According to the Centers for Disease Control and Prevention, the current rise in prescription drug abuse and opioid addiction is considered a nationwide epidemic. In 2019, an estimated 10.1 million people aged 12 or older misused opioids in the past year. Specifically, 9.7 million people misused prescription pain relievers and 745,000 people used heroin. Opioid Replacement Therapy (or ORT) is the replacement of a drug of dependence, such as heroin, codeine and OxyContin, with a legally prescribed substitute. There are many advocates and opponent for the recovery approach. Is it a viable approach for long-term recovery?
The answer may not be as simple as making a case for one addiction treatment approach over another. There are both potential benefits and major challenges when using Opioid Replacement Therapy in addiction recovery. We are here to address both approaches. The National Institute on Drug Abuse (NIDA) asserts that there may be more benefit in tackling addiction recovery based on individuals needs, rather than arguing that ORT is more beneficial than behavioral therapy (or vice versa). To give you the best idea of what Opioid Replacement Therapy involves and what alternatives are available, continue reading.
AspenRidge Recovery offers individualized addiction treatment in Colorado. We provide customized approach that considers dual diagnosis treatment and specific needs for every person. Contact us directly at 855-281-5588.
What is Opioid Replacement Therapy?
When it comes to treating addiction in any form, there are many different treatment approaches and theoretical models for treatment. One of these approaches is known as opiate replacement therapy. This is an approach that has become increasingly popular in recent years.
“A variety of effective treatments are available for heroin addiction, including both behavioral and pharmacological (medications). Both approaches help to restore a degree of normalcy to brain function and behavior. Research shows that for some people, integrating both types of treatments is the most effective approach.” – National Institute on Drug Abuse
ORT, or Opioid Replacement Therapy, is exactly what it sounds like. The therapy approach attempts to treat opioid addiction by replacing the substance with another drug that mimics opioid effects.
The most common opiate replacement medications include:
- Antabuse (Disulfiram)
- Suboxone (Buprenorphine)
- Vivitrol (Naltrexone)
- Revia (Naltrexone)
- Narcan (Naloxone)
- Subutex (Buprenorphine)
- Neurontin (Gabapentin)
- Acamprosate (Campral)
All of these medications have at least one thing in common: they are used to treat the withdrawal symptoms of opioid drugs by simulating their physical and psychological effects. Whether or not this is beneficial is the main question of this post.
What Is Opioid Replacement Therapy?
The goal of using these opioid or opiate replacement medications is to more safely and effectively taper of usage of dangerous opioids like heroin or fentanyl. Fentanyl overdose symptoms can be lethal and cause lasting impacts for individuals. The idea is to substitute these extremely potent substances for more treatable medications. This includes everything from heroin to prescription painkillers.
Every kind of opiate replacement prescription, from methadone to naltrexone, is aimed at managing the physical effects of coming off of opioid drugs, otherwise known as withdrawal symptoms.
“When people addicted to opioids first quit, they undergo withdrawal symptoms, which may be severe. Medications can be helpful in this detoxification stage to ease craving and other physical symptoms, which often prompt a person to relapse. While not a treatment for addiction itself, detoxification is a useful first step when it is followed by some form of evidence-based treatment.” –The National Institute on Drug Abuse
In other words, there are several crucial factors of ORT that are important to understand:
- Opioid Replacement Therapy is meant to be a short-term solution to the long-term process of drug addiction recovery.
- ORT is meant to simply decrease cravings and physical withdrawal symptoms.
- Replacement therapies are not supposed to act as a long-term solution to drug addiction.
- ORT can be effective in decreasing withdrawal symptoms.
- ORT is only effective for the long-term if it is followed up by other evidence-based treatment programs for addiction, such as cognitive behavioral therapy.
With these underlying factors of Opioid Replacement Therapy, we can fairly turn to both the benefits and potential challenges of this addiction treatment approach.
While AspenRidge Recovery does not support ORT directly, we want to give you the best information possible so that you can make an informed decision for yourself.
Benefits of Opioid Replacement Therapy
There are numerous benefits of opioid replacement therapy, some that are widely practiced by addiction specialists. For one, opioid substitution therapy (OST) offers people who are opioid dependent an alternative, prescribed medicine. OST has also been found to have wider health, economic, psychological and social benefits. WHO and the United Nations (UN) recommend that OST be provided as part of a comprehensive package for the prevention, treatment and care of HIV among people who inject drugs. Here are some major benefits of ORT or OST:
1. Help With the Management of Withdrawal Symptoms
Medication-assisted treatment for addiction and drug dependence has one major goal: to increase the success of treatment by managing opioid withdrawal symptoms. In this goal, ORTs are largely successful. Medications like buprenorphine have been approved by the FDA specifically for Opioid Replacement therapy purposes.
“Methadone has been used since the 1960s to treat heroin addiction and is still an excellent treatment option, particularly for patients who do not respond well to other medications.” – The National Institute on Drug Abuse
In theory, opioid replacement treatment medications help individuals overcome their addiction by managing one of the most difficult aspects of addiction to overcome: withdrawal symptoms. In practice, the effectiveness of opiate replacement prescriptions has been shown, at least to some degree. Using methadone, buprenorphine, or naltrexone is entirely dependent on each individual case.
2. ORT Can Improve Social Functioning and Participation During Treatment
Let’s be real: one of the hardest parts of addiction recovery is dealing with the withdrawal symptoms in the early stages of recovery. Detox is a necessary but intensely difficult aspect of addiction – from any kind of drug, but especially from heroin and other opioids. This is where one of the potential benefits of Opioid Replacement Therapy comes in.
Opioid addiction treatment medications allow individuals struggling with addiction the ability to focus on the psychological, behavioral and social aspects of their addiction recovery without being distracted by the intensive withdrawal symptoms of opioid addiction treatment. A drug replacement program essentially allows individuals to have better social functioning during treatment. This means that they are better able to participate in the behavioral therapy aspect of a program, because opioid replacement prescriptions handle the physical effects of withdrawal for them.
Replacement therapies can address the physical withdrawal symptoms associated with opioid addiction. Opioid replacement prescriptions like buprenorphine often successfully handle one of the most common signs of opioid addiction: physical dependence and the experience of physical withdrawal symptoms. For many people, addressing the physical symptoms of addiction helps them address the behavioral, social and even mental aspects of addiction as a direct result of Opioid Replacement Therapy, or ORTs. More than that, mitigating the physical symptoms of addiction may be enough for some people to completely overcome the other factors of addiction.
3. Opioid Replacement Therapy Means A Higher Chance at Long-Term Recovery
Some studies have shown that Opioid Replacement Therapy can translate into a higher chance at long-term recovery from opioid addiction.
“Scientific research has established that pharmacological treatment of opioid addiction increases retention in treatment programs and decreases drug use, infectious disease transmission, and criminal activity.” – The National Institute on Drug Abuse
In other words, replacement therapy reduces the short-term negative impact of addiction while also increasing the likelihood of long-term recovery. Of course, this also comes with a number of challenges. With this in mind, we do want to recognize that ORT may be a healthy and helpful option for those who have suffered from addiction for a long period of time. Withdrawal from opioid addiction only becomes more difficult over time, and opiate replacement medication may give those suffering from long-term addiction the ability to consider dual diagnosis treatment and other approaches.
4. Mitigate Risk of Infection Due to Injection of Opioids
One of the most alarming aspects about the national opioid epidemic are the resulting diseases caused by not just the drug itself, but the effects of usage. More lethal substances like fentanyl and heroin carry a higher risk of users injecting. Unsterile needles increases the chances and risks for infections and deadly diseases like HIV and AIDS. Opioid Replacement Therapy can help mitigate some of these risks.
Opioid substitution therapy (OST) is a type of harm reduction initiative that offers people who are dependent on opioids (such as heroin) an alternative, prescribed medicine – most typically methadone or buprenorphine – which is swallowed rather than injected
Challenges of Opioid Replacement Therapy
While the goal of ORT is to replace opioids with a less addictive substance that can be weaned over time, the reality is not necessarily that simple. According to at least one study, only 25 percent of individuals using methadone replacement therapy will be able to quit methadone altogether over time.
The rest will either continue using methadone or start using it all over again once they enter another addiction treatment program.
The implication here is clear: while methadone, buprenorphine and other opioid replacement medications may address the short-term withdrawal effects of opioids, they may introduce a range of other side effects. These potential side effects include:
- Feelings of anxiety or restlessless
- Sleeping problems (such as insomnia)
- Feeling drowsy
- Nausea or vomiting
While replacing opioid dependence with other medications may be necessary for some, it is crucial to know that Opioid Replacement Therapy is not without its own set of side effects and challenges. Other challenges may also include:
2. ORT Means Slow Treatment for Serious Addiction
While very few addiction professionals advocate for the long-term use of opioid replacement medications like Narcan or Subutex, the fact of the matter is that these medications may slow the treatment process dramatically. Antabuse, Neurontin, Campral and medications like these prescriptions do not necessarily erase the withdrawal effects associated with opioid detox. Instead, they essentially put off the withdrawal symptoms of opioid detox by simulating the drug’s effects.
This can translate into a much slower, drawn out process of treatment. In other words, the effectiveness of Suboxone and drugs like it is dependent on both the reality of withdrawal later on and the introduction of other effective behavioral therapies.
3. Opioid Replacement Therapy Does not Address the Underlying Emotional and Psychological Factors of Addiction
One of the biggest challenges in treating opioid addiction with opiate replacement therapy is that using the medication outlined above does not necessarily address some of the more important issues of addiction.
People experience addiction for a wide range of reasons, and sometimes it may not be enough to simply address the physical withdrawal symptoms through opioid replacement medications.
Instead, any successful addiction treatment program must address the underlying emotional and psychological factors of addiction.
4. Replacement Therapy May Be the Wrong Choice for Many Who Could Have Addiction Treated with Behavioral Therapies
The bottom line is this: replacement therapy is helpful for some people and unhelpful for many other people. There are many different options in opioid dependence treatment, and anyone facing addiction would do well to consider all of their options. The potential danger of Opioid Replacement Therapy is that it can be treated as the cure-all for opioid addiction. But this is simply not the case. Instead, addressing the root cause of addiction (either psychological or social) may be more helpful for many people facing opioid addiction.
“ORT should not be confused with or substituted for long-term, abstinence based therapies. Psychology-based therapies are proven to get at the root cause of addiction.” – Dr. Constance Scharff
5. Opioid Replacement Therapy Also Means a Higher Chance of a New Kind of Addiction
From methadone to Suboxone, opioid replacement drugs pose a new kind of danger for individuals struggling with substance addiction and abuse.
Some opioid replacement medications have been shown to be safer than others, but the fact remains that Opioid Replacement Therapy can essentially translate into an addiction on the very prescriptions that were meant for treatment. In order to mitigate these effects, any form of opiate replacement therapy should be accompanied by behavioral therapies for addiction treatment.
The Bottom Line: Addiction Recovery With and Without ORTs
Given both the benefits and challenges of Opioid Replacement Therapy, there is really only one conclusion: ORT can work for some people, and simply would not work for others. Determining whether or not addiction recovery through ORTs would work for you is entirely an individual case. Suboxone, Subutex and methadone could give you the opportunity to overcome opioid withdrawal symptoms; but these opiate replacement medications could also simply serve as a crutch for another addiction altogether.
Treating opioid dependence is complicated, and there are many different approaches to addiction treatment. The important point here is that ORTs should never be expected to solve all of the problems caused by opioid dependence or other forms of drug addiction. In other words, opioid replacement medications should only be used as part of a larger behavioral treatment for opioid addiction – if Opioid Replacement Therapy is used at all.
For more information about our dual diagnosis treatment approach contact us directly at 855-281-5588.