Pharmacotherapies for Opiate Addiction
A few months ago, Hazelden, one of the country’s most well-known 12-step based treatment centers, made headlines when it announced that it would be using long term anti-addiction medications for some of its opiate addicted clients. This represented a sharp change in philosophy for Hazelden. The treatment center had been founded on the idea that abstinence is the cornerstone of recover. Hazelden’s recovery approach has its roots in the principles of Alcoholics Anonymous. But for the first time, Hazelden will begin offering maintenance pharmacotherapies for opiate addiction (addiction to heroin or opioid painkillers). Hazelden’s shift in philosophy is mainly due to the high percentage of relapse they have observed in their opiate addicted clients.
Pharmacotherapies for Opiate Addiction: Maintenance and Detox
There are basically two types of pharmacotherapies for opiate addiction: Detox and Maintenance. Detox pharmacotherapies for opiate addiction are used in almost every medical detox facility or treatment center that offers detox. These are opiate based medications that are used until clients are weaned off the opiates. They are administered in a decreasing manner, with less and less of the drug given each day of the detox.
Maintenance pharmacotherapies for opiate addiction are somewhat more controversial. This is long-term administration of opiate medications to prevent relapse. The medications basically curb cravings and block other short-term opiates-like heroin and most painkillers-from binding to opiate receptors. So if a person tries to use their drug of choice while on maintenance pharmacotherapies for opiate addiction, they will not get the “high.” Critics claim that this is simply trading one addiction for another. However, studies indicate that administering maintenance pharmacotherapies for opiate addiction can reduce overdose fatalities by more than 50%. They also reduce the spread of disease and crime in areas where opiate addiction is common.
Pharmacotherapies for Opiate Addiction: Methadone and Buprenorphine
The two most common pharmacotherapies for opiate addiction are methadone and buprenorphine. Buprenorphine was not originally developed to treat opioid dependency. It was initially indicated for the short-term treatment of opioid withdrawal. However, much like methadone, it wasn’t long before buprenorphine began to be used as a daily, long-term treatment for opioid dependency. The use of buprenorphine to treat morphine dependency resulted in part from a paradigm shift in the medical community. In 2000, Congress passed a law allowing physicians to prescribe narcotics to treat opioid which allowed access to opiate treatment in a medical setting rather than limiting it to federally approved Opioid Treatment Programs.
Although buprenorphine has mainly replaced methadone in private practice, federal opioid dependency programs still used methadone. It works similarly to buprenorphine in that it binds to the opioid receptors in the brain. These drugs have the added benefit of preventing the user from attaining the “high” from heroin and other prescription opioids, because they bind more strongly and for a longer period of time, effectively blocking the receptors from binding to any other drug. However, methadone is a full agonist at the opioid receptors, whereas buprenorphine is a partial agonist, so there is less chance of overdose with buprenorphine.