Medications to Help You Kick Your Opioid Habit

Content provided by the Faculty of the Harvard Medical School
Excerpted from a Harvard Special Health Report

Medications for opioid addiction (see Table) help prevent or ease withdrawal symptoms and reduce cravings. Although sometimes criticized as "replacing one addiction with another," these medications can restore normalcy to people's lives and enhance their motivation to change.

Methadone (Diskets, Dolophine, Methadose). Methadone is the best-known and most frequently used medication for treating opioid dependence. Methadone binds to the same opioid brain receptors to which heroin, morphine, and prescription (synthetic) opioids bind. Compared with opioids of abuse, methadone remains attached to the receptor and continues to exert its effects for much longer. A single dose of methadone can ease or prevent opioid withdrawal symptoms and alleviate cravings for 24 to 36 hours.

Doctors use methadone to ease withdrawal symptoms among patients who are detoxifying (clearing their system of drugs). Some people opt to continue methadone indefinitely as a way to help them remain abstinent, a practice known as methadone maintenance therapy. The blood pressure–lowering drug clonidine (Catapres, Duraclon) and naltrexone are other medications sometimes used to help people detoxify from opioids.

When taken at appropriate doses, methadone does not produce a high. However, if you take a dose that exceeds your tolerance level, it can cause intoxication that ranges from a mild to a more intense high. As a result, methadone has street value and the potential for misuse. For these reasons, methadone is available only through specialized clinics that follow strict federal, state, and local regulations. These clinics typically couple methadone treatment with counseling and other types of support for people with opioid addiction. People report to the clinic daily to get their treatment. They also must regularly provide urine samples, so their clinicians can monitor them for any illicit drug use. Blood samples allow doctors to check if the person is getting the correct dose of methadone. Some clinics occasionally permit people who successfully abstain from illicit drug use and who do well in treatment to take multiple doses home, so they can cut back on the number of trips to the clinic.

Buprenorphine (Suboxone, Subutex). Buprenorphine is similar to methadone, but it can both stimulate and block opioid receptors, depending on the dose you take. Buprenorphine comes as a tablet or film that dissolves under the tongue. At lower doses, buprenorphine works mostly to stimulate the receptors; at higher doses, it does the opposite. Because of these properties, buprenorphine is less likely than methadone to lead to misuse.

Unlike people on methadone, people on buprenorphine need not attend a clinic to use the drug. Doctors in private practice can prescribe buprenorphine if they have the appropriate licensing and they also refer patients for drug counseling. Usually, a person starts by taking Subutex (which contains only buprenorphine) for two days and then switches to Suboxone, which contains buprenorphine and naloxone. The naloxone is added to discourage people from dissolving the tablet and injecting it in an attempt to get high. If a person injects Suboxone, the naloxone in the drug may cause them to develop withdrawal symptoms. But when the drug is dissolved under the tongue as directed, very little naloxone enters the bloodstream, so the patient feels only the effects of the buprenorphine.

Buprenorphine offers certain advantages over methadone: it is safer and its withdrawal symptoms are briefer. More importantly, it offers an alternative for people who are concerned about keeping their recovery treatment private. Some doctors propose that buprenorphine is most appropriate for people who are extremely motivated to abstain or who have mild dependence.

People taking buprenorphine should beware of two uncommon side effects: respiratory problems or impaired thinking. Driving or operating machinery may be unsafe, especially when first starting the medication.

Naltrexone (Depade, ReVia, Vivitrol). Although FDA-approved for use with people struggling with opioid addiction, naltrexone does not have a good track record of helping people stay opioid-free. The reason might be because naltrexone triggers withdrawal, so people often are unwilling to take it as directed. Long-acting naltrexone (Vivitrol), which is given by injection at the doctor's office and lasts for a month, might prove better at keeping people off opioids, but one review article concluded that there is not enough evidence to make that claim.

Naloxone (Narcan). Doctors sometimes use naloxone, another opioid antagonist, in two controversial forms of detoxification called rapid and ultra-rapid detoxification. Both techniques attempt to shorten the duration of withdrawal, which normally lasts five to 10 days, by displacing opioids still in the system and speeding the process. During ultra-rapid detoxification, people are anesthetized for 24 hours and are thus spared the worst aspects of opioid withdrawal. But some experts maintain that rapid detoxification is dangerous and not effective for treating addiction, in part because the process doesn't address the variety of other problems associated with addiction.

Generic name

Brand name

How it works

Common side effects

Comments

buprenorphine

Subutex

Eases withdrawal symptoms by binding to opioid receptors.

Headache, pain, insomnia, excessive sweating, constipation, nausea. Can trigger withdrawal symptoms if taken while opiate drugs are still in the system. Stopping medication abruptly can trigger withdrawal symptoms.

Taken in tablets or film dissolved under the tongue. Should not be taken until at least 24 hours after using other opiate drugs.

buprenorphine and naloxone

Suboxone

Eases withdrawal symptoms and blocks euphoria from opiates.

Similar to buprenorphine.

Taken in tablets dissolved under the tongue. May be prescribed for use outside a substance abuse clinic.

methadone

Diskets, Dolophine, Methadose

Eases withdrawal symptoms in a manner similar to buprenorphine.

Severely slowed breathing; irregular heart rate. Most dangerous at the onset of treatment. Large doses can produce a high similar to heroin. Can be habit-forming.

Taken as a pill, a tablet dissolved in juice, a liquid, or a concentrated liquid solution that must first be diluted. Also used to treat chronic pain. Must be taken at a substance abuse clinic.

naloxone

Narcan

Prevents an opioid high.

Very slow, very fast, or irregular heartbeat. May cause heightened pain sensitivity.

Taken by injection or intravenously. Taken as a pill when combined with buprenorphine (Suboxone).

naltrexone

Depade, ReVia, Vivitrol

Helps people stay off opiates by preventing opiate high in a way similar to naloxone.

Nausea, vomiting, and dizziness. Liver damage has been associated with large doses. Causes withdrawal symptoms if opiates are still in the body.

Taken orally or by injection. Works much longer than naloxone. Take seven to 10 days after last exposure to opiate drugs.

Last Annual Review Date: 2011-11-01 Copyright: Harvard Health Publications
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