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Opioid Abuse Treatment: Know Your Options

By  Gulnaz Khan
Everything you need to know about medication-assisted treatment for opioid abuse and addiction, including methadone, buprenorphine, and naltrexone.

Opioids are a class of drugs that interact with opioid receptors in the brain and body to reduce feelings of pain. These include oxycodone, morphine, codeine, heroin, and fentanyl.

Prescription opioids are often used for pain management and can be safe when taken for short periods as directed by a doctor. But long-term use and misuse of opioids—even when prescribed for medical reasons—can lead to dependence, overdose, and death.

What Is Opioid Use Disorder?

The DSM-5 defines opioid use disorder as “a problematic pattern of opioid use leading to clinically significant impairment or distress.” Signs and symptoms include tolerance, withdrawal, unsuccessful attempts to stop taking the drug, impaired functioning at school or work, and social problems related to opioid use.

In 2016, an estimated 2.1 million Americans had an opioid-related substance use disorder, but only 17.5 percent received specialty treatment, according to the National Institute on Drug Abuse.

Medication-assisted treatment

Medication-assisted treatment is clinically effective for treating opioid use disorder and reduces inpatient detoxification. FDA-approved medications are used in conjunction with counseling and behavioral therapy.

Schedule a consultation with a clinician to discuss treatment options—this might be a qualified physician, psychologist, psychiatrist, or nurse. During your initial assessment, your clinician will ask questions about your opioid use history, medical conditions, mental health history, and financial considerations.

Methadone is a controlled medication used to reduce craving and withdrawal, and block the effects of opioids.

  • Methadone is taken once a day in liquid, tablet, or powder form. It must be administered under the supervision of a physician through a certified opioid treatment program.
  • Methadone is dispensed during in-person clinic visits, but you may be permitted to take doses home between visits based on your stability and program compliance.
  • Treatment length varies. The minimum length recommendation is 12 months, but some patients require long-term maintenance.
  • When stopping treatment, you will work with your doctor to gradually reduce your dose to prevent withdrawal.
  • If you experience difficulty breathing, lightheadedness, rash, chest pain, hallucinations or confusion, or a pounding heartbeat, contact your doctor immediately.

Buprenorphine is another medication used to reduce withdrawal symptoms and cravings. It is also the first treatment medication that can be prescribed and dispensed by qualified doctors’ offices.

  • During the induction phase, a qualified doctor administers buprenorphine during the early stages of withdrawal (12 to 24 hours after abstaining from opioids.)
  • During the stabilization phase, you have significantly reduced or stopped using the problem drug and no longer have cravings. Your doctor may adjust or reduce your dose.
  • During the maintenance phase, you are on a steady dose of buprenorphine. Maintenance time varies and may be indefinite.
  • Buprenorphine is an opioid partial agonist, meaning it produces weak euphoric effects in low doses. Because this increases the risk of misuse, it is combined with the naloxone, a medication that reduces withdrawal effects.
  • Side effects may include nausea, vomiting constipation, irritability, craving, muscle aches, fever, and trouble sleeping.

Naltrexone is a medication used to treat substance use disorders by blocking the euphoric effects of opioids. Unlike buprenorphine and methadone, which activate opioid receptors, naltrexone blocks opioid receptors, eliminating the risk of misuse.

  • Naltrexone comes in a monthly injectable or daily pill form. Unlike buprenorphine and methadone which require special licensing, it can be administered by any healthcare provider licensed to prescribe medications.
  • You must complete managed withdrawal from opioids 7 to 10 days before receiving naltrexone.
  • Side effects may include headache, diarrhea, upset stomach, vomiting, trouble sleeping, joint or muscle pain, and nervousness. Seek medical advice immediately if you suspect liver injury, experience worsening injection-site reactions, or allergic pneumonia.