Medications for Opioid Use Disorder Explained

Misuse of prescribed opioid drugs, diverted opioid medications, and illicitly acquired heroin can lead to opioid use disorder (OUD). Like general substance use disorders, OUD is a relapse-prone and chronic condition linked to a considerably higher rate of overdose deaths.

Over 16 million individuals worldwide are affected by opioid use disorder, including 2.1 million in the United States. Opioids are responsible for over 120,000 deaths each year. However, effective medications for opioid addiction do exist according to controlled trials, despite low clinical practice. Methadone, buprenorphine, and naltrexone are the drugs that have the potential to help many people recover from opioid addiction, but medication-assisted treatment remains underused by most providers.

When someone has an opioid use disorder or opioid dependence, they become physically dependent on the drug, marked by withdrawal symptoms including cravings. It can challenge people to quit using opioids when they have developed a physical dependence that disrupts everyday routines, including personal relationships, employment, and functioning. Prescribing the right medications in behavioral health programs can help.

Common Symptoms of Opioid Use Disorder

Opioid use disorder has physical, behavioral, and psychological signs and symptoms. The failure to stop using opioids is a clear sign of misuse, dependence, and, finally, addiction. Other symptoms of OUD include:

• Depression
• Anxiety
• Poor decision making
• Drastic mood swings
• Slow breathing rate
• Irritability
• Lowered motivation
• Changes in sleep patterns
• Spending alone time
• Abandoning responsibilities
• Being nervous and cranky

Medication-Assisted Treatment for OUD

Although there are effective medications available, around one out of every four people with opioid use disorder receives specialized treatment. Individuals with an opioid use disorder can benefit from medication-assisted treatment (MAT). Medication is used in conjunction with psychotherapy and behavioral therapies.

Brain chemistry plays a role in a person’s mental illness as well as their treatment. As a result, medications can be provided to assist in the modification of one’s brain chemistry. Medications are also used to treat opioid cravings, and withdrawal symptoms, and to inhibit the euphoric effects of the drugs.

Cognitive-behavioral approaches are common in therapy, boosting motivation to change and providing education about substance abuse treatment and relapse prevention. It usually involves taking part in self-help and therapy groups. MAT has been proven to help patients stay in treatment programs while lowering opioid usage, overdoses, and other risks associated with opioid use disorder.

Medication-assisted treatment is useful in health care for two major purposes:

1. treating withdrawal symptoms during detoxification (opioid detoxification)
2. preventing relapse on an ongoing basis (maintenance treatment).

Opioid Detoxification

• Psychiatry and use of medications can relieve withdrawal symptoms in those undergoing detoxification. This is frequently done in inpatient settings where withdrawal symptoms are monitored.
• Opioid detoxification drugs may use prescription opioids (such as buprenorphine)as supplementary medications to limit withdrawal symptoms.
• In opioid treatment programs, supervised detoxification alone is ineffective and raises the danger of overdose without medication assistance.

Treatment Maintenance

Methadone, buprenorphine, and naltrexone are the three FDA-approved drugs for the long-term treatment of opioid use disorder. Unlike naloxone which assists in saving lives after overdose, these assistive medicines can maintain and support recovery during addiction treatment. They all work by acting on the opioid receptor system.

Methadone Treatment

Methadone functions as a mu-opioid agonist. Methadone can suppress opioid withdrawal symptoms and lessen the need/urge to use opioids due to its long duration of effect (i.e., the half-life of around 24 hours).

Methadone is taken orally once a day and is available as tablets, diskettes, and a liquid formulation designed to help avoid misuse.

Benefits of Methadone

Methadone helps patients stop taking illegitimate opioids by reducing withdrawal and cravings. It can also help patients regain chemical equilibrium in their brains, allowing them to feel “normal” and concentrate on their rehabilitation.

Methadone Risks

Since methadone can only be prescribed in an OTP, this might pose practical issues, such as needing daily travel to the program for dose. Methadone also has several adverse effects, including constipation and drowsiness, and can be diverted (e.g., sold or given to others).

Buprenorphine Treatment

Buprenorphine is an opioid partial agonist that effectively suppresses opioid withdrawal symptoms and cravings. It also induces a functional opioid blockade in which its binding to mu opioid receptors prevents other opioids from binding and exerting their effects.

Buprenorphine is usually taken orally. The FDA approved 6-month buprenorphine implants and monthly subcutaneous injections that yield relatively high plasma concentrations.

Benefits of Buprenorphine

Buprenorphine’s therapeutic effectiveness in the treatment of OUD has been thoroughly proven. Buprenorphine compliance is high, and it’s linked to improved rates of sobriety, less criminal activity outcomes, and fewer unintentional overdoses.

Buprenorphine Risks

The use of buprenorphine has been hampered by resistance to opioid agonist drugs (such as the notion that you are simply “changing a drug with a drug”). Diversion has also been reported (for example, selling or giving one’s prescription to others).

Naltrexone Treatment

Naltrexone inhibits the euphoric effects of other opioids (such as heroin) by occupying mu opioid receptors. It does not exert direct psychoactive effects.

Naltrexone was first available as an oral formulation to be taken once daily. The FDA has authorized a naltrexone sustained-release formulation that provides one month of coverage after a single dosage.

Benefits of Naltrexone

Naltrexone is regarded to be reasonably safe for long-term treatment because when it is used as directed, it increases the chance of sobriety while lowering the risk of overdose.

Naltrexone Risks

Despite its safety and favorable profile, oral naltrexone has had relatively limited clinical application since it is difficult to initiate therapy and patients are often nonadherent. Opioid-dependent individuals who seek naltrexone treatment must first undergo detoxification, this can be difficult for some individuals and in certain cases, impossible.

Overview of Opioid Use Disorder Medications

These medications, according to the National Institute on Drug Abuse (NIDA), do not replace one addiction with another. Medications in therapy do not cause a person to become euphoric.

Instead, medications minimize opioid cravings and withdrawal symptoms without recreating problem drug use. These medications rebalance addiction-affected brain circuits. Here’s a visual overview of OUD medication effectiveness.

Methadone

Reduces opioid cravings: Yes

Reduces illicit opioid use: Yes

Reduces opioid overdose risk: Yes

Increases treatment retention: Yes

Buprenorphine

Reduces opioid cravings: Yes

Reduces illicit opioid use: Yes

Reduces opioid overdose risk: Yes

Increases treatment retention: Yes

Naltrexone

Reduces opioid cravings: Yes

Reduces illicit opioid use: Yes

Reduces opioid overdose risk: Inconclusive

Increases treatment retention: Yes

Behavioral Therapies for the Treatment of Opioid Use Disorder

Behavioral therapies are considered to have little effectiveness in treating the complex psychological and physical elements of opioid use disorder when given alone. Consequently, behavioral therapies for opioid use disorder have been administered in the context of structured approaches (e.g., residential programs) or after the completion of detoxification and stabilization to avoid relapse, and most effectively, in combination with approved medications such as methadone, buprenorphine, or naltrexone.

In addition to medication therapy, behavioral therapies can assist OUD: 

• Improved drug adherence 
• Treatment for additional factors (e.g., social factors, stress) 
• Addressing medication shortcomings

The kinds of behavioral therapy that improve drug effectiveness are disputed; but, those with the most scientific support include:

• Contingency management approaches reinforce certain behaviors by providing patients with material rewards for achieving behavioral goals in substance abuse treatment. For example, an individual may be given a voucher as a prize for passing a urine drug test or for attending counseling and therapy sessions regularly.
• Cognitive-behavioral approaches aim to assist people in recognizing and reframing negative thinking patterns that contribute to their opioid use and disruptive behavior.
• Structured family approaches assist people with OUD and their families in understanding and coping with the condition, as well as the social and other consequences it might bring.
• Motivational enhancement therapy gives patients options for dealing with their mixed feelings about opioid usage and promotes motivation and commitment to treating OUD.

Become Your Best with The Haven-New England

Contact The Haven-New England to learn about our treatment facilities if you are experiencing opioid use disorder symptoms.

A safe, comfortable withdrawal can secure a lasting future of satisfied living without opioid use. We provide medication-assisted opioid detox as well as a variety of treatment options that can be tailored to you for effective, long-term opioid addiction recovery. Discover your many options with our compassionate team.