Understanding opioid addiction and treatment

The US Department of Health and Human Services define opioids as ‘... a class of drugs that include legal drugs to reduce pain (such as oxycodone, hydrocodone, codeine, and morphine) and also include the illegal drug heroin and synthetic opioids such as fentanyl.’ 

• Prescription opioids are generally safe when used for a short time and as prescribed by a clinician.
• People can become addicted to both prescription opioids and illegal opioids. 
• Both legal and illegal opioids can lead to drug dependence, addiction, overdose and death.

Misusing opioids can include not following instructions from your doctor, taking pills that are not prescribed for you or taking opioids to get high.

How do you know if you are addicted to opioids?

The signs and symptoms of addiction can be physical, behavioral and psychological. The Mayo Clinic describes symptoms of drug addiction as the following:

• Continuing to use increased amounts of the drug to achieve the same effect 
• Continuing to use the drug, even though it is harming your physical and mental health
• Engaging in risky behaviors such as driving or stealing when under the influence of the drug
• Avoiding social activities or missing work
• Interfering with relationships
• Using the most of your time to get the drug, use the drug, or recover from the effects of the drug
• Struggling with your attempts to stop using the drug 
• Experiencing withdrawal symptoms

How do opioids work?

Opioids travel through the blood and attach to receptors in the brain. Opioids can block pain, cause sensations of pleasure like calmness or happiness, and slow heart and breathing rates.

What is Fentanyl?

Fentanyl is a powerful synthetic opioid that is roughly 100 times more potent than morphine and 50 times more potent than some forms of heroin.

• Other illicit drugs can be laced with fentanyl, unknown to the user.
• This can cause unintentional overdoses because fentanyl is so potent. 

Mixing opioids with other drugs can cause dangerous side effects including difficulty breathing, coma, brain damage and death. 

If you are taking prescription pain medications, do NOT take the following without first talking to your health care provider: 

• Alcohol (including beer, wine and liquor).
• Antihistamines (including allergy medications such as Benadryl®).
• Cough medicine/cough syrup.
• Barbiturates,benzodiazepines (often used as sleeping pills and sedatives, such as Ambien®, Xanax®, and Valium®), and other drugs that cause sedation or respiratory depression.
• General anesthetics (often used for surgery).

What should I look for in a treatment program for myself or a loved one?

The Surgeon General’s Office recommends that a treatment program should have:

• Personalized diagnosis, assessment, and treatment planning—one size does not fit all, and treatments should be tailored to you and your family. 
• Long-term disease management—addiction is a chronic disease of the brain with the potential for both recovery and recurrence. Long-term outpatient care is the key to recovery. 
• Access to FDA-approved medications. 
• Effective behavioral interventions delivered by trained professionals. 
• Coordinated care for other/co-occurring diseases and disorders. 
• Recovery support services—such as mutual aid groups, peer support specialists, and community services that can provide continuing emotional and practical support for recovery.

What do treatment programs include?

• Medication-assisted treatment (MAT)
• Counseling and behavioral therapies
• Residential and hospital-based treatment

How does counseling treat opioid abuse and addiction?

Counseling for opioid abuse and addiction can help you:

• Change attitudes and behaviors related to drug use.
• Build healthy life skills.
• Stick with other forms of treatment, such as medication-assisted treatment (MAT).
• Get referrals to other resources.

How do behavioral therapies treat opioid abuse and addiction?

• Can change attitudes and behaviors related to drug use.
• Helps to handle stressful situations and various triggers that might cause another relapse. 
• Medications work better and help people remain in treatment longer.

MAT is a treatment for addiction that includes the use of medication along with counseling and behavioral therapy. It is important you work with a healthcare provider to develop the best treatment plan for you. 

Which medications are used to treat opioid addiction?

Methadone, buprenorphine and naltrexone are medications approved to treat opioid addiction. 

Methadone: Methadone is an opioid. It is provided at a dose that helps stabilize the brain without causing a “high.” It is taken by mouth, usually as a liquid, and is provided through a specialized treatment center called an “opioid treatment program (OTP).”

Buprenorphine (e.g. Suboxone®): Buprenorphine has partial activity of an opioid. It is provided at a dose that helps stabilize the brain without causing a “high.” Buprenorphine is usually taken dissolved under the tongue and can be prescribed by a physician, nurse practitioner or physician-assistant who has completed additional training and is “waivered.”

Naltrexone (e.g. Vivitrol®):  Naltrexone blocks the effects of opioids. It is taken when someone has completely stopped opioids to help prevent use. It can be taken by mouth daily or as a monthly injection.

Methadone and buprenorphine can decrease withdrawal symptoms and cravings. They work by acting on the same targets in the brain as other opioids, but they do not make you feel high. Some people worry that if they take methadone or buprenorphine, it means that they are substituting one addiction for another. This is not true. It’s important to remember these medicines are a treatment. They restore balance to the parts of the brain affected by addiction. This allows your brain to heal while you work toward recovery. Similar to taking medications for other chronic diseases like diabetes or high blood pressure, it is likely these medications will be necessary long-term (can range from years to life-long).