What You Should Know About Medically-Assisted Treatments

Written by Buprenorphine Doctors

It’s ironic to admit on this webpage that the Internet’s webpages can confuse readers with its sheer volume of information. But any never-ending list of resources for opioid treatment risks concealing its vital information, and might discourage readers from searching for it.

So, straightforward clarification of relevant treatments become necessary in the avalanche of Internet articles on opioid addiction. Here are the things you need to know about four common relevant drugs used for medically-assisted treatments (MATs) in opioid addiction recovery.

Methadone

What is Methadone?

Methadone is a synthetic opioid used to relieve pain and to help those suffering from opioid addiction through their recovery. It was first developed as an alternative to morphine, and has served as a medical painkiller for decades. As a treatment for opioid addiction, it assists patients’ recovery from heroin, codeine, morphine, and others.

How does Methadone work?

Methadone, like all opioids, alters how the body’s pain receptors receive pain. Its pain relief somewhat lessens the physical suffering of opioid withdrawal, but methadone also reduces the body’s ability to achieve the euphoric high which opioids provide them. Methadone helps patients through painful withdrawal, but also reduces their cravings for more harmful opioids following that period.

How is Methadone administered?

Methadone is physically administered as a tablet, as a tablet which dissolves in liquid, a liquid, and a liquid taken orally. It is the main ingredient in the brands Dolophine, Methadose, and Methadone Diskets. Because methadone can be abused as an addictive opioid, it’s required that patients follow only the exact doses ordered by their doctors. Furthermore, prescription of methadone products requires federal accreditation through the Substance Abuse and Mental Health Services Administration (SAMHSA), as well as regulation on its exact uses from both the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA). Per federal law, methadone can only be administered in authorized opioid clinics.

Treatments using methadone vary according to the individual patients: some patients will need higher doses than others, some patients will need to visit methadone clinics to be treated while others can self-administer at home, and some patients will undergo longer methadone treatments than others. The recommended minimum for methadone patients is roughly twelve months, but treatments can often go much longer than this time period.

Methadone is prescribed as only one aspect of holistic recovery programs that also entail counseling and social support groups.

What are the risks of Methadone?

Methadone can be just as addictive as heroin, which might tempt patients to abuse it as a replacement opioid. Abuse of methadone can lead to a deceptive risk of overdose. A patient may not feel the effects of methadone very strongly in the body, and though it is there, the patient might take another dose to feel its effects more strongly. Doing so can cause a dangerous build-up of methadone in the body and risk overdose, which can be fatal. Methadone also comes with the possibility of painful withdrawal, and so patients must consult their doctors to begin tapering off methadone treatment, rather than ceasing its use all at once.

Look here, here, and here for more information on methadone.

Buprenorphine

What is Buprenorphine?

Buprenorphine is an opioid used to help those suffering from opioid addiction recover both during and after the initial withdrawal period. It was first discovered back in 1965 as a compound present in thebaine, and was later introduced into the market as buprenorphine hydrochloride in 1980.

How does Buprenorphine work?

Buprenorphine acts as a pain reliever that produces a small level of euphoria, though it’s a much lower level than opioids like morphine, heroin, or even methadone. This minor high helps addiction recovery patients weather the pain of opioid withdrawal. However, buprenorphine introduces a “ceiling effect” at a moderate dose, where the patient’s euphoria will no longer increase if the dose of buprenorphine increases. Because buprenorphine levels off this way, addiction to it and overdose from its use become less likely for its patients.

How is Buprenorphine administered?

Treatments using buprenorphine can be administered by ingestion of tablets or by placing buprenorphine in film form under the tongue, where the film dissolves. Buprenorphine is available as Suboxone, Subutex, Zubsolv, Belbuc, and Butrans.

Buprenorphine for opioid addiction recovery must undergo some federal authorization, though the process isn’t as rigorous as the regulations of methadone. This is because of the 2000 Drug Addiction Treatment Act (DATA), which permitted authorized physicians to dispense buprenorphine in more settings than just federally-approved methadone clinics. DATA allows buprenorphine prescriptions in office settings, community hospitals, correctional facilities, and health departments. The prescription of buprenorphine supplements the larger recovery program’s use of counseling and community support participation.

What are the risks of Buprenorphine?

As an opioid, buprenorphine presents the risk of abuse and addiction for the patients who use it in their treatment. However, due to its limited opioid strength and ceiling effect, the risk of abuse, addiction, and overdose are less than those of methadone. In addition, receiving naloxone or a similar medication alongside buprenorphine can make this small chance of addiction even less likely.

There is a chance that the patient will experience symptoms of withdrawal when attempting to use less buprenorphine. These effects include nausea, vomiting, cramps, sleeplessness, anxiety, and irritability. Like the chance of abuse, patients can avoid the side effects by taking buprenorphine exactly as their doctors instruct in doses and regularity.

Look here, here, and here for more information on buprenorphine.

Naltrexone

What is Naltrexone?

Naltrexone is a drug that acts as an opioid antagonist—counteracting the euphoric pain relief effects of opioid agonists such as heroin and morphine, as well as opioid treatments like methadone and buprenorphine. It can be prescribed to treat opioid addictions as well as alcohol abuse.

How does Naltrexone work?

Naltrexone blocks those receptors in the body which receive the highs of opioids and, with enough treatment, can prevent the body from achieving opioid euphoria entirely. Patients who used naltrexone have also reported decreased cravings for the opioids they were once dependent on. These outcomes can help patients resist relapse in the future.

How is Naltrexone administered?

Naltrexone can be taken for opioid addiction recovery as a tablet (likely as ReVia and Depade) or via injection (as Vivitrol). Patients may not receive naltrexone until they have completed 7–10 days of medically-supervised detoxification, to insure that their bodies are free of opioids. But all doctors who are licensed to prescribe medication are able to prescribe naltrexone without special federal regulation. Naltrexone enjoys relative ease of prescription and dispensation because there is no risk of patients becoming addicted to it. It is generally part of a larger recovery treatment that will likely include an opioid (methadone or buprenorphine), followed by counseling and participation in communal support groups.

What are the risks of Naltrexone?

As already mentioned, naltrexone poses no risk of addiction for its patients, because it blocks the body’s pleasure receptors rather than stimulating them as opioids do. However, a long-term treatment using naltrexone might increase the risk of overdose should a patient relapse following treatment. Naltrexone decreases the body’s tolerance for opioids, and should someone attempt to abuse opioids after naltrexone treatment, their body will respond less to their once-usual doses. Adding more doses to achieve the opioid high can cause a toxic build-up in the body, which could cause a fatal overdose.

There are also mild side-effects of naltrexone treatments: bodily aches and pains, headaches, nausea, tiredness, and anxiety.

To learn more about naltrexone, look here, here, or here.

Naloxone

What is Naloxone?

Naloxone is a medication designed to temporarily reverse the symptoms of opioid overdoses. It is an opioid antagonist similar to naltrexone.

How does Naloxone work?

Naloxone, as an opioid antagonist, prevents the body’s receptors from receiving the chemical high of opioids and relieves the respiratory slowing caused by opioid overdoses. It has a quicker effect than naltrexone, though it is more temporary.

How is Naloxone administered?

Naloxone can be used as an injection or as a nasal spray. The injection is available to use for both medical professionals and non-professionals, who can use an auto-injection device. That auto-injection is generally Ezvio, and the nasal spray is generally Narcan. Unlike naltrexone, naloxone can be administered in an emergency and doesn’t require the weeklong waiting period for opioids to exit the body.

Research and medical usage proves that naloxone is safe and effective, and so it has been made readily available for prescription. It can be featured as an opioid recovery treatment following doses of methadone or buprenorphine, all within a larger program that pairs these MATs with both counseling and participation in community support groups.

What are the risks of Naloxone?

Naloxone poses no risk of addiction, because it is an opioid antagonist. However, like naltrexone, treatment with naloxone can cause subsequent opioid use to become more dangerous. Presence of naloxone in the body can dull the expected high of opioids, leading to greater doses that will harm the body and possibly cause another overdose.

Naloxone can cause some minor side effects: nausea, sweating, nervousness, and increased heart rate.

To learn more about naloxone, look here, here, or here.

These four components of MATs for opioid addiction are certainly not the only options, but they are relevant to the ever-shifting response both doctors and lawmakers make. There is more information available at any of resources linked on this page for further reading. However, it’s important to understand that doses of these substances alone are not the complete formula to opioid recovery. Medications are a supplement to the time, community support, and counseling which full recovery demands from its patients.


Buprenorphine Doctors