Opioid Use Disorder Treatment: Doctor-Recommended Drugs and Therapy
Opioid use disorder is prevalent in the US, but obtaining necessary treatment can be challenging due to long-standing barriers to care and the stigma associated with this condition, per a 2019 report from the National Academy of Sciences.
A spike in opioid-related deaths in the US, per new government data, highlights the need for expanded access to therapies. Here's what to know if you're seeking medication-assisted treatment or therapy for opioid addiction or dependence.
What is an opioid use disorder?
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders defines opioid use disorder as "a problematic pattern of opioid use leading to problems or distress." You might be diagnosed with this condition if you experience two or more of the following symptoms over a 12-month period:
- Taking opioids at a higher quantity or longer than prescribed
- Regularly working to limit or stop opioid use without success
- Spending large amounts of time taking opioids or working to procure them
- Continuing to take opioids even when they bring social or interpersonal problems
- Struggling to fulfill life obligations
- Foregoing or limiting participation in certain activities due to opioid use
- Taking opioids in a physically hazardous situation
- Craving or strong want for opioids
- Taking opioids, even if they cause or increase physical or psychological problems
- Increasing tolerance throughout the use of opioids
- Feeling withdrawal after stopping use of opioids
"Opiates provide an innate calming effect on both the body and brain system. When they are prescribed for pain, they specifically target those areas. However, if misused, this is where we oftentimes see problems arise," Chris Gleason, the executive director at Brightside Recovery in Tinley Park, Illinois, tells Health.
How is opioid use disorder treated?
Opioid use disorder, like diabetes, is a chronic disease that requires ongoing, varied forms of treatment, explains Jeanmarie Perrone, MD, a professor of emergency medicine and director of the division of medical toxicology and addiction medicine initiatives for the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
"Patients who are on diabetes medicine could still come in with high blood sugar. And we don't say, well, that's your fourth time here with high blood sugar; we're not going to treat you at all anymore," Dr. Perrone tells Health.
There are multiple treatment options available once a person is ready to seek help for an opioid use disorder. Medical professionals may provide these treatments during in- or residential stays or through outpatient care.
Medications for opioid use disorder can decrease opioid use, lower relapse rates, increase the rate of treatment retention, and lower rates of opioid-related overdose deaths, among other benefits, says " Elizabeth Evans, MD, a psychiatrist and addiction specialist at Columbia Doctors Midtown in New York City, tells Health.
There are three medications approved by the US Food and Drug Administration for opioid use disorder treatment:
Methadone is an opioid agonist that reduces cravings and withdrawal symptoms by activating opioid receptors. It also limits, or even stops opioids' effects, reports John Hopkins Medicine. It is only available through a Substance Abuse and Mental Health Services Administration (SAMHSA)-certified treatment program. Administrators will provide the medication daily, but if a person demonstrates compliance and progress, they may be able to take doses at home.
Buprenorphine works similarly to methadone but is a partial opioid agonist meaning it still "binds to opioid receptors but activates them less strongly than full agonists do," says Dr. Evans. Unlike methadone, buprenorphine is available by prescription.
A 2018 study from Annals of Internal Medicine looked at how taking methadone or buprenorphine impacted overdose risk in people who had overdosed between 2012 and 2014. Across a 12-month follow-up period, deaths due to an opioid overdose decreased in people taking methadone by 59% and buprenorphine by 38%, compared to participants without medication-assisted treatment.
This drug is somewhat different than its counterparts. It does not activate opioid receptors. Instead, it prevents opioids "from producing rewarding effects such as euphoria, and it can also help with cravings," says Dr. Evans.
The other big difference: a person can only take naltrexone if their system is free of opioids. Per the US National Library of Medicine (NLM), your doctor will tell you not to start naltrexone if you've used opioids in the past seven to 10 days. It is available in a prescription pill or an administered monthly long-acting injection.
Naloxone is not a treatment but an emergency preventative measure.
"Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. Naloxone has no effect on someone who does not have opioids in their system," says Dr. Evans.
Carrying naloxone is important for anyone with an opioid use disorder, a loved one who does, or if you want to be prepared in general. Individuals can obtain free naloxone kits at many pharmacies, community-based distribution programs, local public health groups, or local health departments. Many of these organizations and those online offer training courses.
Therapies for opioid use disorder
There are two forms of therapy anyone with an opioid use disorder may wish to pursue: individual and group.
According to the NLM, people may try cognitive-behavioral therapy, motivational enhancement therapy, or contingency management in a one-on-one setting with a mental health professional.
"Structured behavioral therapies focus on helping motivate individuals towards change, helping them to develop skills to manage triggers and cravings, as well as identify ways to develop and engage in a life that is meaningful to them," says Dr. Evans.
People can also attend group therapy to learn and gain support from others dealing with an opioid use disorder. Family counseling can help repair relationships and show loved ones how to best support you.
Seeking treatment for opioid use disorder
Although anyone could develop an opioid use disorder, the stigma associated with it may deter some people from getting medical help.
"We need to continue to treat this as a disease," says Dr. Evans. "By taking a disease management approach, we can help others to understand that this is simply not a moral failing or a behavior problem that has roots in medical disease."
Various environmental motivators may lead a person to seek treatment. According to Dr. Perrone, these factors include facing a breaking point with a family member or a loved one or partner, becoming tired of missing out on valuable things, and incurring the expense of opioids, which can cause loss in other areas of their life.
"Most people should seek treatment at the onset of any type of withdrawal so that they can be medically managed and decrease the severity," says Gleason.
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