Opioid Treatment: Medication & Therapy Options

What Are Opioids?

Opioids are a class of drugs with pain-killing properties, which are used medicinally and misused for recreational purposes. According to recent data, most people who misuse opioids use prescription painkillers vs. illicit drugs like heroin.⁶ While these painkillers can be helpful to people struggling with chronic pain, they are also highly addictive and very dangerous.¹

There are three related risks associated with opioid use: dependence, withdrawal, and overdose, which can lead to respiratory depression and death. Opioids are the number one cause of fatal overdoses worldwide.^1,7

Opioids vs. Opiates: What’s the Difference?

Opiates are substances derived from the poppy seed (e.g., heroin, morphine, and codeine), while opioids are synthetically created to mimic the effects of opiates.^1,2 Synthetic opioids can be much stronger than traditional opiates, and are responsible for most of the fatal overdoses that occur in the US.^1,8

Fentanyl: The Deadliest Synthetic Opioid

Fentanyl is a synthetic opioid that is 50-100 times stronger than heroin or morphine. Originally made by pharmaceutical companies, fentanyl is now being made by drug cartels. Often, people who are buying heroin or prescription painkillers on the street are unknowingly being sold fentanyl.⁸ This has led to a dramatic rise in fentanyl addiction and overdose deaths in recent years, thus dramatically increasing the existing opioid epidemic.^1,6

What Is Opioid Addiction & Can It Be Treated?

Opioid addiction is formally called opioid use disorder (OUD), a treatable disorder characterized by cravings, problematic use, and difficulty stopping or controlling use.⁷ Unlike other widely misused drugs, opioids are highly physically addictive, meaning people quickly develop a physical dependence on them. Physical addictions also lead people to build up a tolerance to opioids, which they try to overcome by increasing their dose.⁷

While opioid use disorder is difficult to overcome, a number of effective treatments have emerged to help. In most cases, people who are struggling with OUD are recommended for medication-assisted treatment (MAT), which includes a combination of therapy and opioid addiction medications.^23,4,9 MAT can be provided via inpatient, intensive outpatient, and normal outpatient rehab centers.

Typically, the goals of opioid addiction treatment are:⁹

• To establish sobriety from illicit or prescribed opiate or opioid drugs
• To lessen cravings and opioid withdrawal symptoms
• To support long-term remission and prevent relapse
• To improve long-term survival rate of people with OUD
• To encourage engagement in treatment, therapy, and opioid addiction recovery groups

Opioid Addiction Treatment Options

There are many options for opioid addiction treatment (inpatient and outpatient). The vast majority of rehab facilities follow evidence-based guidelines for the treatment of OUD, including a combination of medication and therapy (MAT).^2,3,4 The type of treatment a person receives depends on several factors, including the severity of their dependency and the risk of relapse, as well as the affordability of treatment.⁶

These are settings where you may receive opioid addiction treatment:

• Inpatient settings: provide medically supervised detox, a highly secure and structured drug-free environment, and 24 hour overnight treatment, including group therapy, individual therapy, medication, and case-management services
• Residential settings: provide a structured, sober-living environment for people in opioid addiction recovery; certain rules include having to work, pay rent, assist with chores, submit to random drug screens, and engage in some form of outpatient treatment
• Intensive outpatient programs: skill groups and group therapy are offered 3-5 days per week, as well as on-site drug screening, individual or family counseling sessions, case management, and medication management
• Outpatient programs or medication-assisted treatment (MAT) clinics: provide medications like Suboxone or Methadone and may have on-site group or individual therapists; alternatively, they may require patients to establish group or individual treatment elsewhere
• Group therapy or self-help groups: may be focused on building recovery skills or giving and receiving help to others in recovery from an addiction; this may be led by a therapist or peer-led groups like Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery (free to attend)

Medication-Assisted Treatment (MAT)

MAT includes a combination of therapy and medications.^2,3,4,9 It’s considered a frontline treatment for opioid use disorder, and can be provided in inpatient or outpatient rehab or treatment centers.⁶ It may be based on cognitive behavioral therapy (CBT), motivational interviewing, or other proven therapies. The medication component of MAT always involves the use of FDA-approved medications:^2,3,6,9

Here are opioid use disorder medications:

Buprenorphine (with or without Naloxone)

This can be given in a daily tablet, dissolvable film, or monthly injection. It works by partially or fully binding to certain opioid receptors to reduce cravings and withdrawals. It’s non-intoxicating when Naloxone is included in the formula. Some of the more common adverse effects include drowsiness, brain fog, constipation, and headaches.

Typically, buprenorphine is considered safer and much less intoxicating than methadone, meaning it can be self-administered at home vs. in a clinic. That said, it does still have addictive qualities, meaning that people cannot simply stop taking it without experiencing withdrawals; they will need to taper slowly with the help of a medical professional

Methadone

This is a daily liquid or tablet administered in a clinical setting, which attaches to opioid receptors in the brain to block withdrawals and cravings; however, it can be partially intoxicating. Compared with buprenorphine, methadone is more likely to lead people to feel dizzy, sleepy, or cognitively impaired. Adverse effects include weight gain, drowsiness, constipation, and more serious issues like respiratory, liver, or heart problems.

Complications with methadone are more likely when people are taking other substances/medications. Methadone can cause people to experience withdrawals when they stop using it, so they will need to taper slowly with the help of a medical professional.

Methadone has slightly better long-term remission rates than buprenorphine, but it’s normally administered only in a clinic, meaning people on this medication have to travel to a clinic every day to get their dose.

Naltrexone

This monthly injection blocks opioid receptors in the brain, thus preventing people from being able to experience the pleasurable effects of opioids. It isn’t meant to help ease withdrawals or cravings. Instead, it’s administered to people who have already experienced withdrawals and want to prevent relapse.

Naltrexone, also known as Vivitrol, is only administered every 3-4 weeks. The medication works by blocking the effects of opioids, preventing people from being able to get high. It does not usually lead people to feel intoxicated or impaired, but it can have slight effects on mood and energy levels. One benefit is that it isn’t addictive, and people who are taking it can stop without experiencing withdrawals.

Lofexidine

Taken as needed, this tablet attaches to adrenergic receptors (vs. opioid receptors) in the brain to help alleviate withdrawal symptoms. Lofexidine is a less commonly used MAT medication; however, it’s still helpful to some people who are experiencing opioid withdrawals. Formerly, it was used off-label for opioid use withdrawal (similar to the medication clonidine), but was FDA-approved for OUD in 2018.

While there is less data on the use of lofexidine for OUD, early research shows that it can be effective in reducing withdrawal symptoms. Also, this medication is non-habit forming and has relatively mild adverse effects. Hypotension, dizziness, sleepiness and dry mouth are experienced by some people who take this medication.

Naloxone

This emergency medication, also known as Narcan, blocks opioid receptors in the brain and can be used to reverse symptoms of an overdose via nasal spray or injection. Alternatively, naloxone can be added to buprenorphine (film, tablet, or injection) to lessen the euphoric effects of an opioid, making it a less-risky medication for people trying to overcome dependence..

When used alone, naloxone is most commonly an emergency medication for people who have overdosed on opioids. Naloxone can reverse the effects of a fatal overdose when it is administered quickly enough, making it a life-saving drug.

Therapies for Opioid Addiction Treatment

Everyone who receives MAT is required to engage in counseling. Behavioral therapies like cognitive behavioral therapy (CBT), motivational interviewing, and contingency management are all considered effective tools for treating OUD and other substance use disorders.^2,3,4 Therapy can be provided individually, in groups or even in family therapy. They also can be provided in a number of different settings, including inpatient and outpatient clinics.Goals are personalized.

Here are several examples of potential goals for OUD therapy:^3,6

• Help to improve coping skills to overcome urges and triggers
• Establish sobriety and overcoming challenges in early recovery
• Develop a relapse prevention plan to reduce the risk of relapse
• Work to address underlying issues like trauma, grief, or stress
• Treat co-occurring mental health conditions like depression, anxiety, or post-traumatic stress disorder (PTSD)
• Encourage clients to stay engaged in treatment (including any prescribed meds)
• Work to develop healthier lifestyles, routines, and a strong support network
• Provide resources for people in recovery including vocational & housing support
• Help clients repair relationships with family and loved ones
• Identify relapse triggers and early warning signs

Cost of Opioid Treatment

Opioid treatment is offered in most areas, but cost can be a significant barrier. For example, not everyone has health insurance that covers the cost of rehab, therapy, or MAT. Even those who do may have high deductibles or copays that make treatment unaffordable.

According to a 2021 article from the National Institute on Drug Abuse and data from the National Drug Helpline, here are average costs for opioid treatment in the US:^10,11

• Methadone treatment, including medication and therapy: $126 per week, $546 per month, or $6,552 per year
• Buprenorphine, including medication and outpatient visits twice per week: $115 per week, $498 per month, or $5,980 per year
• Naltrexone, including the medication and some outpatient visits: $168 per week, $1176 per month, or $14,112 per year
• Inpatient rehab or medical detox: Between $250-$800 per day
• Residential addiction treatment: $5,000-$80,000 or more, depending on the length of stay, whether it is a private luxury facility, where it is located, and what amenities and services it provides
• Intensive outpatient treatment: $3,000-$10,000 total

How to Find Opioid Treatment

Begin the search for addiction treatment by scheduling an appointment with a licensed therapist who specializes in dependence. Use a free online therapist directory or go through your insurance company to find an in-network therapist. It’s important to choose a therapist who has credentials to back up their experience.^6,9,11

Final Thoughts

Opioid use disorder can be difficult to overcome, but it’s easier with help and support. Keep in mind that there isn’t a one-size-fits-all solution for opioid addiction. It may even be possible to overcome dependence by using free support groups like NA or SMART Recovery. Addressing root issues, learning coping skills, and building healthy routines and relationships are equally important to the recovery process.