Navigating Substance Misuse Treatment for Opioid Use
By Peg Rosen
Quitting opioids is one of the most positive changes you’ll make in your life. It’s also a really hard one, since getting off these drugs can be difficult.
The good news is that you don’t have to just tough things out. There are medications that can block your cravings and prevent withdrawal. Medication treatment for opioid use disorder, also referred to as medication-assisted treatment or medication for opioid use, can also reduce your chances of relapsing.
Some people may say that using meds to quit opioids is just swapping one drug dependence for another, but that is not correct. No one would tell a person with diabetes to get through their illness without medication. Addiction is a disease too. No one should tell you to turn down effective treatment for opioid use disorder.
Medication treatment isn’t a must if you choose to quit opioids. Many people are treated for opioid use disorder without medication. Health providers are working to change perceptions, however, because medication treatment is safe and effective, and it can help sustain recovery.
How Medication Helps You Quit Opioids
When you use opioids, they attach to receptors in your brain and cause a flood of chemicals called endorphins. Endorphins block pain and make you feel euphoric, relaxed, and detached from day-to-day troubles.
Over time, you can get used to this opioid high and may get to a point where you can’t imagine living without it. Your body changes too. It begins demanding more and more drugs to deliver the high it craves. Without enough drugs, you begin to feel symptoms of withdrawal.
There are three approved medications that can help with opioid use disorder. Some people need to stay on them for several months, some for a few years, and some forever. It depends on the severity of your addiction and how vulnerable you are to relapsing.
Each type of drug that’s approved to treat opioid addiction has its own pros and cons. Together with a health-care provider, you can find the one that is best for you.
Methadone
Methadone is a synthetic opioid, which means it is made in a lab. Because it is an opioid, it satisfies your body’s physical demand for the drug and decreases cravings and other symptoms of withdrawal. And because methadone works very slowly in your body, it doesn’t deliver a high when used appropriately.
Methadone is very strong and is often the preferred medication for people with severe, long-term addiction issues. It is also low in cost, especially if you go to a public clinic. Since methadone is an opioid, you become physically dependent on it over time and it can be abused. Patients taking the medication are generally required to go to a methadone clinic for their dose on a regular basis. If you stop using it, you’ll need to do it gradually and with medical supervision so you do not experience significant withdrawal.
Buprenorphine/Suboxone
Like methadone, buprenorphine is a synthetic opioid that satisfies your brain’s demand for opioids but doesn’t deliver a high when used appropriately. It is less likely to be abused than methadone because it only activates opioid receptors in the brain to a certain point.
Buprenorphine is typically prescribed as Suboxone, which is a combination of buprenorphine and another medication, naloxone. Naloxone is best known for its use in reversing opioid overdoses and saving lives. In this case, the purpose of adding naloxone to buprenorphine to create Suboxone is to make it less likely the medication will be used to get high.
When Suboxone is taken sublingually (under the tongue), as it is designed to be used, it acts as if it only contains buprenorphine. However, if Suboxone is crushed and injected (in order to try to get high), the naloxone kicks in, and rather than producing a high, it causes withdrawal.
A health-care provider can give you a prescription for buprenorphine to take daily on your own like any other medication. There is also a form of extended-release buprenorphine called Sublocade that is injected monthly. Like with methadone, you become physically dependent on buprenorphine over time. If you stop taking it, you’ll need to do it gradually and with medical supervision to minimize withdrawal.
In some cases, people taking Suboxone may experience withdrawal. This happens when someone takes Suboxone too soon after they last used an opioid, leading to withdrawal symptoms. That experience is difficult, but it does not mean Suboxone doesn’t work or isn’t worthwhile. Suboxone is effective when taken correctly at the right time.
Naltrexone
Naltrexone is a nonaddictive, nonopioid medication that doesn’t prevent withdrawal symptoms. It blocks opioid receptors, decreasing cravings and making it more difficult to get high if you use opioids. In order to be on naltrexone, you must clear all opioids from your system. That can take several days or even weeks, and you may need medically supervised detox to help get you through withdrawal.
In some cases, drugs like buprenorphine are used during the early stages of recovery, and then patients may switch over to nonaddictive naltrexone to prevent relapse. Naltrexone may also be used as an alternative when someone can’t tolerate other addiction medications. Some people may also prefer a drug that does no
What Else You Should Know When Considering Medication Treatment for Opioid Use Disorder
Medication may help relieve the physical challenges of quitting opioids, but it should be just one part of a larger recovery plan that includes counseling or other forms of support.
Talk therapy can help you figure out and work through the reasons you started using — or became addicted to — opioids, which can include depression, anxiety, trauma, a chaotic and unhealthy home life, pressure from friends, or a combination of those things or others.
Counseling, peer support programs, and 12-step recovery programs such as Narcotics Anonymous can also help you rebuild your life, learn coping skills to manage life’s stresses without drugs, determine if you need to be on medication for any mental health conditions, and adjust to living drug-free. Recovery centers and clubhouses are great places to find these.
There’s a lot to consider when it comes to how and where you’ll get the help you need. You will need to determine, for example, whether you’ll be better off starting at an inpatient rehab facility, where most of your care is under one roof and you’ll have 24/7 supervision, or if you should begin with outpatient rehab, where you live at home, possibly continue working or going to school, and travel to a facility on a daily or weekly basis for treatment.
You may also consider the following questions:
- Should you get counseling one on one, in a group, or both?
- Should you participate in a peer-led group, such as Narcotics Anonymous?
- Should your family also get help so they can support you in your recovery and cope with emotions and experiences related to your opioid use?
- What can you afford?
- What’s available where you live?
How to Get Started
Luckily, you don’t have to sort through all of this on your own. Your job right now is to take the first step toward getting healthy by reaching out to someone who can figure out what your best options are or help you find someone who can.
If it’s possible and comfortable for you, you might go to your parents or caregivers. You may also turn to another adult you trust, such as an older relative, family friend, school counselor, or coach. Then, with their support, you can reach out for guidance from professionals such as:
- Your primary-care provider. They’ll be able to assess your situation and do a physical exam. Depending on the severity of your addiction and what’s available where you live, they may prescribe medication and remain part of your care plan or refer you to a specialist or treatment center.
- A psychiatrist specializing in addiction. These physicians can prescribe medication and help you decide on next steps.
- A certified mental health counselor specializing in substance use issues. These licensed therapists provide talk therapy one on one or in small groups. They also typically know the best treatment options in your area and who can prescribe medication, and they can help you put together a care plan.
- Your school counseling office. If you’re in high school, your school nurse or the counseling office can be a good place to go. If you’re a college student, counseling centers are often plugged into the local recovery community and can connect you with therapists, support groups, and rehab programs.
- A local harm-reduction program. Many cities have clean needle exchanges and some have comprehensive overdose-prevention centers that provide clean, safe places for using drugs. They do not try to convince people to quit. If asked, though, they will provide counseling or will know where to refer you for help. They can also provide naloxone and contact emergency services if you overdose.
- The Substance Abuse and Mental Health Services Administration. Their Opioid Treatment Program Directory lists what’s available state by state.
This can all seem like a lot right now. Remember that you do not need to do everything at once, but rather take recovery step by step. The important thing is that you’re interested in doing something about your opioid use. Even if you’re not ready to quit now, it’s worth reducing harm and talking to someone. They can help you make a plan that reduces your risks while you are still using.
The road toward recovery can be a slow one, but with support, hope, and patience, you can get to where you want to be.
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