Heroin Addiction Treatment Medications
Research evidence suggests that an effective way of treating heroin addiction typically consists of using heroin treatment drugs in combination with behavioral counseling.1 Pharmacotherapy in heroin addiction treatment is used to help reduce withdrawal symptoms, prevent relapse, and treat co-occurring disorders.2
In addition to heroin addiction treatment medications, there are also medications that can effectively reverse the effect of heroin overdose and save a person’s life.3 The available heroin treatment statistics speak in favor of both personal and societal benefits of treatment.
Medication-Assisted Treatment for Heroin Addiction
Medication-assisted treatment (MAT) is the widely adopted standard in treating heroin and other opioid addiction disorders. In this type of approach, heroin treatment drugs are used to help the patient safely detox and abstain from heroin use. At the same time, various forms of behavioral therapy are used in order to change the patterns of thinking and behavior that lie at the basis of a person’s drug abuse.1 This comprehensive combination of medications and behavioral counseling is specifically tailored to meet individual treatment needs.4
Benefits of MAT for Heroin Treatment
A great number of heroin users may benefit from MAT in the following ways:5
- MAT has a positive impact on program retention, which is vital for treatment success. In comparison to patients who are not treated with medication, patients who receive both heroin treatment medications and behavioral therapy tend to stay in treatment longer and not drop out before treatment goals are accomplished.
- Using adequate treatment medication decreases heroin use and lowers the number of overdose deaths.
- MAT may improve the patients’ social functioning and reduce criminal activity.
- As a result of successful treatment with heroin treatment drugs, the person is less likely to engage in risky behavior and be exposed to other health risks. This mainly refers to infectious diseases such as HIV and hepatitis C, which are common among heroin users.
- MAT improves birth outcomes in pregnant heroin users. Pregnancy requires special care and either continuing heroin use or trying to quit without medical help may have severe effects on the baby. This means that heroin treatment drugs may be necessary to ensure the safety of pregnant patients.6
FDA-Approved Heroin Treatment Drugs
Heroin treatment medications work through the same receptors of the nervous system as heroin, but they are significantly safer. There are three categories of medications used depending on how they interact with opioid receptors:1
- Agonists activate opioid receptors so the patient experiences the opioid effects similar to those of heroin.
- Partial agonists activate opioid receptors, but to a lesser extent.
- Antagonists attach to opioid receptors and block the effects of opioid drugs so the patient does not feel the pleasure when taking opioids.
The US Food and Drug Administration (FDA) approved the following heroin addiction treatment drugs:
Methadone is an opioid agonist which acts slower than heroin. It is used to reduce cravings for heroin, helps to mitigate unpleasant withdrawal symptoms, and blunts and blocks the effects of opioids.7 Although this treatment drug itself is addictive, methadone maintenance therapy has a long tradition in addiction treatment under medical.8
In contrast to illicit opioids, methadone is a heroin treatment drug that does not cause euphoria or sedation, which makes it possible for a person to function normally in their daily life.9 Methadone is taken orally once a day and can be obtained only through approved treatment programs.10 The forms of methadone approved by FDA are:7
- Dolophine (methadone hydrochloride) tablets.
- Methadose (methadone hydrochloride) oral concentrate.
Buprenorphine is a partial opioid agonist, which means that it produces the opioid effect, but it is weaker than heroin or methadone. Unlinke methadone, buprenorphine can be prescribed by physicians, which makes treatment more accessible to those for whom methadone clinics are not a convenient treatment option.11
This heroin treatment drug is available in many forms, some of which include the substance called naloxone. Naloxone is an opioid blocker that is added to buprenorphine to prevent abuse. Namely, in case someone tries to inject buprenorphine instead of taking it as prescribed, naloxone will cause unpleasant withdrawal symptoms. This is a way of discouraging patients from abusing heroin treatment medications.12
This is a list of FDA-approved buprenorphine products:11
- Subutex (buprenorphine) sublingual tablet
- Sublocade (buprenorphine extended‐release) injection for subcutaneous use
- Probuphine (buprenorphine) implant for subdermal administration
- Bunavail (buprenorphine and naloxone) buccal film
- Cassipa (buprenorphine and naloxone) sublingual film
- Suboxone (buprenorphine and naloxone) sublingual film for sublingual or buccal use, or sublingual tablet.
- Zubsolv (buprenorphine and naloxone) sublingual tablets
Unlike methadone and buprenorphine, naltrexone blocks the effects that heroin has on the receptors of the nervous system, which reduces opioid cravings. Its advantage is that it can be prescribed by physicians and there is no potential for its abuse or diversion. Another advantage is that it is used once a month, which may be more convenient for patients than daily dosing.13
However, its effectiveness is limited as patients often do not follow the treatment plan that involves this drug.1 In order to start treatment with naltrexone, a patient needs to be opioid-free for 7 to 10 days, which means that fewer people are able to successfully start treatment.14
In opioid addiction treatment, naltrexone is administered in the form of an extended-release intramuscular injection once every four weeks by a physician. Although this heroin treatment medication is not an opioid, if not administered carefully, it can still have adverse effects, such as increased risk of overdose or severe reactions at the site of injection. Therefore it is necessary to carefully monitor patients during treatment.13
The FDA-approved injection of naltrexone is called Vivitrol.1
Lofexidine is an FDA-approved drug for treating unpleasant withdrawal symptoms. Unlike methadone and buprenorphine, which are also used in withdrawal, lofexidine is not used for long-term addiction treatment. It is rather used as medical aid during detoxification, which is only the first stage in treatment.14
Frequently Asked Questions
Contrary to common perception, heroin treatment drugs are not used simply as a safer substitute for heroin. These medications do not aim to simulate the effects of heroin but work on establishing a biochemical balance in the body that makes it possible for the person to lead a normal life, both physically and psychologically.9
The type of drug, dosage, and the length of use will depend on the individual patient. The doses of heroin treatment medications may be adjusted over time. However, once the patient is stabilized on the appropriate dose, it may be necessary to keep taking medication indefinitely in order to prevent relapse.11 Heroin addiction treatment medication is therefore similar to medications for chronic health conditions where relapse is likely to occur unless medication is used.9
Opioid overdose is treated by using a medicine called naloxone, which quickly blocks the effects of heroin. This drug can very quickly restore normal breathing in people whose breathing has stopped as a result of overdosing with heroin or other opioids.15
It is available as an injectable solution, a handheld auto-injector, and a nasal spray. With a view to reducing overdose death rates, naloxone is now being used more by police officers, emergency medical technicians, and non-emergency first responders. Friends and family of those struggling with heroin addiction are also advised to be ready to apply naloxone. Some states even have laws that make it possible to get naloxone without prescription.8 Additionally, one of the goals of FDA is to make all forms of naloxone more available across the country as an approved potentially life-saving heroin treatment drug.12
Heroin treatment medications are safe when administered by trained professionals and used as prescribed. Nevertheless, there are some common risks related to heroin treatment drugs:11,7
- Diversion and abuse, when medications are not used as prescribed or by the person who they were prescribed to.
- Risk of overdose, when a person takes a higher dose of heroin treatment medication or uses it in combination with alcohol or other drugs.
In addition, like any other medications, heroin treatment medications can also have side-effects such as allergic reactions, constipation, restlessness, insomnia, etc.11,7 In case these or some more severe symptoms appear, patients should immediately report them to their healthcare professional.
1. National Institute on Drug Abuse. (2018). What are the treatments for heroin use disorder?
2. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction DrugFacts.
3. Substance Abuse and Mental Health Service Administration (2020). MAT Medications, Counseling, and Related Conditions.
4. Substance Abuse and Mental Health Service Administration. (2021). Medication-Assisted Treatment.
5. National Institute on Drug Abuse. (2016). Effective Treatments for Opioid Addiction.
6. National Institute on Drug Abuse. Drug Use Hurts Unborn Babies.
7. Substance Abuse and Mental Health Service Administration (2020). Methadone.
8. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.
9. Substance Abuse and Mental Health Service Administration. (2009). Know Your Rights: Rights for Individuals on Medication-Assisted Treatment.
10. Psychiatric Research Institute. What Is Methadone?
11. Substance Abuse and Mental Health Service Administration. (2020). Buprenorphine.
12. National Institute on Drug Abuse. (2019). Naloxone.
13. Substance Abuse and Mental Health Service Administration. (2020). Naltrexone.
14. Wakeman, S. (2018). Lofexidine: Another option for withdrawal from opioids, but is it better? Harvard Health Publishing.
15. National Institute on Drug Abuse. (2020). Opioid Overdose Reversal with Naloxone.