What Is the Best Treatment for Opioid Addiction?

Opioid substance abuse involves two categories of substances: heroin and prescription pain relievers. It is estimated that around 2.1 million people in the U.S. are suffering from an opioid use disorder (OUD), which is 0.8% of the population over the age of 12. A more detailed statistical picture of this issue in the U.S. is provided by the National Survey on Drug Use and Health carried out in 2017 by the Substance Abuse and Mental Health Service Administration, which established the following facts:¹

• Around 11.4 million people in the U.S. aged 12 or older misused opioids in the year prior to the survey.
• Within this category of substance use, heroin was used by 886,000 people, while as many as 11.1 million people misused prescription drugs.
• Out of the total number of people with OUD, 1.7 million people with a prescription pain reliever use disorder and 0.7 million people with a heroin use disorder.

Studies that monitor OUD trends in the US population over the years found that there has been a decrease in OUD since 2016, most probably due to improved treatment access and opioid addiction treatment success rates.

Despite the improvement as regards the number of people who abuse opioids, the statistics regarding the number of opioid deaths is worrying, with the number of opioid deaths in the U.S. increasing. In 2019, this increase was by approximately 4.6%.² In addition to the generally well known harmful effects of drug abuse, this high risk of overdose in case of opioid abuse underlines the urgency to enter the best treatment for opioid addiction as soon as possible. Unfortunately, even with good opioid addiction treatment success rates that characterize available treatment programs, in the U.S. only about one in four people with OUD receive treatment for this condition.³

What Is the Difference Between Opioids and Opiates?

Opioids are chemical substances that bind to the opioid receptors of the surface of neurons, which results in reducing the intensity of pain. Although the term opioid is often used interchangeably with opiate, these are different categories:

• Opioids are a broader category which includes all natural, semisynthetic, and synthetic opioids.
• Opiates refer only to the category of natural opioid substances, extracted from the poppy plant, such as heroin, morphine, and codeine.

Prescription opioids are often referred to as opioid analgesics, which can be natural, semi-synthetic, and synthetic.⁴ These medications are prescribed for treating moderate to severe pain and are generally safe when taken for a short time and as directed by a doctor. However, due to the fact that they produce euphoria in addition to pain relief, they are often abused, which can result in OUD due to their high addiction potential. The most frequently abused prescription opioids in the U.S. are:²

• Buprenorphine.
• Methadone.
• Oxycodone.
• Hydrocodone.
• Tramadol.
• Codeine.
• Fentanyl.
• Morphine.

What Is Opioid Use Disorder?

Opioid use disorder (OUD) is defined as problematic use of opioids that causes harm and distress, and is a more preferred term for labeling this issue than opioid abuse or opioid addiction, which are also commonly used terms.⁴

When after extended use a person needs a larger dose of opioids to achieve the same effect, the person has developed opioid tolerance.⁴

If the person’s body is adjusted to the presence of opioids and requires regular opioid use for normal functioning, this is called opioid dependence. Compared to some other substances, opioids can lead to physical dependence within a short time, namely 4 to 8 weeks.³

If a person tries to quit using an opioid drug, they typically experience unpleasant physical symptoms which is a state called withdrawal. Withdrawal symptoms occur only after opioid users have developed tolerance.⁵

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association, to be diagnosed with OUD, a person needs to exhibit at least two of the following symptoms within a period of one year:³

1. Needing larger amounts of opioids or taking opioids over a longer period than intended
2. Desire to reduce opioid use or failed attempts to do so
3. Spending a lot of time on opioid use – obtaining, using, and recovering from use
4. Craving to use opioid substances
5. Failing to fulfill duties at work, school, or home
6. Continued opioid use despite its negative impact on social or interpersonal relations
7. Continued opioid use despite its negative effects on physical or psychological health
8. Giving up or reducing activities because of opioid use
9. Using opioids in dangerous situations
10. Having developed tolerance.
11. Experiencing withdrawal when not using opioids

Treatment for Opioid Addiction

As any type of addiction, opioid addiction is seen as a treatable chronic disorder. The best opioid addiction treatment success rates are achieved when behavioral counseling is combined with medications. This is the widely accepted standard called medication-assisted treatment (MAT).⁶

Studies have shown that MAT has the following positive effects:⁶

• Decreasing opioid use
• Lowering the number of opioid overdose deaths
• Reducing criminal activity
• Reducing infectious disease transmission
• Improving social functioning
• Improving birth outcomes in pregnant opioid users

Furthermore, MAT increases treatment retention. In other words, patients who are treated with medication are less likely to drop out from behavioral therapy than those who do not receive medication and only receive treatment in the form of counseling.⁶

What Makes the Best Treatment for Opioid Addiction?

According to the National Institute on Drug Abuse (NIDA), successful treatment involves the following steps:⁷

1. Medically supervised detox during opioid treatment
2. Behavioral therapy
3. Assessment of potential co-occurring mental health disorders (such as depression or anxiety)
4. Long-term follow-up activities the purpose of which is to prevent relapse

Medications Used in Opioid Addiction Treatment

Medications used in opioid addiction treatment may include the following:⁶

• Methadone (Dolophine®, Methadose®)
• Buprenorphine (Suboxone®, Subutex®, Probuphine®, Sublocade™)
• Naltrexone (Vivitrol®)

Methadone and buprenorphine target the same neural receptors as heroin and morphine to relieve withdrawal and cravings. It is important to note that they do not substitute one drug addiction with another one. Naltrexone works differently: it blocks the effects of opioids in the brain and is used only when people have already been detoxified.⁶

How Can Behavioral Therapy Aid the Recovery From Opioid Use?

Taking medication is not sufficient unless the person changes their attitudes and behaviors and adopts healthy life skills, which would help them remain abstinent after the detox phase. In other words, medically assisted detox should be seen as the first stage in opioid addiction treatment but cannot ensure long-term abstinence without behavioral therapy. Common forms of behavioral therapy used in opioid treatment include:⁸

• Contingency management interventions/motivational incentives, which involve tangible rewards for patients to reinforce positive behaviors, mainly abstinence.
• Community Reinforcement Approach Plus Vouchers, which relies on recreational, familial, social, and vocational reinforcers and material incentives, to make drug-free life feel more rewarding than substance use.
• 12-Step facilitation therapy, which relies on self-help groups, i.e. peer support in sustaining recovery.
• Family behavior therapy, which engages family members in treatment; this helps explore and resolve some causes of addiction and improves the home environment.

What Is the Best Setting for Opioid Abuse Treatment?

What the best treatment for opioid addiction is depends on the evaluation of a specific case, in particular severity of the condition, the existence of co-occurring disorders, accessibility of treatment facilities, as well as the existence of a safe home environment and family support.⁸ This kind of assessment can be done only by trained professionals, after which a concrete individual treatment plan can be made.

• Inpatient or residential treatment programs are often optimal for patients with more severe forms of OUD, as they provide 24-hour supervision and support.
• Outpatient treatment programs for opioid addiction can vary in intensity but all involve regular visits to treatment facilities for either individual or group therapy appointments.

As staying in treatment long enough is critical for successful recovery, the patient’s state and treatment needs will change over this period of time. Reassessing these needs and modifying the treatment plan accordingly are among the key principles of effective treatment.⁷

 

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