Opioid Replacement Therapy: Good or Bad?

Although all drugs come with a certain risk of addiction, there are some found to be especially addictive compared to others. Among the most addictive substances are alcohol, tobacco, cocaine and crack cocaine, crystal methamphetamine, and heroin. Due to the severity of addiction that stems most notably from opiates like heroin, the opioid epidemic has called for drastic treatment measures.

In recent years, Opioid Replacement Therapy, also known as medication-assisted treatment, has become increasingly prevalent. The key to making a decision for what kind of treatment to choose comes from first understanding opioid addiction, then understanding available options, and finally weighing the pros and cons of each.

Classic Treatment Model

The preferred means of treating addiction, including opiate addiction, is typically an inpatient program at a residential treatment facility, beginning with a period of medically-supervised detox and followed by aftercare and possibly a period in a halfway house or sober living facility.

However, while inpatient and intensive outpatient programs have proven to be effective for many who suffer from dependency and substance abuse disorders, there’s no single treatment that works best for every addict. As such, it’s necessary for there to be a variety of addiction recovery treatments available in order to account for the diverse needs and preferences of the numerous individuals that are currently in need of treatment.

Opioid Replacement Therapy is considered an alternative to more traditional treatment programs, such as inpatient and outpatient recovery treatment, for treating opioid addiction and has remained very controversial. There are some who advocate very strongly for its efficacy while others tend to be adamantly against replacement therapy.

The Severity of Opioid Addiction

Arguably the most addictive mind-altering substance around, heroin has been well-documented in its ability to rapidly turn users into addicts and being so notoriously difficult for addicts to quit once dependence has developed. In fact, opioids in general and heroin in particular are so highly addictive as to be classified as its own affliction called opioid use disorder, characterized by the compulsive and uncontrollable use of opioids—heroin and pharmaceutical opioids such as morphine, hydrocodone, oxycodone, and so on.

Heroin addiction and opioid use disorder are the results of developing both physical and psychological dependence on the drug, sometimes referred to as dependence-withdrawal syndrome.

It’s often the fear and severity of withdrawal symptoms that keeps many who are addicted to opiates from seeking and participating in rehabilitative treatment. The onset of withdrawal symptoms can occur in as little as a few hours after the last dose and includes hot and/or cold flashes, anxiety, sudden increase or decrease in libido, muscle aches, teary eyes, mental fog and confusion, runny nose, sweating, insomnia, restless legs, yawning, and dehydration.

While these early withdrawal symptoms are unpleasant, it’s when they’re combined with the severity of advanced stage withdrawal that includes diarrhea, nausea, abdominal cramping, vomiting, and a marked increase in muscle and joint pain, that it becomes worse.

Not only is the withdrawal unpleasant, but to an addict who’s detoxing from opiates it can seem to last forever. Although the length of time that a heroin addict suffers from withdrawal symptoms will vary according to a number of factors—length of time spent in active opiate addiction, tolerance built to opiates, the amount of opiates that was being administered on a daily basis, and so on—it’s generally accepted that withdrawal symptoms will peak after a few days and will remain severe for about a week or possibly longer. Additionally, it can take as much as a few weeks for the symptoms to subside or for the addict to transition into much more manageable post-acute withdrawal.

What is Opioid Replacement Therapy?

Opioid Replacement Therapy, or medication-assisted treatment, has emerged as a treatment option for individuals suffering from addiction to heroin and other opiates. By definition, replacement therapy refers to treatment in which the individual replaces an illicit opioid like heroin or painkillers bought on the street with a non-euphoric, longer-acting opioid. The addict is administered the opioid substitution while under medical supervision.

These medications used in Opioid Replacement Therapy have various effects on the patients,  some inhibiting a euphoric response to opioids while others will act as a replacement of the opioid of choice completely.

Vivitrol

The first drug on the list for Opioid Replacement Therapy is Vivitrol. Vivitrol is considered an opioid blocking medication, meaning it prevents any euphoria or pain-relieving feelings to result when using opioids. It can be administered as an injectable via intramuscular gluteal injection or taken daily as an oral medication. It is also extremely effective in treating alcoholism by reducing the urge to drink. With the craving for alcohol removed, many have found cessation of drinking far easier with Vivitrol.

While Vivitrol removes the rewarding feelings from using opioids and alcohol, it does not counteract their effects. This means if you use opioids or alcohol while taking Vivitrol, you can still overdose.

Your chance for overdose is actually increased because you cannot feel the effects of the substances you’ve ingested, which can make knowing when to stop impossible.

This is why any addict seeking Vivitrol treatment is required to be clean off of drugs and alcohol for at least two weeks prior to commencement of treatment. This may present a problem to any addict or alcoholic suffering from a severe addiction. The patient will also not get off scot-free as far as this being an “easy-fix” for addiction. Additional counselling and monitoring is required by the health care provider during treatment. The shot itself is an integrated portion of the treatment program.

Suboxone

Perhaps one of the more recognizable methods for Opioid Replacement Therapy, Suboxone, or Naloxone, is another option for addicts. Suboxone has long been used in medical detoxes at inpatient treatment facilities around the world as a sort of step-down method when getting off of opioids. By using a Suboxone taper, many addicts are slowly weaned off of opioids.

Suboxone itself is a combination of buprenorphine and naloxone. Suboxone also acts as opioid blocker, which negates the use of any opiate.

Suboxone maintenance is one of the more popular treatments in the Opioid Replacement Therapy family, as its long term use does not cause damage to the internal organs. It also traditionally does not give the patient a feeling of euphoria or a “high” when administered in the correct dosage. Under the careful supervision of a health care provider, the appropriate dose is determined and it will regulate the opioid dependency of the patient.

It is important to note; however, that there is a dependency to the medication that the patient will develop. It is an opioid replacement. That means, the patient will have to remain on the medication for an elongated period of time. If the patient would ever want to stop using Suboxone, a taper much like the ones used in a medical detox, would be required. There is no going “cold-turkey” when on Suboxone and despite the taper, symptoms of withdrawal will be present.

Methadone

Of all the techniques, methadone (brand name Dolophine and Methadose) has been under the most scrutiny for its various side effects.

Methadone is available as a tablet, liquid, or an injectable. It is an opioid blocker as well as a craving and withdrawal symptom reductor. It is required to be taken once a day and it works for 24 to 36 hour increments of time. Methadone is only administered by a licensed medical health professional at designated dispensaries known as “Methadone Clinics.” Since it is a man-made opiate, much like morphine, much care and caution is used when providing methadone maintainence services.

When applying for this type of Opioid Replacement Therapy, a sort of vetting process is performed. You will not be administered the medication on your first visit. An initial screening by the attending health care practitioner is required. This determines the appropriate dosage required as well as if the patient is a good candidate for treatment.

Since the dispensement of the medication is almost always required to be on-site, by undergoing methadone maintenance, you will need to visit the clinic on a daily basis. After sometime, the doctor may allow you to occasionally take a small number of doses home with you, but that is not always the case. It is a very big commitment as you cannot miss even one dose.

There are also a multitude of risks associated with methadone use. If taken incorrectly, overdose can occur. In the last ten years, methadone overdose has increased by 5.5 times. A physical dependence on the medication is also inevitable, and should treatment ever need to stop, a withdrawal process will abruptly commence. It is thought to be a very intense withdrawal process as well.

The Pros and Cons of Opioid Replacement Therapy

As mentioned previously, replacement therapy has been a very controversial treatment for opioid addiction. Those who are against replacement therapy often argue that rather than recovering from addiction, replacement therapy is simply substituting one dependency for another and doesn’t help addicts to become independent from chemical substances. However, there are a number of arguments in support of replacement therapy, suggesting that it’s more a means of harm-reduction than of recovery.

Rather than addicts continuing to risk contracting infectious diseases and putting themselves in positions in which they might commit crimes while in active addiction, Opioid Replacement Therapy is a faster and less painful means of reducing some of the more serious risks associated with being in active addiction.

While Opioid Replacement Therapy might help those with a severe addiction to begin living a safer and healthier life, the biggest drawback to replacement therapy is that addicts remain physically dependent on a substance, albeit a substance that’s not illicit and one that reduces much of the risk associated with addiction rather than actually recovering from dependency.

There’s growing evidence that replacement therapy can be used in the initial stages of inpatient treatment as a means of tapering the severity of opioid withdrawal, but this isn’t yet a common practice and will require ongoing study to determine how this may beneficial to patients. There may be instances in which replacement therapy is an ideal option for some individuals suffering from opioid addiction, but it remains that the best journey from addiction will always be to recover from chemical dependency altogether.

If you or someone you love is suffering from addiction to opioids or other substances, Drug Treatment Center Finder is here to help. Our recovery specialists have helped countless individuals suffering from substance and behavioral addictions to begin the journey toward recovery. Don’t wait to start your new life—call us today at 855-619-8070.

Alyssa Harbina :