Medication-Assisted Treatment
An estimated 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain medicines in 2016.1 Treatment admissions linked to these medications more than quadrupled between 2002 and 2012, although only a fraction of people with prescription opioid use disorders receive specialty treatment (18 percent in 2015).1Overdose deaths linked to these medicines nearly quadrupled (from 4,400 to nearly 19,000, or 1.5 to 5.9 per 100,000 persons) from 2000 to 2014.2 There is now also a rise in heroin use and heroin addiction as some people shift from prescription opioids to their cheaper street relative; 626,000 people had a heroin use disorder in 2016, and nearly 13,000 Americans died of a heroin overdose in 2015.1,3 Besides overdose, consequences of the opioid crisis include a rising incidence of infants born dependent on opioids because their mothers used these substances during pregnancy4,5 and increased spread of infectious diseases, including HIV and hepatitis C (HCV), as was seen in 2015 in southern Indiana.6
Effective prevention and treatment strategies exist for opioid misuse and addiction but are highly underutilized across the United States. An initiative of the Secretary of Health and Human Services7 began in 2015 to address the complex problem of prescription opioid and heroin use. This initiative emphasizes improved education of healthcare providers in managing pain and prescribing opioids appropriately; wider availability and adoption of the effective overdose-reversing drug naloxone, which research has shown to be a lifesaver in communities where it has been distributed to people who use opioids, their families, and potential bystanders;8 and wider implementation of evidence-based treatment strategies.
Effective medications exist to treat opioid use disorders: methadone, buprenorphine, and naltrexone. These medications could help many people recover from opioid addiction, but they remain highly underutilized. Fewer than half of private-sector treatment programs offer medications for opioid use disorders, and of patients in those programs who might benefit, only a third actually receive it.9 Overcoming the misunderstandings and other barriers that prevent wider adoption of these treatments is crucial for tackling the problem of opioid addiction and the epidemic of opioid overdose in the United States......
Much of what's on this page was sourced from NIDA & NIH. They update their articles frequently, so to get the most relevant and accurate information, please follow the links below to their articles.
Read more about Medication Assisted Treatment by following the links below:
"Medications to Treat Opioid Addiction" by NIDA & NIH
"Effective Treatments for Opioid Addiction" by NIDA & NIH
Article
PDF
Table of Contents
- Overview
- How Do Medications to Treat Opioid Addiction Work?
- Efficacy of Medications for Opioid Use Disorder
- Misconceptions About Maintenance Treatment
- Treatment Need vs. Diversion Risk for Opioid Addiction Treatment Medications
- Impact of Medication for Addiction Treatment on HIV/HCV Outcomes
- Treatment of Opioid Use Disorder in the Criminal Justice System
- Opioid Addiction Medication in the Military
- Treatment for Pregnant Mothers and Babies
- How Much Does Opioid Treatment Cost?
- Access to Naloxone
- References
The following descriptions were sourced from Wikipedia and Drugs.com and describe the different medications involved and used in medication-assisted treatment.
Medication-Assisted treatment for addiction includes the use of medication often coupled with counseling and other supports. Treatment that includes medication is often the best choice for opiate addiction. Medication gives a person who is addicted to opiates an opportunity to regain a normal state of mind without experiencing the drug induced highs and lows. Medication also can reduce cravings and withdrawal symptoms. Medication-Assisted treatment can give the person a chance to focus on the lifestyle changes that lead back to healthy living.
Taking medication for opiate addiction is like taking medication to control heart disease or diabetes. Some people may need it for a short period of time, and some, just as with other health conditions, may need it for longer periods of time, or even for the rest of their lives. It is not the same as substituting one addictive drug for another. Used properly, the medication does not create a new addiction. It helps people manage their addiction so that the benefits of recovery can be maintained. Medication-Assisted treatment allows many to successfully work, maintain healthy relationships, and participate in their families and communities. The three most common medications used in treatment of opiate addiction are methadone, buprenorphine and naltrexone. Cost varies for the different medications. As with all medications, discussing the pros and cons of different treatment options with trained professionals is the best way to determine which course of treatment might be best for a loved one.
Methadone
Sold under the brand name Dolophine, among others, is an opioid used to treat pain and as maintenance therapy or to help with tapering in people with opioid dependence. Detoxification using methadone can either be done relatively rapidly in less than a month or gradually over as long as six months. While a single dose has a rapid effect, maximum effect can take five days of use. The effects last about six hours after a single dose. After long term use, in people with normal liver function, effects last 8 to 36 hours. Methadone is usually taken by mouth and rarely by injection into a muscle or vein.
Side effects are similar to those of other opioids. Commonly these include dizziness, sleepiness, vomiting, and sweating. Serious risks include opioid abuse and a decreased effort to breathe. Abnormal heart rhythms may also occur due to a prolonged QT interval. The number of deaths in the United States involving methadone poisoning declined to 3,300 in 2015 from 4,418 in 2011. Risks are greater with higher doses. Methadone is made by chemical synthesis and acts on opioid receptors.
Methadone was developed in Germany around 1937 to 1939 by Gustav Ehrhart and Max Bockmühl. It was approved for use in the United States in 1947. Methadone is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. Globally in 2013, about 41,400 kilograms were manufactured. It is regulated similarly to other narcotic drugs. It is not particularly expensive in the United States.
Buprenorphine aka Subutex
Sold under the brand name Subutex, among others, is an opioid used to treat opioid addiction, acute pain, and chronic pain. It can be used under the tongue, by injection, as a skin patch, or as an implant. When used for opioid addiction it is recommended that a health care provider observe the person while they take the medication.[3] For longer term treatment of addiction a combination formulation of buprenorphine/naloxone is usually recommended. Maximum pain relief is generally within an hour with effects up to 24 hours.
Side effects may include respiratory depression (decreased breathing), sleepiness, adrenal insufficiency, QT prolongation, low blood pressure, allergic reactions, and opioid addiction. Among those with a history of seizures, there is a risk of further seizures. Opioid withdrawal following stopping is generally mild. It is unclear if use during pregnancy is safe and use while breastfeeding is not recommended. Buprenorphine affects different types of opioid receptors in different ways. Depending on the type of receptor it may be an agonist, partial agonist, or antagonist.
Buprenorphine was approved for medical use in the United States in 1981. In 2012, 9.3 million prescription for the medication were written in the United States. Buprenorphine may also be used recreationally by injection or in the nose for the high it produces. Some use it as a substitute for heroin. In the United States it is a Schedule III controlled substance. For the tablets the wholesale cost in the United States is between 0.86 and 1.32 USD per daily dose as of 2017.
Naltrexone aka Vivitrol
Sold under the brand names ReVia and Vivitrol among others, is a medication primarily used to manage alcohol dependence and opioid dependence. In opioid dependence, it should not be started until people are detoxified. It is taken by mouth or by injection into a muscle. Effects begin within 30 minutes. A decreased desire for opioids however may take a few weeks.
Side effects may include trouble sleeping, anxiety, nausea, and headaches. In those still on opioids, opioid withdrawal may occur. Use is not recommended in people with liver failure. It is unclear if use is safe during pregnancy. Naltrexone is an opioid antagonist and works by blocking the effects of opioids, both those from inside and outside the body.
Naltrexone was first made in 1965 and was approved for medical use in the United States in 1984. As of 2017, the wholesale cost of tablets is about US$0.74 per day in the US. The extended-release injections cost about $1,267 per month ($41.20 per day).Naltrexone, as bupropion/naltrexone, is also used to treat obesity.
Suboxone
Suboxone contains a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication, sometimes called a narcotic. Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse.
Suboxone is used to treat narcotic (opiate) addiction.
Read more at the National Institute on Drug Abuse
