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Treatment of Opioid Addiction: A Comparison

Addictions (both substance and behavioral) involve the mesolimbic systems or pathway of the brain, which is the part of the brain that regulates behavior with the release of the chemical dopamine.

Dopamine is the pleasure and reward chemical. With an addiction, the behavior exists in order to obtain the pleasure and reward experience created by dopamine and the addictive behavior exists regardless of the knowledge of negative consequences.

All humans are born with the addictive system wired and ready to go because we all seek to feel good. Addictions involve both environmental factors and genetic factors. Social systems and family environment play a strong role in addictions.

Modern statistics on addictions have shown that almost half of all Americans suffer from some type of serious addiction. In 2009, drug fatalities outnumbered traffic fatalities (Aladag, B, 2013).

What are Opioids?

Opioids are narcotics or prescription pain killers and are derived from opiates and morphine derivatives and include:

  • Morphine
  • Methadone
  • Codeine
  • Hydrocodone
  • Heroin
  • Oxycodone
  • Buprenorphine
  • Fentanyl

Opioids stimulate the µ-opioid receptors in the brain. The µ-receptor causes feelings of analgesia (no pain), sedation (relaxation) and euphoria (happiness).

Opioid addiction is a very progressive, chronic, and often fatal disorder. Advanced use of the drug leads to permanent brain damage that causes individuals to lose their ability to make a choice regarding the substance and compromises their health, which rapidly degenerates.

Opioid addicts become obsessive and compulsive with respect to the drug regardless of negative consequences.

Withdrawal

When trying to break an addiction to opioids, users will experience withdrawal symptoms, which include:

  • Bone/joint pain
  • Sweating
  • Runny nose
  • Anxiety
  • Diarrhea
  • Severe flu-like symptoms

Treatment

There are three basic types of treatment for opioid addiction, these include the following options:

• Medication treatment: Methadone or Suboxone
• Abstinence based psychotherapy following detoxification
• Combination of medication and therapy

Medication Treatment

Methadone was discovered by the Germans in 1939 where it was used as an analgesic to treat soldiers. The medicine was called Dolophine. In 1947, the Eli-Lily Company purchased the rights to the medication and changed its name to Methadone.

In 1964, clinicians started using the drug to treat patients seeking help for Heroin addiction. Methadone cannot be prescribed in doctor’s offices and can only be dispensed in special clinics

Methadone is a synthetic µ-opioid receptor agonist which suppresses opioid withdrawal symptoms and blocks euphoric effects of opioids for 24 hours. This is why once daily dosage is sufficient treatment.

Dosage for treatment should be accomplished orally rather than intravenously. Intravenous methadone treatment causes the “rush” experience and is not conducive for treatment. Only oral ingestion of methadone is appropriate for treatment.

When taken orally, in liquid form, methadone is metabolized slowly through the liver, releasing its effects throughout the day in a steady manner. This approach prevents withdrawal sickness.

Patients tend to receive treatment at a methadone clinic each morning at around 5:00 a.m., and then go about their day. Liquid is the best form for treatment. Tablets are also used, but can be easily abused and sold on the black market.

Suboxone (contains buprenorphine and antagonist naloxone, Narcan, to guard against abuse) can be prescribed in a doctor’s office just as an antibiotic can. In fact, it is the first drug approved by the FDA for opioid addiction treatment that can be prescribed in a typical medical clinic.

This drug is a partial µ-opioid receptor agonist with higher binding strength than opioids.

Suboxone is not to be taken while still using heroin or other opioids because it will cause severe withdrawal symptoms. In fact, it is advised to avoid using Suboxone until a patient is fully in a state of withdrawal from opiates.

Suboxone is most effective for patients that have been addicted for less than one year. For people with heavier addictions, it is recommended that Methadone would be a more appropriate treatment. Suboxone is safer than methadone.

There is also a drug called Subutex, which is a drug that only contains the agonist buprenorphine. This drug tends to be more easily abused because it does not contain Naloxone.

Compare and Contrast

Methadone vs. Suboxone

Methadone: Full µ-opioid receptor agonist, once daily dose, must be tapered off/can be addictive, cannot take dose at home, must have used an opioid for more than 12 months, counseling required to take treatment, high risk of addiction, less expensive, risk of fatal overdose is high, only dispensed in special clinics

Suboxone: Partial u-opioid receptor agonist, once daily dose, must be tapered off/can be addictive, can take dose at home, no time criteria, counseling not required for treatment, less risk of addiction, more expensive, risk of fatal overdose is low, can be prescribed in doctor’s office and taken at home.

It should be noted, that not all is rosy with medication treatment, and many people have reported experiencing long term issues with their dependence on Methadone, Subutex, and even Suboxone. It is recommended that great caution be taken when using medication treatment methods for opiate addictions.

It is also important to realize that medication is not necessary for treating an opiate addiction. While it may be difficult to process through the detox experience without the help of medical assistance, it is not impossible, and may be easier in the long run.

Treatment of Opioid Addiction: A Comparison

Sharie Stines, Psy.D

Sharie Stines, Psy.D. is a recovery expert specializing in personality disorders, complex trauma and helping people overcome damage caused to their lives by addictions, abuse, trauma and dysfunctional relationships. Sharie is a counselor at LIfeline Counseling & Education Inc., in Southern California (www.lifelinecounselingservices.org). Lifeline Counseling is a non-profit organization 501(c)(3) corporation. Sharie is also an abusive relationship recovery coach - therecoveryexpert.com

 

APA Reference
Stines, S. (2015). Treatment of Opioid Addiction: A Comparison. Psych Central. Retrieved on December 14, 2018, from https://pro.psychcentral.com/treatment-of-opioid-addiction-a-comparison/

 

Scientifically Reviewed
Last updated: 27 Nov 2015
Last reviewed: By John M. Grohol, Psy.D. on 27 Nov 2015
Published on PsychCentral.com. All rights reserved.