Medication-Assisted Treatment for Opioid Addiction: What’s Available, What Works
One expert recommends that everyone battling opioid use disorder keep Narcan at home for emergencies — and seek information about available addiction therapies.
Do you know someone who is battling an opioid addiction? If so, it’s important to understand all of the available treatment options.
Physicians can prescribe medication to help reduce dependency on opioids over time. And emergency aid is available — without a prescription — that can help stop a dangerous overdose.
Jonathan Morrow, M.D., Ph.D., an assistant professor of psychiatry and a certified addiction specialist with University of Michigan Addiction Treatment Services (UMATS), spoke more about opioid addiction and the treatment options out there.
How does someone become addicted to opioids?
Morrow: People get addicted to pain pills the same way they get addicted to other drugs. If you use any addictive drug repeatedly, there is always a risk for addiction. It depends how much and how often you are using and the reasons you are using the drug. Your likelihood of developing an addiction also depends on your own personal history and genetics. Certain people are more susceptible to developing an addiction than others.
How can you overcome a pain pill addiction?
Morrow: If you are taking pills and you want to come off of them, you need to consider two things. The first is that you might have a physical dependence on them. If this is the case, you need to gradually wean off the drug by taking fewer every day. Ask a physician for help and guidance.
The second is that you may have an actual addiction, which is a psychiatric disorder. This happens when the drug is driving your behavior. When someone is addicted to drugs, they have cravings, and they spend too much time using the drug, seeking the drug and recovering from the drug. Using the drug no longer improves their functioning. When an addiction happens, it is difficult to stop on one’s own because the person has lost a sense of control over the drug. You are no longer really using the drug for the same reason you started. The drug itself is funneling your desires toward more drug use.
How long does it take to become addicted to pain pills?
Morrow: Opioids should be used no more than two to three weeks. If you use pain pills any longer than that, you are going to be at high risk for developing addiction.
What therapies are available for someone with an opioid addiction?
Morrow: If someone is addicted to opioids, they should work with an addiction specialist and doctor. They will be able to walk you through safe options to recovery.
The three main drugs used to treat opioid addiction are:
Naltrexone (an opioid antagonist): This monthly injection can be prescribed by any physician, though typically only addiction specialists are comfortable providing it. The patient must be opioid-free for at least 48 hours before starting naltrexone to avoid severe withdrawal symptoms. Sometimes patients need to go through inpatient detoxification for three to seven days before starting these medications.
Buprenorphine (a partial opioid agonist): This is taken daily as a film or tablet that dissolves under the tongue, though monthly or weekly injections may soon be available. Again, the patient should abstain from opioids at least 24 to 48 hours before starting to avoid severe withdrawal. Any physician can prescribe buprenorphine, but they must first obtain a DEA (Drug Enforcement Administration) waiver by completing an eight-hour online course.
Methadone (an opioid agonist): This is provided as a liquid that is taken daily at a specialized methadone maintenance clinic. It is not available outside of that setting for opioid addiction. Patients accepted at one of these clinics can start taking methadone right away, as there is no need for detoxification.
What should potential patients know about these treatments?
It is important to understand that once these medications are started, they should be taken for the foreseeable future. Treating an addiction with these medications is just like treating diabetes with insulin — you need to manage your condition daily. When you stop treating the addiction, it comes back.
Without medication, relapse rates for opioid addiction are 90 percent within a year, even with intensive treatment. Relapse rates drop to 40 to 50 percent with medication. But relapse rates jump back up to 90 percent among individuals who discontinue medication.
I would encourage everyone making this decision to talk it over with your physician, because it can save your life. Key outcomes such as overdose deaths, HIV infections, violent crimes, unemployment and child neglect improve about 50 percent with medication-assisted treatment.
How long does it take to recover from addiction to opioids?
Morrow: Unfortunately, you can never completely be free from an addiction; it is a lifelong condition. You can, however, become sober today. But it takes work to maintain that sobriety daily. Many people who invest in addressing their addiction can achieve meaningful recovery.
What about Narcan? What should people know about this commonly used drug?
Morrow: Narcan (also known as naloxone) can treat a narcotic overdose in an emergency situation. This drug is used differently than the opioid antagonists I previously mentioned.
Naloxone acts very rapidly, and you can take it as a nasal spray or injection. It is very easy to use. Anyone with a known opioid addiction should have Narcan in their home for loved ones to use if necessary.
Most pharmacies carry the drug, and you don’t need a prescription to get it.
The bottom line is that recovery is real. Effective treatments are available, and they do work.
For more information on U-M’s addiction services, including evidence-based outpatient treatment, visit the UMAddictionCenter.org’s program page.