You probably know that certain medications can be used to help treat addiction to various drugs, from nicotine to heroin.
So, do they work?
The short answer is: Yes, they can often work very well—depending of course on the specific drug, individual circumstances, and the quality of medical support.
But many people find this idea troubling. If you experience problems with one drug and use another (prescribed) drug to help address these problems, they wonder, aren’t you just switching one addiction for another?
Actually, that assumption is not justified.
Why not? Because drug use and addiction are two different things. Many of us regularly use prescribed or recreational drugs (e.g., alcohol) without becoming addicted.
“There is absolutely no reason to just dismiss the idea.”
Addictions (or substance use disorders, as drug addictions are clinically known) involve loss of control and serious negative consequences. According to SAMHSA:
“Substance use disorders occur when the recurrent use … causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.”
The good news is, this in no way describes the lives of many of us who take prescribed addiction medications!
The confusion relates to stigma around drug use, reflected in subtly judgy terms used to describe addiction meds—such as “medication-assisted treatment” (MAT). Author and addiction expert Maia Szalavitz has written:
“We don’t…have ‘medication-assisted’ treatment for any other disease: We don’t call antidepressant therapy using Prozac ‘Prozac-assisted treatment’; nor do we call diabetes care with insulin ‘insulin-assisted treatment’—even though in both cases, as with addiction, behavioral changes are usually also important to recovery.”
The takeaway? While all treatments should be assessed on their individual merits, there is absolutely no reason to just dismiss the idea of using medication to treat your addiction.
Meds for Opioid Addiction
Let’s focus now on one vital category: those medications prescribed to people who are addicted to opioids. Opioids (including both prescription painkillers and “street” drugs like heroin) are currently of huge concern to government, media, clinicians and the public.
One key fact: Sustained treatment with either methadone or buprenorphine (Suboxone) unequivocally works to reduce opioid-related deaths by half or more. Both drugs can also protect patients against a host of other health problems—and the law enforcement-related problems generated by our current drug laws.
We’ll look at a few options in detail. But remember: When making a choice about medication, always consult a doctor, and consider your unique circumstances. Finding a medication that feels right increases your likelihood of sticking with treatment.
1. Methadone (often sold under the brand name Dolphine®; liquid or tablet)
How It Works:
Methadone is a full opioid-agonist—meaning it activates the same brain receptors as heroin and other opioids. By doing so, it relieves symptoms of opioid withdrawal. Methadone is the best studied of the maintenance medications, having been in use for this purpose since the 1960s.
Benefits and Risks:
The World Health Organization (WHO) states: “even after 40 years, substitution therapies such as methadone are still the most promising method of reducing drug dependence.” The National Institutes of Health has stated: “the safety and efficacy of MAT has been unequivocally established.” Studies—such as this 2017 meta-analysis—have repeatedly demonstrated that sustained methadone treatment massively reduces mortality rates across a variety of populations.
Compared to buprenorphine, methadone (because it’s a full agonist) is most useful for people accustomed to high opioid doses.
Methadone does have risks associated with it, including the risk of overdose, which is greater than with buprenorphine. (This risk, however, is primarily associated with simultaneous use of other substances that have toxic interactions with methadone).
Another “risk” of methadone is entirely government-inflicted. Restrictive regulations in the US—including the stigmatizing requirement for methadone patients to constantly attend clinics to receive it—discourage participation and adherence.
But the positives far outweigh the negatives. WHO, the UN Office on Drugs and Crime and UNAIDS all agree that methadone treatment is linked with “substantial reductions in illicit use, criminal activity, deaths due to overdose, and behavior that leads to a high risk of HIV transmission.”
2. Buprenorphine (often sold under the brand name Suboxone®; a dissolvable film)
How It Works:
Buprenorphine suppresses withdrawal symptoms and cravings associated with opioids. Like methadone, it attaches to opioid receptors in the brain. But because it is only a partial opioid agonist, buprenorphine has a “ceiling effect”—after a certain point, taking more will not increase its effects. Suboxone was approved by the FDA in 2002.
Benefits and Risks:
The endorsements applied by all those major international bodies to methadone, based on many studies, equally apply here: Sustained, medically supported treatment with buprenorphine greatly reduces mortality and, like methadone, carries other major benefits to health and lifestyle.
Compared to methadone, buprenorphine is generally better suited to people with less severe opioid addictions, accustomed to somewhat lower doses.
US regulations around buprenorphine/Suboxone are somewhat better than for methadone: Suboxone can be prescribed by a limited number of physicians, though these physicians are still unjustifiably restricted in the total number of Suboxone patients each can treat (currently up to 275.) You can go to a doctor to get a prescription and fill the prescription in a drug store, as with any normal medication. And you can take the pill at home—unlike with methadone, where you might have to go to a clinic every day to get it.
There is a lower risk of overdose than with full agonists. But remember that it is very dangerous to mix buprenorphine or methadone with other respiratory depressants, such as alcohol or benzodiazepines.
3 . Naltrexone (often sold under the brand names Vivitrol ®, a monthly injection; and ReVia ®, a pill)
How It Works:
Naltrexone is an opioid antagonist, meaning it binds with and blocks opioid receptors but does not activate them. If someone with active naltrexone in their system ingests opioids, they will not feel the effect. Naltrexone was approved by the FDA to treat opioid addiction in 1984. (Be careful not to confuse naltrexone with naloxone/Narcan, a drug used to treat opioid overdose.)
Benefits and risks:
Naltrexone is more accessible than methadone and Suboxone. However, it is less studied and potentially riskier. There is a substantial risk of overdose because people may take large amounts of opioids to try to overcome the “block.” There is also substantial risk of overdose once someone stops using naltrexone, as they may attempt to use at their previous dosage.
Naltrexone can only be administered to someone who has had all opioids out of their system for at least two weeks—which can be difficult to attain. Because of this, and the other risks, naltrexone is only recommended for specific, very highly motivated populations who have been using opioids for only a short time.
4. Diacetylmorphine (medical-grade heroin, also described as Heroin-Assisted Treatment or HAT)
How It Works:
It simply means giving people who are addicted to heroin that same drug, but in circumstances that greatly increase patients’ safety and control over the situation. In Europe and Canada— though not in the US—medical-grade heroin is administered by doctors to at-risk populations. Using heroin itself as the medication may sound shocking to people who haven’t previously heard of this, but the results justify the practice.
Benefits and Risks:
This remains illegal in the US, so cannot be safely attempted in this country. However, in those countries where it is available (since the mid-1990s in Switzerland), the legal status of heroin for addicted patients means they can receive a form of the drug that contains no dangerous impurities, is correctly dosed, and is administered safely under medical supervision (often, with the patient’s consent, in gradually diminishing doses).
While no drug use is entirely risk-free, this practice has been proven by multiple studies to protect people from overdose, infection, arrest, HIV transmission, the need to engage in criminal activity to pay for drugs, and other problems.
As one study concluded in 2007: “the overall positive results of completed HAT trials undoubtedly [justify] some role of HAT in the addiction treatment landscape.” The difficulty is getting politicians to follow the science.
One Last Note
Sadly, the number of people in the US struggling with opioid addiction far exceeds the number able to access the medications that could help them.
This is for a number of reasons: Not all insurers cover these medications; laws severely limit the number of prescribing clinics and doctors and create onerous hurdles for patients; pharmaceutical companies keep prices high; and stigma and laws against people who use illicit drugs dissuade many who might benefit from seeking help.