How is opioid dependence treated?

Principles of treatment

Opioid dependence is an ongoing (chronic) and relapsing condition.1 Like other chronic medical conditions, such as diabetes or high blood pressure, it often requires long-term treatment.2

It may take a number of attempts to reduce or stop heroin and other opioid use altogether and you may experience some relapses along the way.1 This is normal when trying to change your lifestyle and these relapses should not be seen as failures. The important thing is to work out what you can learn from these relapses and what you can do differently when you face similar situations in the future. It is very important for the drug user to seriously want to be free of opioids. All treatment options require determination and a willingness to learn to live opioid free.

Treatment for opioid dependence2

There is no “best way” to treat opioid dependence. You may need to try a number of different treatments to find out which one works best for you. Often people will use a number of different treatments over time as their situation changes. The purpose of the treatments is to:

  • Reduce or stop heroin and other illicit opioid use
  • Prevent further harms from heroin and opioid use
  • Improve the life and well-being of the person with opioid dependence.

When you are ready, approach your doctor or a support service to find out more information about your different treatment options.

Types of treatment

There are a number of different medications and support programs that can be used to treat opioid dependence. Medicines used to treat opioid dependence either focus on:2,3

  • Detoxification or detox programs aiming at stopping all opioid use (abstinence)
  • Management of craving and withdrawal symptoms with medications used to treat opioid dependence (also called the pharmacological treatment of opioid dependence) in order to reduce or stop illicit opioid use

Detox programs

Detox programs aim to help people to reduce and stop taking opioids over a short time period. The main advantage of this approach is it’s a short treatment course, however it may be associated with a risk of relapse.3 If you decide with your doctor to choose this approach, think about how you are going to manage your lifestyle once your detox is over. Counselling or joining a support group is a good way forward and is usually recommended.

Pharmacological treatment

Pharmacological treatment of opioid dependence involves using medications such as, for example, buprenorphine and methadone to manage cravings and withdrawal symptoms to avoid or reduce illicit opioid use. Buprenorphine is usually taken either as daily dose, under the tongue (sublingual) or in the mouth (transmucosal), or by subcutaneous (under the skin) injections once a week or once a month.2-5 Methadone is usually taken as a daily oral dose.2,3,6

As opioid dependence is a chronic (long-term) condition, treatment may be needed for several months to several years.2 Regular use of these medicines aims to prevent opioid withdrawal, reduce cravings, reduce the use of illicit opioids such as heroin and may improve your quality of life. For people who choose this method it may help stabilise opioid use, while you make long-term changes in your life.2,3

While medications aim to help you cope with the physical aspects of opioid dependence (cravings and withdrawal symptoms), counselling and other support services can help you deal with any underlying issues and life stressors that have the potential to cause a relapse and a return to illicit opioid use.1,2,3 It is often advised that you change your friendship groups and remove your associations to other drug users. This should reduce your accessibility to opioids and possible influences to re-use.

Make sure that you are being honest with yourself. You need to WANT change, when you are ready.

When you speak to your doctor, it is recommended that you ask about all the different treatment options for opioid dependence and discuss with them what would be the best treatment for you.

References

1. Evans CJ, Cahill CM. Neurobiology of opioid dependence in creating addiction vulnerability. F1000Res. 2016; 5.
2. Dematteis M, Auriacombe M, D’Agnone O, Somaini L, Szerman N, Littlewood R, Alam F, Alho H, Benyamina A, Bobes J, Daulouede JP, Leonardi C, Maremmani I, Torrens M, Walcher S, Soyka M. Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus. Expert.Opin.Pharmacother. 2017; 18: 1987-1999.
3. Bond AJ, Witton J. Perspectives on the pharmacological treatment of heroin addiction. Clinical Medicine Insights: Psychiatry 2017; 8: 1-10.
4. Coe MA, Lofwall MR, Walsh SL. Buprenorphine pharmacology review: update on transmucosal and long-acting formulations. J Addic Med 2019; 13(2):93-103.
5. Blanco C, Volkow ND. Management of opioid use disorder in the USA: present status and future directions. Lancet 2019; 393(10182):1760-1772.
6. Thornton & Ross Ltd. Methadone mixture summary of product characteristics. 2015.

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