Treatment for Opioid Addiction

Opioid Misuse and Addiction Treatment

Treatment for Opioid Addiction
URL of this page: https://medlineplus.gov/opioidmisuseandaddictiontreatment.html

Also called: Opioid Abuse and Addiction Treatment, Opioid Use Disorder Treatment

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions cancer. Some health care providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your health care provider. However, opioid misuse and addiction are still potential risks.

What are opioid misuse and addiction?

Opioid misuse means you are not taking the medicines according to your provider's instructions, you are using them to get high, or you are taking someone else's opioids. Addiction is a chronic brain disease. It causes you to compulsively seek out drugs even though they cause you harm.

What are the treatments for opioid misuse and addiction?

Treatments for opioid misuse and addiction include

  • Medicines
  • Counseling and behavioral therapies
  • Medication-assisted therapy (MAT), which includes medicines, counseling, and behavioral therapies. This offers a «whole patient» approach to treatment, which can increase your chance of a successful recovery.
  • Residential and hospital-based treatment

Which medicines treat opioid misuse and addiction?

The medicines used to treat opioid misuse and addiction are methadone, buprenorphine, and naltrexone.

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. But it is not; 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.

There is also a combination drug that includes buprenorphine and naloxone. Naloxone is a drug to treat an opioid overdose. If you take it along with buprenorphine, you will be less ly to misuse the buprenorphine.

You may safely take these medicines for months, years, or even a lifetime. If you want to stop taking them, do not do it on your own. You should contact your health care provider first, and work out a plan for stopping.

Naltrexone works differently than methadone and buprenorphine. It does not help you with withdrawal symptoms or cravings. Instead, it takes away the high that you would normally get when you take opioids.

Because of this, you would take naltrexone to prevent a relapse, not to try to get off opioids. You have to be off opioids for at least 7-10 days before you can take naltrexone. Otherwise you could have bad withdrawal symptoms.

How does counseling treat opioid misuse and addiction?

Counseling for opioid misuse and addiction can help you

  • Change your attitudes and behaviors related to drug use
  • Build healthy life skills
  • Stick with other forms of treatment, such as medicines

There are different types of counseling to treat opioid misuse and addiction, including

  • Individual counseling, which may include setting goals, talking about setbacks, and celebrating progress. You may also talk about legal concerns and family problems. Counseling often includes specific behavioral therapies, such as
    • Cognitive-behavioral therapy (CBT) helps you recognize and stop negative patterns of thinking and behavior. It teaches you coping skills, including how to manage stress and change the thoughts that cause you to want to misuse opioids.
    • Motivational enhancement therapy helps you build up motivation to stick with your treatment plan
    • Contingency management focuses on giving you incentives for positive behaviors such as staying off the opioids
  • Group counseling, which can help you feel that you are not alone with your issues. You get a chance to hear about the difficulties and successes of others who have the same challenges. This can help you to learn new strategies for dealing with the situations you may come across.
  • Family counseling/ includes partners or spouses and other family members who are close to you. It can help to repair and improve your family relationships.

Counselors can also refer you to other resources that you might need, such as

  • Peer support groups, including 12-step programs Narcotics Anonymous
  • Spiritual and faith-based groups
  • HIV testing and hepatitis screening
  • Case or care management
  • Employment or educational supports
  • Organizations that help you find housing or transportation

What are residential and hospital-based treatments for opioid misuse and addiction?

Residential programs combine housing and treatment services. You are living with your peers, and you can support each other to stay in recovery.

Inpatient hospital-based programs combine health care and addiction treatment services for people with medical problems. Hospitals may also offer intensive outpatient treatment.

All these types of treatments are very structured, and usually include several different kinds of counseling and behavioral therapies. They also often include medicines.

  • Buprenorphine (Substance Abuse and Mental Health Services Administration)
  • Methadone (Substance Abuse and Mental Health Services Administration)
  • Naloxone (Substance Abuse and Mental Health Services Administration)
  • Naltrexone (Substance Abuse and Mental Health Services Administration)

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Источник: https://medlineplus.gov/opioidmisuseandaddictiontreatment.html

20118 Opioid Addiction

Treatment for Opioid Addiction

When people think of opioid use problems or addictions, they may think of street-obtained, or «street» opioids, such as heroin or fentanyl. However, problematic opioid use can also include improperly taking prescribed opioid medications such as oxycodone, morphine or codeine, or taking an opioid medication that was not prescribed for you.

Opioids are a class of powerful drugs that are usually prescribed to treat severe pain. If opioids are abused, they can create feelings of intense pleasure or euphoria, but they can also lead to fatal overdose. Opioids are an effective medication when used as prescribed, but they carry a risk of addiction because of their powerful effects.

Both street-obtained and prescription opioids can be misused. Heroin is a common street opioid that can be snorted or smoked, though it carries the greatest risks when injected.

These risks include spreading HIV or hepatitis B or C by sharing needles, skin infections, collapsed veins, bacterial infections and overdoses.

People can also misuse prescription medication by crushing the pill and then chewing, snorting or injecting it.

Fentanyl is an opioid that is prescribed as a skin patch. It is 100 times more powerful than morphine and used to treat severe pain.

Most street fentanyl in Canada is produced illegally as a powder and is being increasingly found in street drugs such as heroin and cocaine, and used to make tablets that look prescription medications.

Many overdoses have occurred because people did not know that what they were taking was contaminated with fentanyl.

If you or someone you know uses opioids, it is a good idea to have a free naloxone kit. Naloxone is a medication that can temporarily reverse the effects of an opioid overdose and allow time for medical help to arrive.

If someone is overdosing, call 911 right away! You can then use your naloxone kit  while you wait for medical help.

Signs & Symptoms

Opioid addiction is defined by a group of signs, symptoms and behaviours that indicate a person is both physically and psychologically dependent on the substance. These include:

  • using over a longer period or using more than planned
  • wanting to quit or cut down, or trying unsuccessfully to quit
  • spending a lot of time and effort getting, using and recovering from opioids
  • experiencing cravings
  • failing to fulfil responsibilities at work, school or home as a result of opioid use
  • continuing to use opioids despite the negative social consequences caused by opioid use
  • giving up activities that were once enjoyable
  • using opioids in dangerous situations
  • needing to take more of the drug to get the same effect (tolerance, a sign of physical dependence)
  • feeling ill when opioid use suddenly stops (withdrawal, a sign of physical dependence)
  • crushing, snorting, smoking or injecting opioids
  • running prescription medications early
  • drawing on many sources for opioids (e.g., prescriptions from two or more physicians or both a prescription and street opioids)
  • showing signs of opioid intoxication (e.g., nodding off, pinpoint pupils).

Opioid addiction involves more than just physical dependence.

For example, a person with cancer who is prescribed opioids for severe pain may experience withdrawal symptoms when they stop taking the medication, but is not addicted. Opioid addiction also involves psychological dependence.

This means that the drug is so central to the person’s life that the need to keep using becomes a craving or compulsion, even if the person knows that using is harmful.

Cravings and increasing tolerance may lead the person to buy drugs on the street or go to more than one doctor to get the same drug. They may smoke, snort, crush or inject the drug in order to feel high faster and more intensely. This could affect their relationships with family members or friends, or cause a person to neglect their responsibilities.

Causes & Risk Factors

Opioid addiction is caused by a combination of physical and psychological factors. They include:

  • access to opioids, whether from legal or illegal sources
  • physical tolerance to opioids
  • the need to use increasing quantities
  • compulsive use
  • withdrawal symptoms.

Risk factors for developing opioid addiction include:

  • personal history of substance use issues involving any substance, including alcohol
  • family history of substance use problems or addiction
  • history of pre-adolescent sexual abuse
  • history of psychiatric problems.

Diagnosis & Treatment

Two main treatment options are available for opioid addiction:

  • opioid agonist therapies using methadone or buprenorphine 
  • addiction treatment counselling (e.g., withdrawal management, day treatment, mutual aid groups such as Narcotics Anonymous).

Methadone and buprenorphine are opioid medications that do not cause intoxication at the correct doses. When they are prescribed, they eliminate a person's withdrawal symptoms, which may help them stabilize their life. Opioid addiction treatments usually involve a combination of opioid agonist therapies and addiction treatment counselling.

Sources:Fundamentals of Addiction: A Practical Guide for Counsellors © 2014 Centre for Addiction and Mental HealthStraight Talk: Fentanyl © 2017 Centre for Addiction and Mental HealthAbout opioids © 2017 Government of CanadaOpioid crisis in Canada © 2018 Government of CanadaWhat is fentanyl? © 2017 Royal Canadian Mounted Police

Additional Resources

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Источник: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/opioid-addiction

Opioid Addiction

Treatment for Opioid Addiction

Table of Contents

An opioid addiction is a powerful urge to use certain medicines called opioids. But what are opioids? And what is an addiction?

Opioids are medicines that are often prescribed by a doctor to help relieve pain. An addiction is a strong craving to do something. In this case, it’s a strong craving to use opioids. Addiction is a disease that affects your brain and behavior.

At first, you have control over your choice to use opioids. But if you don’t follow your doctor’s instructions for the medicine, its effect eventually makes you want to keep using it.

Over time, your brain actually changes so that you develop a powerful urge to take the opioids.

Opioids are prescribed to treat many issues, including:

  • Toothaches and dental procedures
  • Injuries
  • Surgeries
  • Chronic conditions such as cancer

Some prescription cough medicines also contain opioids.

Opioids work by lowering the number of pain signals your body sends to your brain. They also change how your brain responds to pain. When used correctly, opioids are safe. But when people misuse the medicine (opioid use disorder), they can become addicted. People can also become addicted to opioids by using the drug illegally.

Some opioid drugs include:

  • Opium
  • Codeine
  • Fentanyl
  • Heroin
  • Hydrocodone and oxycodone
  • Hydromorphone and oxymorphone
  • Methadone
  • Morphine
  • Tramadol

An opioid addiction is also called substance abuse. The signs and symptoms of substance abuse can be physical, behavioral, and psychological. One clear sign of addiction is not being able to stop using opioids. Another sign is if a person is not able to stop using more than the amount prescribed by their doctor.

Other signs and symptoms of opioid abuse include:

  • Shallow or slow breathing rate
  • Physical agitation
  • Poor decision making
  • Abandoning responsibilities
  • Mood swings
  • Irritability
  • Depression
  • Lowered motivation
  • Anxiety attacks

You might have an opioid addiction if you crave the drug or if you feel you can’t control the urge to take the drug. You may also be addicted if you keep using the drug without your doctor’s consent, even if the drug is causing trouble for you.

The trouble may be with your health, with money, with work or school, with the law, or with your relationships with family or friends. Your friends and family may be aware of your addiction problem before you are.

They may notice the changes in your behavior.

If you take too many opioids, you may experience an opioid overdose. This is a very serious medical condition. Symptoms include:

  • Unresponsiveness (can’t wake up)
  • Slow, irregular breathing, or not breathing at all
  • Slow, erratic pulse, or no pulse
  • Vomiting
  • Loss of consciousness (passing out)
  • Small pupils in their eyes

An opioid overdose requires immediate emergency medical treatment. If you suspect someone has overdosed, call 9-1-1 right away. In some states, a prescription nasal spray called naloxone (Narcan) is available to keep on hand in case of an overdose. Talk to your doctor to see if you might need this medicine.

Opioid drugs alter your brain by creating artificial endorphins. Besides blocking pain, these endorphins make you feel good.

Too much opioid use can cause your brain to rely on these artificial endorphins. Once your brain does this, it can even stop producing its own endorphins.

The longer you use opioids, the more ly this is to happen. You also will need more opioids over time because of drug tolerance.

Drug tolerance is when your body, over time, gets used to the effects of a drug. As this happens, you may need to take a higher dose of the drug to get the same effect. When you take opioids over time, you need a higher dose to get the same pain relief.

If you stop using an opioid for a period of time, your tolerance will begin to fade. If you need to begin taking it again, you most ly will not need your former higher dose. That can be too much for the body to take. If you stop taking a medication, and then resume, talk to your doctor about dosage.

What is drug dependence?

Drug dependence is when the way your body works changes because you have taken a drug for a long time. These changes cause you to have withdrawal symptoms when you stop using the drug. Withdrawal symptoms can be mild or severe, and may include:

  • Sweating
  • Nausea or vomiting
  • Chills
  • Diarrhea
  • Shaking
  • Pain
  • Depression
  • Insomnia
  • Fatigue

If you have been taking a prescription opioid for a long time, work with your doctor. They can help you avoid withdrawal symptoms by gradually lowering your dose over time until you no longer need the medicine.

What is the difference between drug tolerance, dependence, and addiction?

Drug tolerance and dependence are a normal part of taking any opioid drug for a long time. You can be tolerant to, or dependent on, a drug and not yet be addicted to it.

Addiction, however, is not normal. It is a disease. You are addicted to a drug when it seems that neither your body nor your mind can function without the drug. Addiction causes you to obsessively seek out the drug, even when the drug use causes behavior, health, or relationship problems.

Your doctor or a medical health professional can diagnose opioid use disorder and opioid addiction. Diagnosis will include a medical assessment. It also often includes testing for mental health disorders.

Many people are able to use opioids safely without becoming addicted to them. But their potential for addiction is high. This is especially true if you use them for long-term pain management.

In general, you are more ly to avoid addiction if you can use opioid drugs no longer than a week. Research shows that using them for more than a month can make you dependent on them.

Opioid addiction is a chronic illness and should be treated the same as other chronic illnesses. those, it should continually be managed and monitored. You should feel comfortable discussing treatment with your family doctor, who is properly trained for this treatment.

Treatment for opioid addiction is different for each person. The main goal of treatment is to help you stop using the drug. Treatment also can help you avoid using it again in the future.

When you stop using opioids, your body will react. You will have a number of symptoms that may include nausea and vomiting, abdominal pain, and anxiety. This reaction is called withdrawal.

Your doctor can prescribe certain medicines to help relieve your withdrawal symptoms. They also will help control your cravings. These medicines include methadone (often used to treat heroin addiction), buprenorphine, and naltrexone.

Methadone and buprenorphine help reduce withdrawal symptoms by targeting the same centers in the brain that opioids target. Only they do not make you feel high.

They help restore balance to your brain and allow it to heal. According to National Institutes of Health (NIH), you may safely take the medicines long term, even for a lifetime.

You should not quit them without first telling your doctor.

Naltrexone is another medicine your doctor may prescribe. This medicine doesn’t help you stop taking opioids. It is to help you prevent from relapsing. Relapsing means to start taking opioids again.

 This medicine is different from methadone and buprenorphine because it does not help with cravings or withdrawal.

Instead, according to NIH, it prevents you from feeling the high you would normally feel when you take opioids.

You may also need help with your mental or emotional addition to opioids. Behavioral treatments can help you learn how to manage depression. These treatments also help you avoid opioids, deal with cravings, and heal damaged relationships. Some behavioral treatments include individual counseling, group or family counseling, and cognitive therapy. Ask your doctor for a recommendation.

Medications Methadone BuprenorphineNaltrexone
Types  Tablet, liquid Sublingual (under-the-tongue) tablet, buccal film (small patch that adheres to inner cheek), long-acting injection (shot) Tablet, Intramuscular injection (shot) 
UseDaily· Daily for tablet · Every 4 weeks for injection· Daily for tablet · Every 4 weeks for injection
How to get medicationAt an opioid treatment programCan be prescribed by your primary care doctorCan be prescribed by any medical provider
Craving reduction++++++
Possible Side EffectsSleepiness ConstipationHeart problems (such as heart disease)Interactions with other drugs (there are medicines that you should not use with methadone)Overdose if combined with certain other medicinesHeadache NauseaConstipationInjection site reactions HeadacheInsomnia
ConsiderationsMust be seen daily at firstMay need to be seen 1 to 2 times per week at first, then may move to monthly visitsMust completely withdraw from opioids before starting treatment (usually 7 to 14 days). May be seen monthly for injections

Table adapted with permission from Coffa and Snyder, 2019. Source for formulations Kampman, K. et al. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opiod Use (2015). Source for pregnant patient treatment: Coffa and Snyder, 2019.

The first step toward recovery is recognizing that you have a problem with opioids. If you think you are addicted to them, know that there is help for you. The first step in breaking addiction is realizing that you control your own behavior.

The following steps will help you fight your addiction:

  • Commit to quitting. Take control of your behavior and commit to fighting your addictions.
  • Get help from your doctor. They can be your biggest ally, even if you’re trying to quit a drug they prescribed. Your doctor may be able to prescribe medicine that will help ease your cravings for the addictive drug. Talking with your doctor or a counselor about your problems and your drug use can be helpful, too.
  • Get support. Certain organizations are dedicated to helping people who have addictions. They want you to succeed and will give you the tools and support you need to quit and move on with your life. Ask your family and friends for support, too.
  • How can I prevent getting addicted to opioids?
  • Is the medicine I’m taking addictive?
  • How do I know if I’m addicted to an opioid?
  • What should I do if I think I’m addicted to an opioid?
  • How do I know if a friend of family member is addicted to an opioid?

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Источник: https://familydoctor.org/condition/opioid-addiction/

Effective Treatments for Opioid Addiction | National Institute on Drug Abuse

Treatment for Opioid Addiction

  • Over 2.5 million Americans suffer from opioid use disorder which contributed to over 28,000 overdose deaths in 2014.

    1,2

  • Use of opioids, including heroin and prescription pain relievers, can lead to neonatal abstinence syndrome as well as the spread of infectious diseases HIV and Hepatitis.

Medications, including buprenorphine (Suboxone®, Subutex®), methadone, and extended release naltrexone (Vivitrol®), are effective for the treatment of opioid use disorders.

  • Buprenorphine and methadone are “essential medicines” according to the World Health Organization.3
  • A NIDA study shows that once treatment is initiated, a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid use disorder. However, because naltrexone requires full detoxification, initiating treatment among active users was more difficult with this medication. Once detoxification was complete, both medications had a similar effectiveness.
  • Medications should be combined with behavioral counseling for a “whole patient” approach, known as Medication Assisted Treatment (MAT).

View Transcript

MAT Decreases opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission.4,5,6 After buprenorphine became available in Baltimore, heroin overdose deaths decreased by 37 percent during the study period, which ended in 2009.6

MAT Increases social functioning and retention in treatment.4,5 Patients treated with medication were more ly to remain in therapy compared to patients receiving treatment that did not include medication.4

Treatment of opioid-dependent pregnant women with methadone or buprenorphine Improves Outcomes for their babies; MAT reduces symptoms of neonatal abstinence syndrome and length of hospital stay.7

In November 2017, the U.S.

Food and Drug Administration approved Sublocade, the first once-monthly buprenorphine injection for moderate-to-severe opioid use disorder in adult patients who have initiated treatment with the transmucosal buprenorphine-containing products.

This medication, in addition to Probuphine®, an implantable buprenorphine formulation approved in May 2016, eliminate the need for daily dosing and improve treatment retention. Read the Director's blog — Probuphine: A Game-Changer in Fighting Opioid Dependence.

Reaching Patients in Need

The emergency department (ED) provides a prime opportunity to screen patients for opioid use disorder and initiate MAT. Patients who initiate MAT in the ED are more than twice as ly to remain engaged in treatment compared to patients referred for treatment. Read the JAMA article — Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence

A recent study found treatment with extended-release naltrexone reduced relapse rates among criminal justice involved adults with a history of opioid dependence. Read the NEJM article Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders.

Medications are Not Widely Used

Less than 1/2 of privately-funded substance use disorder treatment programs offer MAT and only 1/3 of patients with opioid dependence at these programs actually receive it.8

  • The proportion of opioid treatment admissions with treatment plans that included receiving medications fell from 35 percent in 2002 to 28 percent in 2012.9
  • Nearly all U.S. states do not have sufficient treatment capacity to provide MAT to all patients with an opioid use disorder.10

Addressing Myths About Medications

Methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery.

Diversion of buprenorphine is uncommon; when it does occur it is primarily used for managing withdrawal.11,12 Diversion of prescription pain relievers, including oxycodone and hydrocodone, is far more common; in 2014, buprenorphine made up less than 1 percent of all reported drugs diverted in the U.S.13

Vaccines currently under development target opioids in the bloodstream and prevent them from reaching the brain and exerting euphoric effects.

Researchers are exploring the potential of Transcranial Direct Current Stimulation, a novel, non-invasive brain stimulation technique, for treating opioid use disorder.

Improving Treatment Delivery — Researchers are exploring how the health care system can reach more people in need of treatment and helping providers understand which treatments will be most effective for which patients.

Reaching Justice-Involved Youth —  NIDA-funded research is aimed at identifying the most effective strategies for improving the delivery of evidence-based prevention and treatment services for youth through our Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) initiative. Read more about Justice System Research Initiatives.

Additional Information

If you or someone you care about has an opioid use disorder, ask your doctor about available MAT options and about naloxone, an opioid antagonist that can reverse an opioid overdose.

References

This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

NIDA. 2016, November 1. Effective Treatments for Opioid Addiction. Retrieved from https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction

NIDA. «Effective Treatments for Opioid Addiction.» National Institute on Drug Abuse, 1 Nov. 2016, https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction

NIDA. Effective Treatments for Opioid Addiction. National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction. November 1, 2016

Источник: https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction

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