News of the dangers and prevalence of opioid use have been rampant in the media as of recently due to the staggering increase in prescription drug-related deaths. The Center for Disease Control (CDC) is calling opioid use a national epidemic given that around 66% of drug-related deaths in 2016 involved opioids. Public health professionals around the country are trying to develop a comprehensive strategy to combat opioid abuse, but what is the best course of treatment? With so many options, how can one determine what is most effective? But asking these questions is the first step in seeking help, the desire to make a change is vital to eventually living an opioid-free lifestyle.
Opioids: The Basics
Before we can understand how to get help for an opioid addiction, we must first acknowledge the basics of opioids and how they affect the body. In definition, an opioid is any natural or synthetic substance which binds to the opioid receptors in the brain which happen to be the areas of the brain responsible for controlling pain, reward and addictive behaviors. Some examples of opioids include fentanyl, methadone, opium, and heroin to name a few. All are equally dangerous in their potential to develop an addiction. They are generally taken orally, except for heroin, which is either snorted or injected.
While the abuse of opioids can produce a sense of euphoria or tranquility, opioids can also serve a medical purpose. The prescription painkillers hydrocodone (Vicodin), oxycodone (OxyContin), and morphine are commonly used in scenarios which call for pain management of a patient. Unfortunately, this legal use of the drugs can all too often develop into an addiction.
The Dangers of Opioid Addiction
Even when taking the prescribed dosage of an opioid, the drug can produce undesirable side-effects on the body and mind including drowsiness; itching; nausea; slowed breathing, heart rate, and brain activity; vomiting; and watery eyes.
However, as with any addiction, the misuse of opioids can produce even worse, and sometimes life-threatening, side-effects such as:
- Increased tolerance for pain
- Infection due to needle sharing, including contracting HIV
- Poisoning as a result of the drug being “cut” with another substance
- Psychological dependence
- Spontaneous abortion, breech delivery, premature birth, increased risk of SIDS, and stillbirth in pregnant mothers
Furthermore, long-term use can lead to organ damage throughout the body, especially the liver, as well as brain damage due to hypoxia, oxygen deficiency, which can occur as a result of respiratory depression. When considering the possible outcomes listed above, the risk of continuing to use opioids is clear and seeking help becomes the obvious next step.
How to Get Off Opioids
Once the decision is made to overcome an opioid addiction, the next step will be to seek medical assistance in doing so. Because the body has become dependent on the presence of the drugs, withdrawal can be dangerous and should be closely monitored by a medical professional to avoid any life-threatening complications. The opioid withdrawal symptoms will vary depending on the length and dosage of opioid use but can include muscle aches, agitation, anxiety, insomnia, sweating, abdominal cramps, chills, depression, diarrhea, nausea, lethargy, and vomiting. Symptoms usually start within 12-30 hours of the last exposure and can last anywhere between a month and several months.
Available Treatment Methods
With so much at stake, it is crucial to know and understand the facts about the different methods of treatment when seeking opioid addiction help. If you or a loved one are trying to decide how to get help for an opioid addiction, below is a list of methods which range in effectiveness.
Outpatient Treatment Programs
Outpatient treatment programs educate patients about the effects of drugs and typically provide group counseling, although more intensive options can include cognitive behavioral therapy, family therapy, individual counseling, job therapy and training, marriage counseling, or peer support systems.
While these programs vary in cost, type and intensity, they are usually cheaper than inpatient programs and may be easier to attend for those individuals with work or family commitments. Reduced drug use, improved employment status, and reduced criminal activity are outcomes for this method.
Similar to outpatient treatment programs, Narcotics Anonymous (NA) is not the most effective method when used as the singular course of treatment. However, NA can be a vital part of an individual’s recovery and maintenance plan once sobriety is achieved. As with it’s more well-known sister program, Alcoholics Anonymous, NA uses a 12-step program to maintain sobriety by accepting a few foundational ideas:
- Substance use disorders are chronic, relapsing-remitting diseases
- Individuals lack control over their disease
- Willpower alone is not enough to reach recovery
- Surrendering to a higher power is crucial to recovery, as is the support structure of the 12-step community
- Being actively involved in NA is key
Inpatient Treatment Programs
Inpatient treatment takes place in a hospital, or a residential treatment facility, and involves a supervised detox by a medical team. Traditionally, these programs last 28 days though some facilities will allow for stays as short as three days or much longer than the standard 28. Some programs are therapy-based and place a focus on counseling, individual and family education, and behavioral training. These types of inpatient programs usually last four to twelve weeks but can be longer. Similarly, multimodal programs use a variety of services and techniques to help individuals achieve recovery including medical care, job training, family therapy, drug education, group or individual psychotherapy, and coping techniques.
Not everyone benefits from or can commit to such programs as inpatient treatment. Mothers with children may not be able to attend a program that requires admission for a period of time as these programs rarely arrange for childcare as part of the process. In addition, people without health insurance or those with low income can also be deterred by the high price tag usually associated with an inpatient program.
While methadone is itself an opioid, it can be used to treat opioid disorders as a method of preventing withdrawal. The idea is that individuals wean down to a small dose and continue using methadone to satisfy the body’s need for opioids. It produces similar effects as other opioids without some of the harmful risks.
In fact, research has shown that one year of methadone maintenance can lower opioid use by 54%. This method also significantly reduces the risk of contracting HIV from a shared needle and has been known to decrease the use of other substances as well, particularly cocaine and alcohol.
A partial opioid agonist, buprenorphine, acts on the same receptors in the brain as pure opioids like heroin or prescription medication. However, much like methadone, it does not produce the same high or have the same dangerous side-effects. At first, buprenorphine results in some euphoria and respiratory depression, but these effects typically level off at a certain point, lowering the risk of misuse and dependency. Buprenorphine differs from methadone as a treatment method in that it can be prescribed by doctors and taken at home. Those choosing buprenorphine as a treatment method should expect to experience decreased withdrawal symptoms, cravings, and risk of accidental overdose.
Contingency management (CM) functions by rewarding individuals for negative drug screens. The rewards are usually vouchers which can be exchanged for tangible prizes which promote a drug-free lifestyle or the chance to win cash prizes. The value of the vouchers or number of tickets received for the cash prize lottery starts small but increases over time. CM can be a successful recovery aid by helping to promote sobriety while also improving clinic attendance rates and compliance with medication-assisted treatment.
Ultra-Rapid Opioid Detoxification
More often than not, detox is not a treatment in and of itself, but ultra-rapid opioid detoxification (UROD) can be a successful measure on its own. The process takes place over the course of two days during which a patient is sedated with general anesthesia and given Naltrexone, an opioid antagonist. In essence, this allows the symptoms and process of withdrawal to speed up while removing the patient’s experience of the uncomfortable side-effects of such withdrawal.
This treatment, however, is not recommended by the American Society of Addiction Medicine (ASAM) and can be extremely costly with a price tag around $10,000.00.
A new treatment method for opioid use, Probuphine consists of four buprenorphine-containing rods implanted under the skin of the inner arm which last six months. This can help patients stay on their medication with increased consistency and prevents misuse or reselling of the drug. While the only dosage currently available is eight milligrams, the manufacturer has said that varying doses are in the works. Probuphine can also be a costly investment, $825 per month if your insurance doesn’t cover the treatment, though most insurers do.
Finally, we have therapeutic communities as a treatment option. These are long-term residential facilities which place an emphasis on encouraging individuals to help themselves. The rationale behind this “self-help” method is that drug use is the cumulative result of personal, psychological, and educational problems rather than a disease. The communities use a combination of supportive and confrontational techniques which allow individuals to identify their specific areas of growth in order to learn how to re-enter society drug-free.
Such communities are highly structured, especially given that the majority of those who come to therapeutic communities have not achieved sobriety using other methods of treatment. The community staff is most often composed of individuals who have recovered from their own substance use disorders, in addition to some psychologists. Typically new residents are assigned to menial work duties but can earn better jobs based on time spent in the community and personal growth.
The primary drawback to therapeutic communities is how demanding they are, both physically and psychologically which results in a high drop-out rate. However, those who remain in a therapeutic communities see high rates of effectiveness.
Ultimately, there is no singular method that is better than the rest and success rates will vary greatly for each person and their particular circumstances. Rather, those seeking opioid addiction help should work to determine what will help them achieve their goals, and work with an ally to develop a plan which may include multiple methods concurrently or in succession. For example, medication can be taken alongside different forms of therapy, detox, community, and inpatient services, providing a patient with the best combination of care available. Considering the facts will help each person determine the best method for themselves. In the end, that’s the best way to succeed in recovery. The sooner you are able to spot the signs of an opiate addiction in a loved one, the faster you will be able to get them to treatment.
If you or a loved one is suffering from an addiction, please know we are here to help you. Our opiate addiction treatment center helps addicts fight the ugly battle of addiction and get them back to a positive lifestyle.