How do you escape from the misery and risks of drug addiction? Most people cannot do it on their own. They need help to return to normal, healthy living. One important form of help is called medication-assisted treatment.
Medication-assisted treatment (MAT) is treatment for addiction that includes the use of medication along with counseling and other support. Treatment that includes medication is often the best choice for opioid addiction. If you are addicted, medication allows you to regain a normal state of mind, free of drug-induced highs and lows. It frees you from thinking all the time about the drug. It can reduce problems of withdrawal and craving. These changes can give you the chance you need to focus on the lifestyle changes that lead back to healthy living.
Taking medication for opioid addiction is like taking medication to control heart disease or diabetes. It is NOT the same as substituting one addictive drug for another. Used properly, the medication does NOT create a new addiction. It helps you manage your addiction so that the benefits of recovery can be maintained.
Your medications could seriously harm or kill someone who has no tolerance for the drug. Take precautions:
Once you’re on a stable dose of medication for the treatment of addiction, it shouldn’t affect the work you do or how well you do your job. For most jobs, there’s no need to mention that you take medication. Your employer has no right to know.
MAT can be a great benefit if you are HIV/ AIDS or Hepatitis B (HBV) or C (HCV) positive. MAT allows you to lead a “normal” life so it’s easier to take care of yourself, to eat better, and to take your medication at the right times. However, prescription drugs for your HIV/ AIDS or HBV/HCV may interfere with specific medication, and your dose may need to be changed. Talk with the program doctor about other drugs you have been prescribed.
Routine tests of urine or oral fluids will show whether you have been using other illicit or inappropriate drugs and whether you have been taking your MAT. You may have to give supervised samples to ensure they are yours. With continual negative results, you’ll be asked to take drug tests less often. If you test positive for other drugs, it may hold up your schedule for taking home doses, and your provider may ask that you take drug tests more often.
The Treatment Program Standards require us to perform what are known as “Random Screenings” to monitor your progress with the program. You may receive a call from the office stating that you need to come in for a Random Screening. For this visit, you need to bring all your medications with you to be counted. You will be required to provide a urine sample at the clinic.
You must come in for your Random Screening with 24 hours of receiving the phone call. There are absolutely no exceptions to this rule. Missing a single Random Screening will result in disqualification from the program. Failing a urine screening (showing a positive result for usage of illegal drugs) may result in disqualification from the program.
Assessment includes determining your history with drug use as well as a physical examination by a doctor. You will be asked about medical problems that are commonly associated with opioid addictions, and you may be asked to consent to a blood test to check for HIV, Hepatitis, and other infectious or sexually transmitted diseases.
You may be asked about your drug use, your physical and mental health, your home and family, and your employment.
What are you being tested for? What other services are available? Remember, knowledge is power. You may be assessed again during treatment to review your progress.
The most common medications used in treatment of opioid addiction are methadone and buprenorphine. Sometimes another medication, called naltrexone, is used. Cost varies for the different medications. This may need to be taken into account when considering treatment options.
Methadone and buprenorphine trick the brain into thinking it is still getting the problem opioid. The person taking the medication feels normal, not high, and withdrawal does not occur. Methadone and buprenorphine also reduce cravings.
Naltrexone helps overcome addiction in a different way. It blocks the effect of opioid drugs. This takes away the feeling of getting high if the problem drug is used again. This feature makes naltrexone a good choice to prevent relapse (falling back into problem drug use). All of these medications have the same positive effect: they reduce problem addiction behavior.
All three medications come in pill form. Methadone also comes as a liquid and a wafer. Methadone is taken daily. The other two medications are taken daily at first. After time, buprenorphine is taken daily or every other day, and doses of naltrexone are taken up to 3 days apart.
Methadone to treat addiction is dispensed only at specially licensed treatment centers.
Buprenorphine and naltrexone are dispensed at treatment centers or prescribed by doctors. A doctor must have special approval to prescribe buprenorphine. Some people go to the treatment center or doctor’s office every time they need to take their medication. People who are stable in recovery may be prescribed a supply of medication to take at home.
Medication is introduced carefully. Methadone can be safely taken at the start of recovery. Buprenorphine can be taken once withdrawal has begun. Naltrexone cannot be taken until opioids are completely out of the body, usually 7 to 10 days after withdrawal begins. Taking buprenorphine or naltrexone too soon can make withdrawal worse.
Methadone is a long-acting opioid medication that is used as a pain reliever and, together with counseling and other psychosocial services, is used to treat individuals addicted to heroin and certain prescription drugs.
MMT helps normalize your body’s neurological and hormonal functions that have been impaired by the use of heroin or misuse of other short-acting opioids. Opioids are a group of drugs that act on the central nervous system. They include opiates such as codeine, morphine, and heroin as well as synthetic drugs such as oxycodone, oxycontin, hydrocodone, and methadone.
Appropriate MMT provides several benefits:
Beginning MMT can help stabilize and improve your health and can move you toward getting the care you need.
For safety, your first dose of methadone will be low or moderate. New patients usually start at a dose not to exceed 30 to 40 mgs. A larger dose of 60 to 120 mgs a day may be required for long-term maintenance. You and your physician should determine what dose works best for you.
Your dose is right when withdrawal symptoms, drug cravings, drowsiness, and side effects fade. With a correct dose, you should feel more energetic, clear-headed, and able to do the things that matter in your life. Until you have adjusted, make sure not to drive a car or operate heavy machinery.
You should discuss a dose adjustment with your doctor if you still are experiencing drug cravings. The majority of properly dosed patients have no physical desire to use other drugs.
Methadone interacts with many medications. This can change the safety of the methadone you are taking and potentially can cause withdrawal. It is important to tell your doctor about all of the drugs you take.
Methadone can provide effective pain relief. Yet, once you are on a stable dose of methadone, you may be tolerant to its pain-relieving effects and may require additional pain medication. Some MMT patients need more pain medication than patients who are not a part of MMT.
At the start of treatment, you will have to go to the clinic daily to take your dose under observation. This daily contact confirms to the staff that you are taking the dose ordered by the physician. It also helps the staff to see if your dose is enough or too much and whether you are experiencing side effects, in which case an adjustment may be necessary.
After a few months, your provider may let you take home or “carry” doses for unsupervised use. Ask to find out when and under what conditions you will be given carry doses. Your provider may take away your take-home privileges if you do not comply with the agreement or if your drug tests are positive for drug use.
The longer you’ve been dependent on opioids, the more likely it is that you would benefit from being on methadone. Those who withdraw from methadone after short-term treatment are more likely to return to drug use than those who stay in treatment until they have obtained the optimal benefits.
Remember the risks that come with drug use: high rates of HIV and Hepatitis C infection among people who inject drugs, greater odds of committing crimes and going to prison, and possible death from overdose.
Recovery to a normal life is possible. You should stay in treatment as long as you are benefiting from it. The length of time you stay in MMT is an issue that should be decided solely by you and your physician. Some people are in MMT only for a few weeks, while others choose to stay in MMT indefinitely.
If you are thinking about ending MMT, talk with the doctor at the program. It can be a slow process to taper off of methadone. Though doses are tapered slowly to reduce withdrawal symptoms, you may experience some aching, insomnia, and lack of appetite for a few weeks. You also may feel a sense of loss, sadness, and sleeplessness for months. However, over time this should dissipate.
Long-term withdrawal can take from 6 months up to a year before you can completely taper off of methadone treatment. You should never set time limitations on yourself; taper off at your own pace in cooperation with your treatment provider.
Throughout treatment and after treatment ends, be sure to maintain and extend your support network. You can request to come back to the program every few weeks for the first year and expect to have the same privileges that you did before tapering off. Should you feel that you may relapse, return to your program immediately for re-dosing. You always can return to treatment. Returning to treatment is not a failure—it’s a choice about what is best for you.
Buprenorphine is a medication used to treat opioid addiction.
Cost varies for the different medications. You may need to take this into account when considering your treatment options. The person who takes buprenorphine feels normal, not high. However, the brain thinks it is receiving the problem opioid, so withdrawal symptoms stay away. Buprenorphine also reduces cravings. If cravings continue to be a problem, your doctor will adjust your medication or help you find other ways to reduce them.
You take buprenorphine as a pill that dissolves under the tongue. You do NOT chew or swallow it. There are two forms.
The pill is taken once a day. Over time, the dose interval may stay at once a day or change to every other day. The main advantages of buprenorphine are:
Important: Not all doctors have approval to prescribe this medication, and not all doctors provide counseling for addiction. Also, daily check-in at a treatment center can be helpful to recovery. Therefore, for some people, a treatment center is the best place to receive medication for opioid addiction.
Before you are given the first dose of any medication for opioid addiction, your doctor will ask you questions about your addiction, health, and other problems. You will get a drug test—usually a check of urine or saliva. You also will have a physical exam and tests for diseases that are common to people who have been abusing drugs. Your liver will be checked to make sure the medication can be safely taken. If buprenorphine is safe and appropriate for you, your doctor may recommend it. You and your doctor or substance abuse treatment provider decide together on a treatment plan. The plan describes the medication routine, the counseling and other services that will be provided, and the rules that must be followed. These rules will be explained to you and you will get them in writing.
Buprenorphine is an effective medication for opioid addiction that does not require daily or weekly visits to a clinic after the initial induction period. It blocks the effects of other opioids. This eliminates cravings and prevents withdrawal symptoms such as pain and nausea. Patients can be maintained on buprenorphine or go through detoxification. Buprenorphine is a different type of opioid than pain pills, heroin or methadone. Because this medication leaves the brain cells more slowly than typical opioids, the withdrawal process is milder and detoxification is generally easier to accomplish. Patients work with a monitoring physician to meet their goals.
Suboxone is composed of two separate medications: buprenorphine and naloxone. Buprenorphine, which is a partial opioid, has opiate affects that are significantly reduced compared to that of full opioid agonists, such as vicodin or heroin. Naloxone, which is not absorbed by the digestive track when Suboxone is taken orally, is added to Suboxone in order to prevent the misuse of the medication by injection drug users and those who are looking to replace their illegal addiction with a legal one.
Treatment begins here. You will be switched from your current opioid of misuse (heroin, methadone, or prescription painkillers) to your treatment medication. You are asked to arrive at the doctor’s office in a moderate state of withdrawal. Being in a state of moderate withdrawal is vital to having the medication work well. If you are not in moderate withdrawal, the medication might actually make you feel worse rather than better (intensifying withdrawal symptoms). This is called precipitated withdrawal.
It is really important to be truthful with your doctor about the last time you used an opioid, which opioid it was, how much you took, and which other drugs or medications you used. Your doctor needs this information to determine the timing of your first dose.
Once you take your first dose, you should begin to feel better within 30 minutes. Your doctor may choose to give you additional doses while you are in the office. Be sure to tell your doctor about how you are feeling during induction so your doctor can find the appropriate dose for you.
When you leave the office, the doctor will likely give you a prescription that will last until your next appointment. The doctor may also want to discuss counseling with you, since medication plus counseling has been shown to produce better results. At the same time, your doctor may suggest enrolling in the Here to Help® Program, which can provide you with an added support system.
Since an individual’s tolerance and reactions to the medicine vary, daily appointments may be scheduled and medications will be adjusted until you no longer experience withdrawal symptoms or cravings. Urine drug screening is required for all patients at every visit during this phase and throughout treatment.
Intake and induction may both occur during the first visit, depending on your needs and your doctor’s evaluation. Call your doctor if you have any questions or concerns.
After your induction is complete, your monitoring physician may still require you to come for follow-up visits every week, or every two weeks until they are sure your dosage level is effective and safe. After this, your follow-up visits might be scheduled less frequently such as every four weeks—but, again, this is at the discretion of your monitoring physician, and is typically based on the results of your urine screening.
This is the second phase of treatment. During this phase, your doctor may continue to adjust your dose until you find, and continue on, the dose that works for you. It is important to take your medication as directed.
During this phase is when you may also begin working on your treatment goals with your doctor and counselor. At times when you feel stressed, or experience triggers or cravings, your doctor may suggest a dose adjustment, or there may be a need to change the frequency of counseling and/or behavioral therapy.
Occasionally, as you achieve your treatment goals and feel confident about your progress, your physician may suggest a dose decrease. During these times, you are “restabilized.” This is why stabilization and maintenance go together.
There are no time limits for treatment with this medicine. Length of therapy is up to your doctor, you, and sometimes your therapist or counselor. If you and your doctor agree that the time is right for a medical taper, he or she will slowly lower your dose (also known as a taper), taking care to minimize withdrawal symptoms. If you feel at risk for relapse during a taper, let your doctor know. You can be restabilized and continue maintenance if needed.
Your doctor will prescribe a low dose to start taking after withdrawal symptoms begin. Dose levels may be adjusted up as needed. Always take doses exactly as prescribed by your doctor.
Buprenorphine can make you feel drowsy at first. You should not drive or perform other high-risk tasks until you know how this medication affects you. If drowsiness continues to be a problem, your doctor may adjust dose levels. You may take buprenorphine for days, months, or years—as long as it is needed to prevent relapse. However, you should be checked often by a doctor if you have liver disease. If you are stable in recovery and want to stop taking buprenorphine, you must do it slowly, over time. This is called tapering. Tapering works best with the help of your doctor or substance abuse treatment provider, after progress has been made in treatment.
Side effects are feelings of discomfort or sickness that come with taking medicine.
Buprenorphine has a few mild side effects. Usually these go away after the medication is taken for a while.
If you have side effects, you should NOT stop taking the medication. Instead, talk with your doctor or substance abuse treatment provider.
An adjustment in dosage or a change in medication may help. There are some simple things you can do to reduce side effects, too.
Also seek help if the following side effects appear, because they may indicate serious liver problems:
You can become dependent on buprenorphine, as with many medications taken over time. For this reason, if you wish to stop taking buprenorphine, you should work with a substance abuse treatment provider to taper off. This prevents withdrawal symptoms from appearing.
Naltrexone is a medication used to treat opioid addiction.
Naltrexone is one of three medications commonly used to treat opioid addiction. The other two are methadone and buprenorphine. Cost varies for the different medications. You may need to take this into account when considering your treatment options.
Naltrexone blocks opioids from acting on the brain, so it takes away the reward of getting high on the problem drug. This feature makes naltrexone a good choice for preventing relapse (falling back into problem drug use). Naltrexone may not stop drug cravings. If it does not help with cravings, your doctor or substance abuse treatment provider will help you find other ways to reduce them.
Naltrexone comes in pill form. Two trade names for it are ReVia® and Depade®. It is also available as a lower cost generic. You take the pill every 1 to 3 days. Naltrexone is also available in a new extended-release form that is injected in the buttocks. This extended-release injectable form has the trade name Vivitrol®. The injection is administered by your physician or other treatment provider once a month. Naltrexone may be a good choice if you are completely past withdrawal and highly motivated to stay in recovery. It also may be recommended if you are in an early stage of opioid addiction.
Before you are given the first dose of any medication for opioid addiction, your doctor will ask you questions about your addiction, health, and other problems. You will get a drug test—usually a check of urine or saliva. You also will have a physical exam and tests for diseases that are common to people who have been abusing drugs. Your liver will be checked to make sure the medication can be safely taken. If naltrexone is safe and appropriate for you, your doctor may recommend it.
You and your doctor or substance abuse treatment provider decide together on a treatment plan. The plan describes the medication routine, the counseling and other services that will be provided, and the rules that must be followed. These rules will be explained to you, and you will get them in writing.
You must have no opioids in your body before starting naltrexone. Otherwise, withdrawal will be extra strong. You first must go through withdrawal under your doctor’s care. This supervised withdrawal is called detoxification or detox. You can start on naltrexone after detox is completed.
Your doctor will first prescribe a low dose. Your dose levels may be adjusted up as needed. Always take doses exactly as prescribed by your doctor. If you are prescribed the injectable form of naltrexone, be sure to keep your appointments for monthly injections.
You may take naltrexone for days, months, or years—as long as it is needed to prevent relapse. However, you should be checked often by your doctor if you have liver disease.
Naltrexone does not cause withdrawal when you stop taking it. If you are stable in recovery and want to stop taking naltrexone, you do not need to taper off over time. However, you should always consult with your doctor before quitting naltrexone.
Some people who take naltrexone carry a medical card in case they need emergency care. The card explains that they cannot receive medications containing opioids and they will need special care if they are in pain. Ask your doctor whether you should carry a card.
Naltrexone has a few mild side effects. Usually, these go away after the medicine is taken for a while. If you have side effects, you should NOT stop taking the medication. Instead, talk with your doctor or substance abuse treatment provider. An adjustment in dosage or a change in medication might help. There are some simple things you can do to reduce side effects, too.
Also seek help if the following side effects appear, because they may indicate serious liver problems:
Medication is one part of treatment for opioid addiction. For many people, another important part is counseling: the opportunity to talk with a professional either one-on-one or in a group with others in treatment. Through counseling, you learn about the motivations and behaviors that led to your opioid addiction. You learn to commit to a more healthful lifestyle. You gain support and skills while working with others to manage your recovery long term.
Counseling can provide encouragement and motivation to stick to treatment. It can help you learn how to make healthy decisions, handle setbacks and stress, and move forward with your life. In group counseling, you connect with others in treatment and make new friends who don’t use drugs. You can get these benefits from support groups, too. These are informal meetings of people facing similar challenges.
It is very hard to go through recovery alone. Support from family and friends is very important. Love and encouragement can help you make the decision to enter treatment and stick with it. Some treatment programs offer counseling for your loved ones. They do this because your addiction may have caused pain and anger or feelings of shame and hopelessness.
Counseling is a useful way for family and friends to learn more about your situation, how to help, and how to handle the problems your addiction has caused them. It is a safe place for them to express feelings and to find out what help is available for everyone affected. There are support groups for families and friends, too. These are safe places to share information and encourage others who have loved ones who are dealing with addiction.
How do you return from the ruin of drug addiction? Most people cannot do it alone. They need help to return to normal, healthy living. One important form of help is called medication-assisted treatment. There are three, equally important parts to this form of treatment:
Support from family and friends
Naltrexone is one type of medication used for treatment of opioid addiction.
Naltrexone helps you avoid relapse. It is legal and taken under a doctor’s care. It is NOT just another drug to abuse. Naltrexone is produced under safe conditions and sold legally. There is no risk of getting tainted doses, which can happen with street drugs.
You can stop taking naltrexone at any time with no withdrawal or craving. It is NOT addictive. Few people have mood swings when taking naltrexone. It does NOT cause depression. If you have symptoms of depression, talk to your doctor— there may be some other cause.