Medications used in treatment
Although no single recovery pathway is right for everyone, people who are addicted to opioids are usually more successful with medication-assisted treatment (MAT). This treatment uses FDA-approved medication together with counseling and behavioral therapies.
Three FDA-approved medications are used in the U.S. to treat opioid addiction: methadone, buprenorphine, and naltrexone.
Methadone is a long-acting medication that reduces cravings and withdrawal symptoms. It can block the euphoric effects of short-acting opioids, such as heroin.
Methadone is usually taken daily as a drinkable liquid. It can be dispensed only at licensed, federally-regulated opioid treatment programs, so having reliable daily transportation to a clinic is important while taking methadone.
Because methadone controls withdrawal symptoms and blocks cravings, people who are addicted to opioids tend to stick with it. This allows them to build a life in recovery and avoid the hazards and problems that come with illegal drug use. People who take methadone for a year or more have the best rates of success.
Methadone can work for people who have made other unsuccessful attempts to stop using opioids. It is a recommended treatment for opioid use disorder during pregnancy.
Buprenorphine works in a similar way to methadone, controlling withdrawal symptoms and blocking cravings. Buprenorphine is usually taken daily as a small film that must be dissolved under the tongue.
Most guidelines suggest people with shorter, less extensive histories of heavy opioid use may be good candidates for treatment with buprenorphine. It also works for more severe opioid use disorder and for people who decide to switch from methadone.
Buprenorphine can be a good choice for people who can’t regularly get to an opioid treatment program. Doctors who have completed a required training and certification process can prescribe buprenorphine for patients they see in the office. While the beginning of treatment usually involves frequent in-office visits, patients may be able to have a prescription to take at home.
Buprenorphine is widely available in a formula that contains added naloxone (commonly known as Narcan), which discourages abusing or injecting it.
Naltrexone blocks the ability of opioids to eliminate pain and induce euphoria. This removes the rewarding aspects of opioid use that result in a desire for more. It is available in either an extended-release injection that is given every 30 days, or in tablet form that is taken once a day by mouth.
Because of the way naltrexone blocks opioid receptors in the brain, it’s not a good fit for everyone. Before starting naltrexone, you need to get through an initial 7-10 days of withdrawal. People with chronic pain problems, who sometimes need to take opioid medications, should work carefully with their doctor about a pain management strategy before starting naltrexone.
Naltrexone works well for highly motivated people who are able to stop opioid use for 7-10 days prior to beginning treatment. It is a good option for those who are eager to eliminate all opioids. The injectable form is helpful for people who have a hard time keeping up with daily pills.
Since it is approved for treating alcohol problems as well, people taking naltrexone may find it also helps them avoid drinking.
(Page published: October 2019)