Treatment for Opioid Dependence-
In seeking what really works for overcoming recidivism in heroin abuse, we must consider all known effective treatments, even those with modest results. That would include medications and behavioral therapy, even if they only seem to provide a temporary fix that gets the addict to the next-better stage. We also need to consider improved efficacy when medications and behavioral therapies are combined.
The following statement is the upshot, or proposition, of this entire article. The powers that be need to implement a protocol of treatments that work across the timeline, from 1) the beginning of addiction, to 2) breaking the habit, to 3) recovery that is maintainable over one’s lifespan. If the maintenance phase is to last over a lifetime, it requires continued awareness and prevention. I say prevention because, once recovered and living a normal life, it’s as though the patient is back at square one, a similar playing field for non-addicts and addicts alike. The differences are in the ability to cope with unwanted emotions. We all have them.
Ergo, it is my opinion that we all start in a pre-addiction phase, where we have the choice to give in to the false emotional relief of a substance. Only some of us seem to have been blessed with good prevention tactics that allow for decent regulation of our emotions, and an awareness of satisfying and healthy ways to get relief when our emotions broadside us. I’m saying that addicts, when they start down the road of addiction, believe their choice to use is going to serve them, even if they understand it’s only temporary. They engage
in their first use because they haven’t found anything else that has given them relief. Once they use an opioid, it puts them into the cycle of looking for relief by using it again, which is all addiction really is. They don’t know of any better way to get emotional relief.
The heroin epidemic tells us awareness and prevention are currently inadequate, far and wide. To get past the problem of recidivism that often ends in premature death, we must span the process of addiction from the beginnings of seeking emotional relief, through the maintenance of a productive and valued life. We must figure out how to get the addict back to square one, where an awareness of healthy choices for emotional relief are within mental and physical reach. This is where possible treatments enter in.
Although today’s legal standard regarding heroin addicts often includes imprisonment, being that it rarely treats the addict for their addiction, I am not exploring it as a possible treatment variable. That leaves us with, in this order, prevention education, medications, rehab centers with behavioral modification therapies, ongoing therapies, support groups, and back to square one: prevention.
According to the people who are in touch with the realities of opioid addiction and recovery, there are treatments that work; however, standardization of good treatment protocol, along with availability are the problem. This is where addicts need non-addicts. They need non-addicts to take a stand with them for specific laws to implement a true “treatment” protocol that is widely available in order to finally give heroin the fix.
My mission in life is to provide awareness of the problems inherent to the epidemic as well as prevention education. I want you to first understand what addicts need to succeed in overcoming their addiction, and secondly, the understanding that we, the general public, are going to have to speak up to get it for them. The time is now for capable people to understand what addicts deal with so as to understand the importance of proper treatment and prevention in a truly meaningful way.
Now that we have covered the emotional reasons addiction starts, in keeping with an addict’s timeline from worst case to best case, let’s start with the treatment of an overdosed, dying opioid addict who needs immediate resuscitation. Then I’ll review what I’ve learned about the medications effective in reducing cravings—those that keep the addict from relapsing into using the drug again. Then I’ll consider the behavioral therapies; rehabilitation programs and treatments that have worked, and what programs, according to experts, typically don’t work and why—which may actually be programs that have great potential to work when combined with other treatments.
As I go along, I’ll throw in some details about availability and access to the treatments. Last but not least, I’ll present long-term, effective maintenance options, which are what I just coined as the “back to square one,” awareness-prevention phase. Here begins the hierarchy of treatment:
- naloxone (not to be confused with naltrexone in the list below this) is for reviving a victim at the time of an opioid overdose.
- This drug is given intravenously by paramedics to revive victims within 2 minutes, and intramuscularly to work within 5 minutes.
- Narcan is a widely-used prescription nasal spray of naloxone.
- It is given in small doses because when used as an antidote to opioids it has the same effect as withdrawal.
- Narcan can be kept on hand by addicts, where others can locate and administer it in case of an overdose.
Now that the overdosed addict gets to live, the following three prescription drugs for opioid addicts are effective in reducing the excruciating pain of withdrawal while also reducing cravings that always persist after the withdrawal phase. These are important because they help addicts get through withdrawal without recidivism, and then they break the cycle of recidivism post-withdrawal by relieving the long-term cravings. The medication brand names are in parentheses:
- methadone (Dolophine®, Methadose®)
- buprenorphine formulated with naloxone (Suboxone®, Subutex®, Probuphine®)
- naltrexone (Vivitrol®)
Methadone has, since the 1960’s, been shown to help reduce opioid cravings. I’ll cover that research later.
Because buprenorphine is a type of opioid, and taken alone can be used to get high, the brand formulas with bupronorphine include naloxone to prevent abuse. Naloxone, as you just learned, can cause the same effects as withdrawal, so it won’t be any fun to try to get high on these prescription medications.
The third medication on the list, naltrexone(Vivitrol®), is for addicts who have been clean for some time and whose brains have started to heal and normalize. That’s because naltrexone “…blocks the effects of opioids at their receptor sites in the brain …” Imagine how awful it would be to experience a sudden shift from having opioids at the brain’s receptor sites, to a sudden blockage or disconnect of them. This would only cause instant withdrawal pain and severe craving, sending the recipient begging for an opioid drug or heroin fix! Ergo, the caveat about the use of naltrexone warrants attention.
Importantly, all these medications are said to reduce cravings and the criminal behavior related to drug seeking, as well as helping addicts become open to behavioral therapy. This gives addicts and their loved ones hope—but unfortunately that hope is often false because of the lack of availability of those drugs, which I will cover soon.
End of Part 2; Part 3 Coming Soon!
I hope you found Part 2 of this article helpful. Your comments are valued and welcome; scroll all the way down past the Footnotes to the highlighted word, “comments.” To get on my list to automatically receive my new blogs as they are posted, please email me at RoriOhara@SuccessSystemsInstitute.com. You can unsubscribe at any time.
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Part 2 Footnotes
 “Role of Naloxone in Opioid Overdose Fatality Prevention; Request for Comments; Public Workshop.” Role of Naloxone in Opioid Overdose Fatality Prevention; Request for Comments; Public Workshop. Accessed December 18, 2016. http://www.fda.gov/Drugs/NewsEvents/ucm277119.htm.
 Treatment, Center For Substance Abuse. “Chapter 3. Pharmacology of Medications Used To Treat Opioid Addiction.” Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. January 01, 1970. Accessed December 18, 2016. http://www.ncbi.nlm.nih.gov/books/NBK64158/.