Medication-Assisted Treatment for Opioid Dependence

More than 130 people die every day from an overdose of opioids in the United States.

Opioids are very powerful narcotics that are effective in relieving pain. and should only be used when necessary for a short period of time, such as after surgery or a serious injury.

Overprescription of pain medication and the abuse of other opioid medication such as heroin or fentanyl — (a synthetic substance similar to morphine) has led to what experts are calling a national opioid epidemic. According to the National Institute on Drug Abuse (NIH), many people (roughly 21 to 29 percent) overuse medication prescribed for chronic pain. Between 8 to 12 percent of these people eventually end up developing an addiction, and 4 to 6 percent who those who misuse opioid medication eventually transition to using heroin.

The problem is more serious than addiction. According to the CDC, death rates are rising dramatically. From the years 1999 and 2017, deaths due to drug overdoses have increased more than four times with more than 70,000 people dying from drug overdoses in 2017 alone. Research shows these deaths are not just young people using drugs recreationally, the population with the highest rated of opioid addiction in the US are adults between the ages of 25 and 54 years old.

Impacts on health and family

What many of us do not consider when taking pain medication is the impact of these powerful drugs on the body. Chronic use can lead to significant liver and kidney damage. Moreover, once addiction to pain medication sets in, many people eventually switch to heroin because of its relatively easy supply on the street and lower financial cost. People using needles to inject heroin are at a high risk of contracting hepatitis and/or HIV due to exposure and sharing of needles.

Research indicates that continuous opioid use has been shown to lead to lower quality of life as it has negative impacts on social, economic, and physical health. Many opioid users sufferer from poor diet and therefore poor nutrition.

Pregnant women who use opioids may not get the prenatal care they need for fear of the physician finding out they are using. The effects of opioids on the unborn child are serious, including preterm labor, fetal death, growth restriction, and neonatal abstinence syndrome (The effects of opioid withdrawal after birth).

Parents who are addicted to opioids are often unable to provide proper care to their children. Leading to developmental delays, child neglect, and abuse.

Why is getting off opioids so hard?

Opioid tolerance, dependence, and addiction are all results of changes in the brain. Once chronic use of opioids begins, the brain responds by creating additional opiate receptors in order to compensate for the flood of opioids into the brain. This is why the user needs more and more of the drug to produce the desired effect.

As dependence develops, the intention for the user changes from pleasure-seeking to prevention of withdrawal and avoidance of emotional and physical pain.

Opiate withdrawal brings intense physical and emotional symptoms. Unassisted withdrawal can lead to depression, insomnia, and eventually relapse in order to escape withdrawal and feel better again.

Physical Symptoms of Opiate Withdrawal

  • Gastrointestinal distress such as abdominal cramps, diarrhea, and vomiting
  • Chills
  • Nausea
  • Tiredness
  • Sweating
  • Runny nose
  • Aching muscles
  • Goosebumps
  • Insomnia

Psychological or emotional symptoms

  • Depression
  • Anxiety
  • Agitation

Benefits of Medicated Assisted Recovery

bottle of prescription pills spilled over

The most effective treatment approach for opioid addiction is the combination of therapy such as Cognitive Behavior Therapy or traditional psychotherapy and medication. Studies show medication and therapy increases the rates of success for long term recovery in comparison to detox followed by abstinence.  

The benefits of using medication to help recovery from opioid addiction include the following:

  • Reduced or eliminated cravings
  • Reduced withdrawal symptoms
  • Increased chance of long-term recovery
  • Reduced likelihood of the need for hospitalization
  • Reduced risk of relapse

Drugs such as naltrexone, buprenorphine (name brand of Suboxone) offset or reverses some of the brain changes associated with opioid use. This is enormously beneficial in helping the client stick to a treatment program and can greatly reduce the amount of discomfort associated with withdrawal.

A treatment approach for the whole person

Treatment for opioid dependence needs to be comprehensive as the effects of opioid withdrawal affect the whole person. Physical, cognitive, and emotional symptoms need care during the sensitive time of withdrawal in order to prevent relapse.

Medication is effective to ease physical withdrawal symptoms and as a result, reduces the risk of relapse. Traditional psychotherapy and cognitive behavior therapy are effective to support the emotional and psychological health. Therapy not only supports the person during withdrawal but also gives them the tools they need to cope and adjust as they move into a drug-free future.

Stefan Kantrowitz MD is a fellowship-trained and board-certified Addiction Medicine and Internal medicine physician practicing in New York. If you would like to learn more, visit his website here.

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