Opioid Replacement Therapy
While the ultimate goal of opioid replacement therapy is an eventual complete abstinence from all opioid drugs, it has a number of other features that benefit drug addicts and the communities where they live. This includes fewer instances of disease transmission, a reduction in crime related to drug-seeking behavior and fewer overdose deaths and suicides.
Opioid Replacement Therapy: How it Works
Drugs like heroin are potent and fast-acting. This means that the euphoric effects are felt almost immediately and are intense but short-lived. This type of therapy works by providing addicts with a similar opiate-based drug that produces less intense euphoric effects, but lasts much longer.
The idea is to slowly wean the addict off the stronger, fast-acting illicit chemicals and gradually reduce the dosage of the opioid replacement therapy drugs until abstinence is achieved. This type of therapy reduces the severity and duration of the effects of Acute Withdrawal Syndrome; a significant barrier to treatment for many opioid addicts.
Primary Drugs Used in Treatment
There are 3 primary drugs currently in use, although some nations use different drugs and some permit the use of morphine and even heroin to treat certain types of addicts. In general drugs used during detox and subsequent drug treatment for opiates include:
*Methadone: One of the most widely used opioid replacement therapy drugs; methadone is also commonly diverted for street use despite significant controls.
*Buprenorphine/Suboxone: Once marketed as a powerful analgesic to treat patients with chronic pain and post-surgical patients, buprenorphine is a leading drugs used in opioid replacement therapy, overtaking the popular methadone in many clinics.
*Naltrexone: Used to treat both alcohol and opiate dependence, naltrexone works by directly affecting the receptor sites where neurotransmission resulting in euphoria occurs.
Why Opioid Replacement Therapy during Drug Detox?
This treatment results in significant benefits when compared to traditional drug detox methods. This includes the ability of treatment professionals to properly dose the addict in an effort to reduce or eliminate withdrawal symptoms – especially severe drug cravings and the potential for respiratory depression and other medical complications.
The therapy generally produces a higher patient retention level, keeping addicts in treatment for a longer period of time than traditional methods. It also reduces the amount of illicit drugs consumed by patients, as the patient needs less illicit substances to achieve the effects they seek.
Overall, addicts on opioid replacement therapy protocols generally abstain earlier and stay clean for longer than addicts who are treated using other protocols or no treatment at all.
(Mattick RP, Digiusto E, Doran CM, O’Brien S, Shanahan M, Kimber J, Henderson N, Breen C, Shearer J, Gates J, Shakeshaft A and NEPOD Trial Investigators, 2001. National Evaluation of Pharmacotherapies for Opioid Dependence: Report of Results and Recommendations. National Drug and Alcohol Research Centre, Sydney.)
Regardless of eventual complete abstinence rates (which are regrettably low), the benefits of opioid replacement therapy to addicts and their communities are immense. By stabilizing addicts with this treatment, many people are able to get their lives back in order, despite the fact that some will remain on the therapy for a year or more, and many eventually return to drug use. However, this type of therapy provides a means for addicts to become stable, reduce their risk of infectious disease and reduce their exposure to drug related violence.
Communities where opioid replacement therapy is practiced benefit from these harm-reduction strategies while providing a clever method of keeping addicts within a certain circle of treatment. This allows for proper observation and intervention, as well as keeping treatment options and support well within the reach of even the most desperate addicts.
The Risks of Opioid Replacement Therapy
There are two primary risks:
1.) Addiction to Treatment Drugs
Because drugs like methadone and naltrexone are opiate-based, there is significant potential for abuse and addiction. In fact, the idea of opioid REPLACEMENT therapy is aptly named, as the concept merely replaces one drug with another. Therefore, the addiction is not resolved; rather, the behaviors associated with it are controlled and modified with the eventual hope that abstinence will be achieved. Unfortunately, for many addicts this is not the case and a large percentage of those being treated using opiate based treatment drugs will eventually return to their street drugs of choice.
There is a serious risk of overdose when patients begin an opioid replacement therapy program and when they cease participation in the program. This is because tolerance levels have changed rapidly during treatment, and neither doctors nor patients can predict these levels accurately. Fortunately, these risks are still acceptable when compared to those associated with no treatment at all. (Kristina Fiore, Mortality Risk of Opioid Replacement Assessed Reviewed by: Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner October 27, 2010)
Opioid replacement therapy during detox can help addicts transition smoothly while avoiding the severity of symptoms usually associated with acute withdrawal. However, because of the ongoing risk of long term addiction to treatment drugs, it’s important that addicts understand that eventually, they must stop using all opiates, or risk long terms problems associated with chronic addiction.