioid drug. It activates the same opioid receptors as other narcotics, effectively eliminating withdrawal symptoms. Providing the correct dose of methadone prevents opioid withdrawal symptoms and eases drug craving but it does not provide the euphoria. The dose can be slowly tapered off, freeing the person from physical dependence without withdrawal symptoms. Methadone is the most effective known treatment for narcotic addiction.

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Buprenorphine alone (Subutex) or buprenorphine plus naloxone (Suboxone) is a newer drug that helps with detox from opioid addiction. Buprenorphine activates opioid receptors, reducing drug craving and preventing withdrawal. Naloxone helps prevent misuse of the medication. Subutex is typically used for acute opiate detoxification, while Suboxone is used either for acute detoxification or maintenance prevention of opiate relapse.

Clonidine is a blood pressure medicine that acts on the brain. Clonidine reduces the effects of the "fight or flight" response, which is over-activated during opioid withdrawal. However, clonidine does not reduce drug craving and is less effective when used alone.

"Rapid detox" programs claim to accelerate the process of detox and opioid withdrawal by giving large doses of opioid blocking drugs. Some programs place an addict under general anesthesia during the detox process. These programs have not proven to be more effective than traditional methods of detox, and may be more dangerous.

Maintenance Therapy After Detox

Completing detox subdues the physical effects of narcotic addiction and opioid withdrawal. But experts say psychological and social factors are the main drivers that push addicts back to using. Stress and situations that remind the brain of the drug's pleasure are common triggers.

When drug cravings strike, they can be extremely hard to resist. Most people who only go through detox and short-term counseling without maintenance treatment will most likely relapse to prescription drug abuse.

Studies show that the chances of beating narcotic addiction are better with long-term maintenance therapy with either methadone or buprenorphine paired with naloxone (Zubsolv, Bunavail, Suboxone) . These drugs are used during the maintenance phase of treatment. People on these drugs are still opioid-dependent, but they are often freed from their destructive drug addiction. They can return to work, drive without impairment, and function normally in society. Naloxone has also been combined with oxycontin ( Targiniq ER ) to deter abuse by snorting or injecting the drug. A person can still become addicted by taking it orally, however.

Methadone is the best-studied, most effective method of recovery from narcotic addiction. Suboxone, while newer, has gained wide acceptance as maintenance therapy.

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A form of buprenorphone than can be implanted under the skin (called Probuphine) is now available to help prevent opiate relapse in people who have already completed detox and are stable on an oral form of buprenorphine. It provides a constant dose of buprenorphine for six months.

Some people have a high rate of relapse when maintenance therapy is stopped, and so they remain on the medicines indefinitely. In others, maintenance therapy is tapered off over months to years.

Naltrexone (ReVia, Vivitrol) is an opiate receptor-blocking medication used in maintenance therapy for narcotic addiction. Unlike methadone and Suboxone, naltrexone does not activate receptors at all, so it does not reduce opioid withdrawal or craving. However, because naltrexone blocks opiate receptors, a person won't get high if he or she uses drugs while taking the medicine. The drug is is most effective when used as part of a broader comprehensive recovery treatment program.

Counseling and 12-Step Programs

Narcotics Anonymous (NA) is an international network of community-based meetings for those recovering from drug addiction. Modeled after Alcoholics Anonymous (AA), NA is a 12-step program with a defined process for overcoming narcotic addiction.

NA is an abstinence-based program. In principle, NA is opposed to the use of maintenance therapy. Methadone Anonymous is a 12-step program that acknowledges the value of methadone or Suboxone in recovery from narcotic addiction.

Most experts and treatment centers recommend participation in a 12-step-based treatment program or other form of counseling. Therapy can take place as an outpatient, or in a residential facility. Alternatives to 12-step-based programs include:

  • Cognitive behavioral therapy
  • Motivational interviewing
  • Family and couples therapy

Recovery from prescription drug addiction can be expensive. However, it is far less costly in comparison with the cost of addiction and continuous use of drugs.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on July 16, 2016

Sources

SOURCES:

Carroll K.M.  American Journal of Psychiatry, 2005.
FDA. "FDA approves first buprenorphine implant for treatment of opioid dependence."
Kosten, T.R. New England Journal of Medicine, 2003.
Mattick, R.P. Cochrane Database of Systematic Reviews, 2003.
Medline Plus: "Opiate withdrawal."
Moore & Jefferson, Handbook of Medical Psychiatry, 2nd edition, Mosby 2004.
Narcotics Anonymous web site.
National Library of Medicine web site: "
Van den Brink, W. Canadian Journal of Psychiatry, 2006.

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