But is it really recovery, or is using methadone just a substitute addiction? Let’s explore the subject further.

What is Methadone?

Methadone is a synthetic narcotic pain reliever with effects similar to morphine. Methadone is also used to help reduce the withdrawal symptoms in people addicted to heroin and other narcotic drugs without producing the “high” associated with those narcotics.

Most opioids are derived from the opium poppy, and include heroin, morphine, codeine, and hydrocodone. Methadone, on the other hand, is totally a synthetic opioid. Even though it is structured dissimilar to naturally derived opioid products, methadone nevertheless acts on the same sites in the body as the other opioids. It’s for this reason that methadone has been used in the treatment of heroin addiction.

What is different about methadone versus heroin and other opioids? For one thing, the onset is slower and it lasts longer in the body. Methadone is usually taken orally as a syrup, rather than by injection.

But methadone is still a narcotic, and it is addicting. Granted, it is less addicting than heroin or other opioids, but addiction is addiction. Why substitute one addictive substance for another?

There isn’t the rush that’s associated with heroin, and the withdrawal phase is not as severe. This is the primary reason many heroin addicts choose methadone as a kind of middle ground between heroin use and total abstinence. Indeed, going “cold turkey” from heroin addiction is almost never successful. Addicts are simply unable to tolerate the severe withdrawal pain and the cravings are insurmountable. It’s far easier to just revert to heroin use.

How Methadone is Used

Tapering off and gradually reducing the dosage of methadone is one way of kicking the heroin habit. Another use for methadone is as daily maintenance. Why would someone choose methadone maintenance? Using methadone in this manner allows the heroin addict to try to rebuild parts of their lives that have been damaged by heroin addiction. It’s not a perfect solution, but it can be useful as a temporary one.

Still, methadone is not a safe drug, as many accounts and numerous studies have found. It is a Schedule II narcotic under the Federal drug classifications, requires a special license to dispense, and carries a high risk of dependence.

Brand names of methadone include Amidone®, Methadose® and Dolophine®.

Side effects of methadone, depending on dose, include dizziness, drowsiness, constipation, lethargy, lowered respiration rate and elevated mood.

Methadone can also serve as a gateway drug for other narcotics. Another reason methadone isn’t safe is that it is dangerous in combination with alcohol and other types of drugs an individual may be taking, particularly barbiturates. Both alcohol and barbiturates act on the central nervous system

Why Methadone is not Recovery

Many addicts do not like methadone and will use the synthetic opioid only until they can return to using heroin, or when they procure a regular supply of heroin once again.

Methadone can also be considered a way to extend addiction, rather than going through the withdrawal that is necessary to get addictive substances out of the body. Extending addiction puts off the likelihood that a person will go into treatment to overcome addiction to heroin or other opioid drugs.

When a patient is dependent on methadone, it should always be dispensed with an approved treatment program. Such a treatment program should also include testing to ensure that the patient doesn’t continue to use heroin on the side.

Methadone use has other side effects as well, which may cause problems for the individual. He or she may be refused a job because they are on methadone and the job includes operating heavy machinery or equipment for which mental alertness is necessary. It is also possible that the individual’s employer will find out about the methadone use, especially if an insurance company is paying for the methadone treatment.

Newer Drugs for Treatment of Heroin Addiction

While methadone is the oldest treatment for heroin addiction, there are newer drugs that have been approved by the U.S. Food and Drug Administration (FDA) for treating opioid addiction.

One of these drugs is naloxone, marketed as Suboxone, which the FDA approved for opiate treatment in 2002. With methadone, a patient has to travel to a clinic to receive a daily dose. With Suboxone, doctors can prescribe a month’s supply of the drug, which is much more convenient for many individuals.

But methadone is less expensive than Suboxone and is more widely available.

Buprenorphine is another drug that has been FDA-approved and is useful in helping to block cravings. The combination of buprenorphine and Suboxone has proven effective in some patients.

Another medication-assisted therapy for opioid dependence is naltrexone, although studies have found that naltrexone treatment is poor except for highly-motivated patients under strong external pressure to comply with treatment regimen. With the introduction of once-monthly injectable formulations, such as Vivitrol, however, this situation may be changing. Vivitrol has been approved by the FDA for preventing relapse to opioid addiction.

Treatment for Opioid Addiction

If methadone or Suboxone and buprenorphine are helpful in allowing an individual to better manage opioid withdrawal symptoms while they are getting treatment to overcome addiction, what kind of treatment works best?

Traditional treatment for opioid addiction includes a period of detoxification (also called detox), followed by counseling and therapy that are designed to help the patient stay off the drug. There are also specific therapies that include Chinese medicine, hydrotherapy, mindfulness meditation and spiritual counseling, restorative yoga, nutritional wellness and detoxification juicing, hypnotherapy, massage therapy, dry sauna, and EEG biofeedback (neurofeedback).

How should you go about finding treatment for opioid addiction? You can start by asking your doctor for a recommendation to a treatment facility that specializes in treating patients addicted to heroin.

Office-based opioid treatment providers often refer their patients to substance abuse counselors, social workers, psychologists or nurses for counseling, but physicians can also provide counseling to their patients as part of medication management. Weekly urine testing early in treatment has been recommended by most clinicians. That is because it is expected that patients will have at least some ongoing use. Prescription intervals can be used as a contingency to help motivate patients to abstain from opioid use, or at least spur them on to a recovery trajectory.

Another avenue to finding therapy is to use the Treatment Facility Locator (http://dasis3.samhsa.gov/) maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA). This is an online searchable directory of drug and alcohol programs showing the location of facilities around the country that treat alcoholism, alcohol abuse and drug abuse problems.

Included are listings for residential treatment centers, outpatient treatment programs and hospital inpatient programs for drug addiction and alcoholism. Select “Detailed Search” and click the box for specific services desired to search for treatment facilities offering such services in addition to detoxification and treatment (including counseling).

Heroin relapse rates are quite high which often necessitates repeated stints in rehab. For this reason, recovery from opioid addiction is usually considered an ongoing process.

In combination with treatment, participation in various 12-step self-help groups such as Narcotics Anonymous is strongly recommended. Indeed, most treatment programs include mandatory participation in 12-step meetings as part of the overall treatment plan.

Outcome for Opiate-Dependent Individuals Entering Treatment

While the path toward recovery from opioid addiction may seem uncertain, with relapse rates high and multiple stays in rehab often required, the outcome is not negative. Indeed, with each treatment stay completed, patients do seem to make progress, according to numerous research studies.

The fact that many opioid-dependent individuals also have other substance abuse problems, specifically alcohol abuse or addiction, and/or use of cocaine or other illicit substances, along with possible co-occurring mental health disorders (including depression, anxiety, bipolar disorder and others), means that it may take longer for the comprehensive treatment to begin to work effectively.

Bottom line: If you are addicted to heroin or OxyContin or other opiates, going into treatment, sticking with it, and developing a strong support network will put you on the road to recovery. It may take you a while to get there, but you can and will see progress as long as you remain committed to sobriety and do the hard work necessary to maintain it.

Is recovery worth it, no matter whether you go the methadone route or another of the FDA-approved treatments for opiate addiction, coupled with counseling, 12-Step meetings and so on, of course? Only you can decide. But your future very much depends on your decision. Why wait? Seek help today so that you can begin to learn how to overcome what very likely is impacting your life in a negative way.

After a Phase 2 study produced favorable results, Walter Ling, M.D., of the University of California, Los Angeles, and his colleagues performed a phase 3 study of the implantable buprenorphine. They tested this form of treatment on 163 adults between the ages of 18 and 65, all of whom were addicted to opioids. Of the group, 108 received buprenorphine implants and 55 received placebo implants. The implants, placed below the skin on the nondominant arm, were removed after 6 months. The patients also received individual drug counseling.

The buprenorphine implant group had significantly more negative urine samples for opioids during the first six weeks. The average percentage of negative urine samples was 40 percent, compared with 28.3 percent for those receiving placebo.

Of those with the buprenorphine implants, 65.7 percent of the patients remained in the study for the full 24 weeks, compared to 30.9 percent of the placebo patients. While 30.9 percent of the placebo group was classified as having failed treatment, no one in the implant group failed.

The researchers write that the implant group also had fewer withdrawal symptoms and cravings, and were more likely to improve than the placebo group. The authors conclude that the use of buprenorphine implants led to decreased opioid use, compared to placebo use.

Source: Science Daily, Implanting Medication to Treat Opioid Dependence Appears Beneficial in Decreasing Opioid Usage, October 12, 2010

Lidocaine has the ability to shut off insula, or the brain nucleus that is responsible for controlling an addiction to drugs. Scientists believe the ability to control or target insula could hold the key to ending drug addiction for many. Insula plays an important role in the brain as it controls the body’s heart rate, blood sugar, hunger, cravings and a number of other functions. It is believed that an impaired insula can eradicate addiction.

In a study of lab rats, amphetamines were given to the rats anytime they entered a well-lit area. This was somewhat of a contradiction for the rats, rodents who tend to love the dark. In this process, the rats quickly became addicted to the amphetamines and returned repeatedly to the same location to receive a new dose.
At this point in the study process, some of the addicted rats were given shots of lidocaine into the insula. As lidocaine is known to impair the signals transmitting between the brain cells, it was effective in changing the behavior of the addicted rats.

Before they received the shots – and after they had developed the addiction – many of the rats were spending as much as 25 percent of their time in the well-lit areas, seeking their next hit. After receiving the lidocaine, that group of addicted rats spent less than 10 percent in the well-lit area.

One scientist involved in the study believes that lidocaine could provide the key for switching off memories related to the experience of taking the drug. The challenge is that right now, giving lidocaine to humans presents considerable risk as infection could develop and potential changes in heart rate could be life threatening. No matter how addicted the individual, injecting something into the brain is still a risk.

The finding is significant nonetheless. And, while lidocaine delivers only a short lasting effect (injected rats only forgot about the drug for about 20 minutes), there is still potential for further development in this area. Further studies are suggested, although developing a process for interrupting multiple interactions between a vast array of brain regions presents considerable challenge.

Until lidocaine can be used through other methods, it will likely continue to be the anesthetic of choice in the dentist’s office.
 

A new study examines the misuse of buprenorphine. Schuman-Olivier and colleagues (2010) investigated whether opioid dependent individuals use buprenorphine improperly to achieve feelings of euphoria or if they are using it to alleviate the difficulties of opioid withdrawal.

The researchers also hoped to understand the pervasiveness of the use of buprenorphine as an illegal drug and how buprenorphine use is less common among opioid users who are enrolled in more comprehensive treatment for opioid dependence.

The study was conducted in an outpatient substance abuse treatment center in New England. The participants were all diagnosed as opioid dependent using DSM-IV criteria. The participants included 44 individuals who were interested in treatment using buprenorphine and 34 patients who were currently using buprenorphine.

The participants were asked to complete, along with other measures, the Buprenorphine Beliefs and Behaviors Questionnaire, to understand their motivation to use buprenorphine; and the Illicit Buprenorphine Use Questionnaire, to assess whether patients were using buprenorphine as an illicit drug. The questionnaires were completed again three months after the original administration by 42 of the participants.

Results determined that 49 percent of the participants who completed questionnaires in the first stage used buprenorphine illicitly. The remaining 61 percent of the illicit use was among new patients who did not yet have access to a doctor’s prescription.

The participants reported that they reduced distress by using buprenorphine, and did not use it as a way to get high. The participants used buprenorphine to self-treat opioid dependence, anxiety and pain. Illicit users were more likely to use buprenorphine to prevent withdrawal, ease pain and treat depression.

The study’s findings may be limited by its small sample size and its short duration. Three months may not be enough time to understand the use of buprenorphine over a long period of recovery from opioid addiction.
The illicit use of buprenorphine went down significantly after new patients were given access to buprenorphine by doctor prescription. Also, the study shows that the individuals who used illegal buprenorphine were using it to self-treat their opioid dependence, rather than using it to get high.
The study indicates that when given buprenorphine through a prescription, opioid users are reducing their illegal use of the medication. The information provided by this study may help policy makers understand use of buprenorphine in treatment for opioid addiction.
 

Kicking opiate addiction doesn’t have to be the painful and dreaded nightmare many addicts envision. There is replacement therapy that has been approved as an alternative treatment for opiate addiction.

What Constitutes Opiate Addiction?

First, however, it’s important to discuss what constitutes addiction to opiates. An individual can be addicted to numerous substances called opiates or opioids. In fact, opioids, commonly prescribed to treat pain, are one of three classes of drugs most commonly abused (the other two being central nervous system depressants and stimulants).

What are Opioids?

Opioids are analgesic medications – pain relievers – that, when taken as prescribed, are often effective in managing pain and rarely cause addiction. It’s when opioids are abused that addiction can occur, often in combination with other addictive drugs and/or alcohol.

Some of the compounds and brand names (in parentheses) within the opioids class are:

• Hydrocodone (Vicodin)

• Oxycodone (OxyContin)

• Morphine

• Fentanyl

• Codeine

• Propoxyphene (Darvon)

• Hydromorphone (Dilaudid)

• Meperidine (Demerol)

How Opioids are Abused

Abuse of the opioids includes snorting crushed powder from pills, taking pills orally, or injecting the medication. The National Institute on Drug Abuse (NIDA) says that injection and snorting have resulted in numerous overdose deaths, especially with the drug OxyContin, which was designed to be a slow-release medication. When an individual snorts or injects such medication, it causes an immediate release into the drug stream, resulting in exposure to high doses and potentially lethal overdose reactions.

But it’s the euphoric reaction that causes many users of opioids to become addicted. The opioids affect regions in the brain that mediate perception of pleasure. The resultant euphoria and/or sense of well-being that opioids users experience is a state that they want to return to again and again. Consistent and chronic abuse of opioids despite negative consequences leads to dependence or addiction to the substances.

What Happens When you Stop Taking Opiates

Even patients who are prescribed opiates for short-term management of pain may develop a physical dependence on them. This physical dependence, however, is not the same thing as addiction. Physical dependence means that, over time, the patient develops a tolerance to the drug and thus requires more of it and more often to achieve the same (pain relieving) effect. Sudden cessation of opiates for which a physical dependence exists brings about withdrawal symptoms.

Withdrawal from opiates, whether the patient is physically dependent on the drugs or has developed an addiction to them, should never be undertaken without careful medical supervision. Such medical monitoring helps to reduce or eliminate severe withdrawal symptoms such as restlessness, bone and muscle pain, cold flashes (“goose bumps”), vomiting, diarrhea, insomnia, and involuntary leg movements.

Prerequisite for Treatment for Opiate Addiction

Before treatment for opiate addiction can begin, the patient must be detoxified of all the drugs in their system. This detoxification also must be medically supervised in order to help ensure minimal withdrawal symptoms. So, the first step in treating opiate addiction is detoxification.

Types of Replacement Therapy for Opiate Addiction

There are four types of medications used in replacement therapy for opiate addiction.

Methadone

Methadone, which is a Schedule II synthetic opioid, is the first and oldest treatment used for opiate addiction. It has been successfully used to treat opiate addicts for more than 30 years. It has also been widely used to treat heroin addicts. The advantages of methadone are that it eliminates withdrawal symptoms and helps reduce craving.

According to a 2002 publication from the Centers for Disease Control and Prevention (CDC), Methadone Maintenance Treatment, methadone a) blocks the sedating and euphoric effects of opiates, b) relieves craving for opiates that is a major factor in relapse, c) relieves symptoms associated with withdrawal from opiates, d) with stable dosing, does not cause euphoria or intoxication itself, thus allowing the individual to work and participate in society normally, and e) is excreted slowly, so it can be taken only once daily.

Methadone replacement therapy for opiate addiction generally takes a minimum of 12 months, according NIDA recommendations, although some individuals benefit from continuing to take methadone maintenance treatment for several years. Methadone is safe when taken for 10 years or longer, according to the NIDA.

Methadone treatment has not escaped criticism and controversy over the years. Some argue that it’s just substituting one addiction for another. Since some patients have diverted their own methadone supplies to augment their income, thus serving as a magnet for crime, methadone treatment in the U.S. is heavily regulated and strictly controlled. Previously, methadone treatment was only available through federally licensed methadone clinics. Following revised guidelines introducing office-based opiate replacement therapy, the Drug Addiction Treatment Act of 2000, methadone maintenance treatment is now available through physicians’ offices, licensed clinics and hospital outpatient and other health care settings. Patients who are taking methadone therapy for opiate addiction must be monitored closely if they are also receiving antiviral therapy for HIV infection, to avoid potential medical interactions.

Buprenorphine

Buprenorphine, another synthetic opioid that is classified as Schedule III, is a more recently-approved treatment for opiate addiction as well as addiction to heroin. Buprenorphine is a derivative of thebaine, an opium extract. According to the NIDA, buprenorphine is the first medication developed to treat opiate addiction in the privacy of a physician’s office. This medication has less risk of addiction than methadone. Buprenorphine binds to the same receptors as morphine, but does not produce the same effects. Buprenorphine’s weaker opiate effects are less likely to cause overdose problems and produce a lower level of physical dependence. This means that patients who discontinue taking buprenorphine have fewer withdrawal symptoms than those who stop taking methadone for opiate addiction.

Like methadone, buprenorphine reduces cravings for heroin and other opiates and also reduces withdrawal symptoms. Buprenorphine also has a ceiling effect in that increased doses of the drug do not produce increased effects beyond a certain point. In some individuals taking buprenorphine, higher doses can actually precipitate withdrawal symptoms. It is, therefore, not as effective as methadone in treating severely opiate-addicted individuals who require high doses of methadone daily. According to the Substance Abuse and Mental Health Administration (SAMHSA), the best candidates for buprenorphine therapy are those who receive 30 milligrams or less of methadone. It is estimated that buprenorphine is effective for about one-half to two-thirds of the population of opiate abusers.

The Food and Drug Administration (FDA) approved buprenorphine tablets in 2002. Two formulations of FDA-approved buprenorphine are available. Subutex (buprenorphine hydrochloride) is used in the initial stages of opiate replacement therapy. Suboxone (buprenorphine hydrochloride and naloxone hydrochloride) is used in the maintenance stage.

Naltrexone

Naltrexone is another medication that blocks the effects of morphine, heroin and other opiates. According to a NIDA report, naltrexone, a long-acting opioid receptor blocker, can help prevent relapse. How it works is that the drug blocks the pleasurable effects of heroin and is therefore useful in treating highly motivated individuals. One caution is that it can only be used with someone who has already been detoxified, due to the severe withdrawal effects it can produce in someone who continues to abuse opioids.

Depending on the dose, naltrexone lasts from 1 to 3 days. Naltrexone has proven effective in preventing relapse in former opiate-addicted prisoners released on probation.

Naloxone

This is a short-acting opioid receptor blocker. Naloxone counteracts the effects of opioids and can be used in treatment of overdoses.

Buprenorphine/Naloxone

This combination drug of buprenorphine and naloxone is a formulation designed to minimize abuse.

Other Drugs

Two other drugs may be prescribed to help reduce the severity of withdrawal symptoms from opiate addiction.

Clonadine, according to the NIDA report, is of some benefit, but it has nasty side effects of sedation and hypotension.

Lofexidine, launched in 1992, is a “centrally acting alpha-2 andrenergic agonist” specifically for use in treating patients with opiate withdrawal symptoms.

Is Replacement Therapy Right for Opiate Addiction?

Experts in treating addiction to opiates have a wide range of treatment programs at their disposal. Weighing the benefits of one medication versus another to treat opiate addiction is part of the overall treatment program specifically designed and tailored for the individual patient.

Taking buprenorphine, for example, is more long-lasting than methadone, and can be taken more conveniently – in take-home prescriptions, for example – than going to a clinic each day.

But just taking replacement therapy for opiate addiction will not get at the root causes of the addiction. That’s why a multi-disciplinary approach to treatment works best, using behavioral therapies in conjunction with pharmacologic treatments. This may involve contingency management therapy, cognitive behavioral therapy (CBT), hypnotherapy, and others. Contingency management therapy uses a voucher-based system of points, based on negative drug tests, which the patient can use to exchange for items designed to encourage healthy living. CBT is intended to help modify the patient’s behaviors and expectations related to drug use, as well as to provide them with effective coping mechanisms to deal with life’s daily stressors.

It is important to note that replacement therapy for opiate addiction is not a “magic bullet” that will instantly take away all cravings and prevent relapse. This type of therapy isn’t something that the patient can take now and forget about. It also takes time. To be effective, the patient needs to commit to staying on the medication for however long it takes – usually a period of years. Also of importance is the fact that co-occurring disorders, multiple addictions, and/or a mental disorder, can complicate the treatment program for opiate addiction. According to clinical reports, buprenorphine may make some psychiatric symptoms worse. In that case, addiction treatment professionals may recommend an effective addiction treatment program that includes methadone instead of buprenorphine.

For the best results, patients need to be fully committed to overcoming their addiction to opiates (and any other co-occurring disorders, multiple addictions and/or mental disorders). In many cases, the best results may be obtained through a residential treatment program at a facility that specializes in the treatment of the particular addiction or addiction the patient has.

Bottom line: if you or someone you know is addicted to opiates and is sincere about overcoming addiction, seek professional help as soon as possible. With detoxification, treatment and counseling, opiate addiction can be overcome. As with all addictions, it will never be cured, but the patient can return to a normal, productive and satisfying life.

For More Information

To find a treatment facility specializing in opiate addiction, use the SAMHSA Substance Abuse Treatment Facility Locator or call them at their toll-free number of 1-800-662-HELP. There’s also the Spanish-language helpline at 1-800-662-9832 and TDD at 1-800-228-0427.

SAMHSA also operates the Buprenorphine Physician and Treatment Program Locator. Note that the number of patients that physicians can treat with buprenorphine is limited by law. Therefore, some of the physicians listed in the locator may not be accepting new patients. Since the site is updated weekly, SAMHSA recommends checking back regularly.

Another SAMHSA site for methadone treatment centers is located at the following website: http://dpt2.samhsa.gov/treatment/directory.aspx

More information on treatment is available at the Center for Substance Abuse Treatment (CSAT).