Treating Opiate Addiction With Replacement Therapy
- Medications currently available to treat addiction to heroin, OxyContin and other prescription opiates are called replacement therapies. This treatment can improve the health of addicted people and reduce the harmful impact of taking illicit drugs.
- Methadone is a long-established replacement therapy.
- A relatively new medication, buprenorphine, has been shown to be effective in helping opiate-addicted
New scientific understandings of brain chemistry are paving the way for significantly improved treatments
for people who are addicted to heroin, opium, legally manufactured pain relievers such as morphine,
OxyContin, Vicodin and Dilaudid and other opiate drugs.
Such improvements can't come a minute too soon. Twelve- to 17-year-olds are the fastest growing group
of people in the United States experimenting with such drugs. And opiates are highly addictive - one half
of all people who use them recreationally will need formal substance abuse treatment related to this
Opiate abuse can bring about significant and long-lasting chemical changes in the brain. These changes
cause a person to experience intense cravings and negative emotions when they try to stop. Because of
this altered chemical state of the brain, the majority of opiate-addicted people who recover require
medication in order to correct these changes, much as a diabetic requires insulin to maintain a more
normal blood sugar level. The most commonly used medications for opiate addiction in the United States
are methadone and buprenorphine. Health professionals call treatment with such medications
A common misconception about replacement therapy is that this treatment is really just substituting one
drug of abuse for another and that people who utilize medications in treatment of opiate abuse are not
really in recovery. This idea fails to recognize that recovering from opiate abuse is not a matter of will
power or moral re-examination. It is a physical illness most effectively treated by using medications such
as methadone and buprenorphine to assist the person in regaining physical stability and then helping the
person address other psychological and spiritual needs.
People with significant opiate addiction are unlikely to recover without some form of replacement therapy
as part of their treatment. On the other hand, replacement therapy alone is not nearly as effective as
combining it with other treatments such as counseling and self-help groups.
Addiction is a chronic illness like heart disease, high cholesterol or high blood pressure. Persons with
these chronic diseases are prone to relapse. The affected person deals with the symptoms associated
with their condition throughout the lifespan. Even in the best of circumstances the symptoms of a chronic
disorder may reappear periodically. This is particularly true during periods of stress or when a person
doesn't closely follow medical recommendations.
Unfortunately the failure to think of addiction in these terms has negatively affected the health of many
opiate-addicted people. This type of thinking often leads patients to be discharged from treatment if they
relapse. But the approach in the treatment of other chronic medical disorders, such as diabetes or heart
disease, is to continue to work with patients even when they do not do well in order to improve long-term
As we continue to learn that addiction is similar to other chronic illnesses, treatment programs are
beginning to adopt new ways of working with patients, sometimes called the harm reduction approach
Harm reduction approaches emphasize the need to shape treatment toward the individual needs of the
patient as opposed to forcing the patient to adapt to the demands of the treatment program's definitions of
recovery. Harm reduction is nothing more than:
- using practical treatment approaches to reduce the negative consequences of drug use,
- encouraging retention in treatment and
- improving the long-term health and general recovery of each addicted person as well as promoting
public health goals.
Important Facts About Replacement Therapy:
- Replacement therapy is not short-term; your friend or family member will need to remain on the
medication for years in order for it to be effective.
- Patients receiving methadone will initially need to be present at the program on a daily basis,
although as they become more stable the daily visits may take only a few minutes.
- Methadone patients can earn the ability to take home some dose of medication over time if they stop
the use of drugs and do well in treatment.
- Patients on replacement therapy, particularly methadone, may encounter travel restrictions, making it
difficult to visit family or take vacations.
- Methadone and buprenorphine are treatments for opiate addiction and will typically not stop the
abuse of other drugs.
- Replacement therapy is not a "magic bullet" and patients usually have to engage in counseling,
mutual help groups, or other forms of treatment to fully recover.
- Methadone side effects such as sedation, sweating, constipation and weight gain usually go away
after a person has been on the medication for a short time.
- In clinical practice it has been observed that buprenorphine produces few side effects, with headache
being the most common. Unfortunately this side effect does not usually fade with time.
- Clinical experience indicates that Buprenorphine can make some psychiatric symptoms worse and methadone may be a better choice in that situation.
FIVE THINGS TO KNOW ABOUT METHADONE
- 1. Methadone allows people to function normally by stopping withdrawal symptoms, eliminating craving
for opiates, blocking opiate induced euphoria, and correcting the neurochemical abnormalities in the
brain caused by opiate addiction.
- 2. Methadone maintenance is the most effective treatment we have for opiate addiction.
- 3. Methadone is the most cost-effective treatment for opiate addiction.
- 4. Participation in a methadone treatment program significantly reduces a person's risk of HIV and
Hepatitis C infection.
- 5. Methadone is the most widely used treatment for opiate addiction in the United States.
FIVE THINGS TO KNOW ABOUT BUPRENORPHINE
- 1. The use of buprenorphine allows people to function normally by stopping withdrawal symptoms,
eliminating craving for opiates, blocking opiate induced euphoria, and correcting the neurochemical
abnormalities in the brain caused by opiate addiction.
- 2. Buprenorphine is a safe medication with a low risk of overdose and very few side effects.
- 3. Buprenorphine can be prescribed by a personal physician in their office and allows patients to recieve
up to 30 days of medication at a time once they are stable.
- 4. Buprenorphine can be prescribed for young people with shorter histories of opiate addiction allowing
intervention early in the addictive cycle.
- 5. Buprenorphine is regulated differently from methadone, making it more like other prescription drugs.
This allows the person to more easily adapt the medication into his or her lifestyle and reduces the
negative attitudes often associated with methadone
FIVE IMPORTANT QUESTIONS TO ASK YOUR REPLACEMENT THERAPY DOCTOR
- 1. What are the risk and benefits to me of methadone and buprenorphine and how will you know if one
of these medications is the best one for me?
- 2. What are your program rules for continuation in treatment if I should relapse or be unable to stop my
- 3. Will I have input into my treatment plan that addresses my needs as an individual?
- 4. What happens if I become unable to pay for treatment?
- 5. Do you have referral relationships with specialty care providers if I need treatment for HIV, Hepatitis C
or become pregnant?