Treating Opiate Addiction With Replacement Therapy

by Scott Farnum, M.S., M.P.A., L.A.D.C., L.C.P.C., N.C.C.

Summary

• 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 people.

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 experimentation.

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 replacement therapy.

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 treatment outcomes.

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.