Opioid addiction has been a crisis in the U.S for many years now. The media, government agencies, and the public are concerned with how to address this national epidemic.
Opioid-related deaths are a major concern, with overdose deaths related to heroin on the rise since 2007. The National Institute on Drug Abuse reports that there were more than 72,000 drug overdose deaths in 2017. The sharpest increases seen were related to fentanyl and synthetic opioids, with nearly 30,000 deaths.
The medical community is in agreement that opioid addiction is a serious threat to health, and treatment is needed for people with opioid dependency. Many people with opioid addictions become dependent after being prescribed opioids to treat intense conditions, such as chronic pain from injuries, pain due to surgeries, and pain from other debilitating conditions such as cancer.
People can quickly become dependent on opioid even after injuries and other conditions have resolved, leaving them to seek higher doses more frequently or find other sources for the drugs. Nearly 80 percent of people who use heroin had initially misused prescription opiates before turning to heroin.
Treatment for opioid addiction has evolved over the past several decades, as addiction specialists and researchers have learned more about addiction and treatment options.
Opioid drugs interact with brain chemistry to facilitate the release of dopamine, which combats symptoms of pain and also creates a sense of euphoria in the body. When the drug leaves the body, the brain experiences a drop in dopamine that can leave the person in pain, feeling depressed, and craving more of the dopamine flood in the brain.
This can become habitual. The body develops a tolerance to dosages of the drug over time. Therefore, it takes increasing levels of the drug to create the same sense of pain relief and euphoria, deepening the body’s dependency on the drug.
In the past, treatment for opioid addiction involved detoxing the person by gradually stepping down their dose and treating the symptoms of withdrawal until the drug was completely metabolized out of the body. After detox, behavioral therapy along with support groups continued the recovery process.
However, relapse rates for people with opioid addiction remained high.
One study reported that up to 91 percent of people in residential treatment for opioid detox and rehabilitation relapsed, with the initial relapse occurring within one week in 59 percent of cases.
Treatment centers found that providing methadone maintenance to people with histories of opioid addictions worked better than detoxing people from opioids altogether. Behavioral therapy is still an integral part of this model.
For the most serious addiction problems, medication-assisted treatment (MAT), in which the individual takes methadone or buprenorphine regularly, may continue for months or even years.
People who simply developed dependency after short-term use, such as after having surgery, do not need medication-assisted treatment. These people generally work with their doctor to step down their dosage and gradually wean off opioids. Most people in these circumstances have been taking their medication as prescribed and do not have serious addiction histories.
For other people with histories of addiction problems or who have been using large amounts of opioids for a long time, MAT will most likely be a better option for long-term success.
Research from the journal Substance Abuse Rehabilitation found that patients who were treated with buprenorphine had reduced chances of relapse and lower medical costs.
In case of an emergency, the medication naloxone can also be used to reverse an opioid overdose.
For long-term addiction treatment, a few MAT options are:
The choice between the different medications and treatment options will depend on a variety of factors, including individual addiction history, how much opioids are in the blood at the time of treatment, and individual tolerance to the medications.
There may be other considerations, such as what kinds of treatment are available in the area and the cost of treatment. Those who are engaged in MAT should also be involved in behavioral therapy or addiction support groups as well.
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Yes, people recover from opioid addictions every day. Addiction impacts the brain, and this is why it is considered a chronic illness. It is not something that can be cured, but it can be effectively managed for life.
It is important that people receive support from addiction specialists and have a treatment plan that addresses their specific needs. Most people will need to undergo a medically supervised detox in which they are treated with a customized protocol. For opioid withdrawal, MAT will likely be used.
Buprenorphine treatment blocks opioid receptors, so people cannot get high if they take other opioids while on their medication. This increases adherence to treatment.
Medications are not enough on their own. Individuals also need therapy.
There are other ways to measure progress other than just relapse rates. NIDA reports that methadone treatment not only decreases drug use but also increases participation in therapy and reduces criminal behavior. Keeping people engaged in other parts of their treatment plan is also a measure of progress and effectiveness.
The course of treatment recommended by most doctors is going to be based on an individual assessment. If you have developed a serious addiction over a long period, MAT is most likely going to be the most effective option.
A review of research published in the journal Innovations in Clinical Neuroscience concluded that methadone treatment continues to be an effective option for many patients, with buprenorphine treatment also offering promising results based on the available research. Methadone has been available for much longer than buprenorphine, but research continues to build demonstrating that MAT with buprenorphine is a good option.
Ultimately, doctors most frequently recommend evidence-based treatment. For opioid addiction recovery, this includes a combination of medical detox (often with the use of MAT), therapy, and ongoing aftercare.
The most important thing is to work with your treatment team, which may include a medical doctor, a psychiatrist, and various therapists, to create a recovery plan that works for you.
Recovery from addiction is a journey, and there will be difficult hurdles to overcome. But recovery from opioid addiction is possible. You can be successful with a comprehensive treatment plan and the right support.
How Effective is Drug Addiction Treatment? National Institute on Drug Abuse. Retrieved January 2019 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment
Lapse and relapse following inpatient treatment of opiate dependence. (June 2010). Irish Medical Journal. Retrieved January 2019 from https://www.ncbi.nlm.nih.gov/pubmed/20669601
Methadone Treatment of Opiate Addiction: A Systematic Review of Comparative Studies. (July 2017). Innovations in Clinical Neuroscience. Retrieved January 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880371/
(August 2018). Overdose Death Rates. National Institute on Drug Abuse. Retrieved January 2019 from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
(September 2018). Relationship between buprenorphine adherence and relapse, health care utilization and costs in privately and publicly insured patients with opioid use disorder. Substance Abuse and Rehabilitation. Retrieved January 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165853/
(June 2018). What are prescription opioids? National Institute on Drug Abuse. Retrieved January 2019 from https://www.drugabuse.gov/publications/drugfacts/prescription-opioids