According to the National Institute on Drug Abuse, people who struggle with opioid use disorder who go to detox without medical assistance are very likely to relapse and begin using opioids once again. One way treatment programs help support people who are addicted to prescription opioids or heroin is by using FDA-approved medications to help reduce symptoms of withdrawal and cravings.
There are many different medications used to treat opioid use disorder (OUD). Some of these are opioid agonists, like methadone, that stimulate opioid receptors in the brain, while others, like lofexidine, are non-opioid medications that are used to alleviate withdrawal symptoms. The one thing all medication-assisted treatment (MAT) medications have in common is that they are most effective when combined with behavioral therapy and peer support.
Medication-Assisted Treatment (MAT) for Opioid Use Disorder
Opioid abuse is an ongoing public health concern in the United States. SAMHSA reports nearly 2 million people struggled with opioid use disorder in 2018. Whether a person is addicted to heroin or prescription opiates, MAT is thought to be a clinically effective way to provide individually tailored treatment and reduce the risk of relapse. The various medications that are regularly used to treat opioid use disorder are proven to improve patient retention in treatment, survival after rehab, and the ability to maintain long-term sobriety.
The Food and Drug Administration (FDA) has approved several different medications, both for the short and long-term management of opioid dependence. Three of the most common are buprenorphine, methadone, and naltrexone.
Medications Used for Opioid Detox
When individuals first stop taking opioids, their bodies will have to adjust to not having opioids in the system. The central nervous system becomes overactive during this adjustment period, resulting in flu-like withdrawal symptoms. Opioid withdrawal can be severe enough to cause relapse, but there are medications that can help reduce symptoms of withdrawal.[3,4] These include:
- Suboxone (buprenorphine/naloxone) – Buprenorphine is a partial opioid agonist that helps treat opioid withdrawal and dependence by reducing withdrawal symptoms and cravings. Naloxone, on the other hand, is an opioid antagonist that blocks the euphoric effects of opioid drugs. Suboxone contains these two medications in a sublingual film that dissolves under the tongue and is taken on a daily basis.
- Subutex (buprenorphine) – Subutex is similar to Suboxone, but it only contains buprenorphine. It is commonly used to treat withdrawal symptoms during detox.
- Methadone – This daily medication is a long-acting opioid agonist that can reduce withdrawal symptoms, alleviate drug cravings, and block the effects of opioids. It can also be prescribed for pain management. If abused, methadone can be habit-forming.
- Clonidine – As an antihypertensive, clonidine is used to treat high blood pressure. However, it is also used to treat some symptoms of opioid withdrawal, such as restlessness, anxiety, hot flashes, sweating, and watery eyes.
- Lucemyra (lofexidine) – This is the only non-opioid medication that is approved to treat alcohol withdrawal. Similar to clonidine, Lucemyra can cause mild sedation, pain relief, and relaxation. As a result, it can treat many symptoms of opioid withdrawal.
The medical treatment of opioid use disorder happens in two phases: the induction phase and the maintenance phase. The induction phase is when the above-listed medications may be used to reduce withdrawal symptoms. The maintenance phase refers to the continued use of certain medications to treat opioid use disorder and prevent relapse.
Medications Used to Treat Opioid Use Disorder and Prevent Relapse
During the maintenance phase, medications like clonidine and lofexidine are usually discontinued. Other medications, such as methadone, Suboxone, and Subutex, may be continued throughout a person’s treatment program and beyond. Patients will work with their physician to determine when is the appropriate time to stop taking their medication.
Additional medications that may be used to treat opioid addiction during treatment are:
- Sublocade (buprenorphine) – in 2017, the FDA approved Sublocade, the first once-monthly extended-release injection of buprenorphine. It is used in patients who have already been on a stable dose of buprenorphine for at least one week. Similar to other buprenorphine medications, Sublocade is intended to reduce drug cravings and prevent relapse.
- ReVia (naltrexone) – Naltrexone is not an opioid nor is it addictive. It simply binds to opioid receptors, reduces cravings, and blocks the euphoric effects of opioids. With no abuse or diversion potential, it can be given as a daily medication to help reduce the risk of relapse.
- Vivitrol (naltrexone) – Vivitrol is a once-monthly, extended-release injection containing naltrexone. The Vivitrol shot is given once monthly in the buttocks by a licensed physician.
The use of these medications must be combined with counseling, behavioral therapy, and peer support. Some patients will also require additional medications for co-occurring disorders and other health issues, including, but not limited to:
- Bipolar Disorder
- Panic disorder
Opioid treatment providers work hand-in-hand with mental health counselors and general practitioners to address all aspects of care.
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All medications physicians may prescribe to treat opioid use disorder work differently, so it’s important to consult with a qualified provider before starting any of these medications. Additionally, the medications prescribed and treatments given should consider the patient’s unique history, beliefs, circumstances, and treatment goals.
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