Treatment Options for Heroin Addiction
By Megan Krause
The heroin epidemic rages on, and as our lawmakers continue to debate drug control policy, our loved ones continue to suffer and die. Consider the most recent statistics:
- Every day, more than 115 Americans die of an opioid overdose (opioids include heroin, prescription pain relievers and synthetic opioids such as fentanyl) (National Institute on Drug Abuse)
- About 80 percent of heroin addicts first misused prescription painkillers (The Substance Abuse and Mental Health Services Administration)
- Opioid overdoses increased 30 percent in 45 states from July 2016 through September 2017; in the Midwest, that number jumps to a shocking 70 percent (U.S. Centers for Disease Control and Prevention)
In October 2017, the U.S. Health and Human Services agency declared the opioid crisis a public health emergency and announced a five-point strategy to combat it. First on that list: better prevention, treatment and recovery services.
It’s about time. Following are the most commonly used treatment options for opioid addiction. If you or a loved one is suffering from opioid addiction, please seek help.
Medication-assisted treatment: Methadone, Buprenorphine, & Naltrexone
Medicated-assisted treatment (MAT) is the use of prescription medications to help people reduce or quit their use of heroin and other opiates. It’s important to note that medication should be used in combination with counseling and behavioral therapy.
Methadone eases the symptoms of opiate withdrawal and blocks the effects of other opioids. It comes in pill, liquid and wafer form and is taken once a day. According to SAMHSA, methadone is particularly effective in higher doses for heroin addicts. The idea is to wean off the medication under a doctor-supervised taper schedule.
By law, methadone must be administered through an opioid treatment program certified by SAMHSA, and patients will have to travel to a clinic every day to receive their doses. Once a patient demonstrates progress and commitment to treatment, they may be allowed to take their methadone dosages home with them and make fewer trips to the clinic.
Methadone is addictive and must be used exactly as prescribed.
Most commonly known under the brand name Subutex, this drug reduces the symptoms of opioid withdrawal, decreases cravings for opioids and blocks their effects. It comes in a wafer form (taken under the tongue) or as an injection, skin patch or implant. Unlike methadone, doctors can write this prescription from their offices, which has significantly increased access to this medication.
There is a potential for misuse and addiction to buprenorphine.
Naltrexone works by blocking opioid receptors, which reduces opioid cravings, and by blocking the effects of other opioids. Naltrexone comes in two forms:
- Pill form (brand names ReVia, Depade), taken at 50 mg once per day
- Injectable extended-release (brand name Vivitrol), administered at 380 mg once a month
There is no potential for abuse with naltrexone, and it can be prescribed by a doctor in-office.
This drug is most commonly known by its major brand name, Suboxone, and as one would expect, it combines the abilities of both drugs. It can be taken by mouth, dissolved under the tongue, or dissolved on the inside of the cheek.
Behavioral therapies are a vital part of treating any substance abuse disorder. This type of treatment helps people:
- Identify and change their beliefs and behaviors related to drug abuse
- Develop coping skills
- Understand and avoid triggers that could prompt another episode of drug use
Inpatient & outpatient treatment programs
You’ll find behavioral therapy as part of the treatment plan in reputable inpatient and outpatient programs.
When people talk about “going to rehab,” this is usually what they’re talking about. The patient enters an inpatient facility for anywhere from 28 to 90 days, where treatment typically consists of individual and group therapy, drug education classes, yoga, art and recreation therapies, family counseling, and exposure to 12-step meetings.
In outpatient treatment, the patient continues to live at home or in sober living while attending treatment classes and groups at an outpatient facility. Similar to inpatient treatment, treatment usually consists of one-on-one and group therapy and a range of classes, depending on the patient’s needs and goals.
A note about both types of treatment programs: A reputable program adheres to standards that are backed by scientific evidence—meaning, there is evidence that it works. Before entering treatment, ask if they follow the recommendations of any of the following organizations:
- The National Institute of Drug Addiction
- The Substance Abuse and Mental Health Service Administration
- The American Society of Addiction Medicine
- The Joint Commission
- The National Institute of Mental Health
Twelve-step programs (aka the “Anonymous” fellowships) have helped millions of people all over the world get clean and sober. This model of recovery is based on the idea that by working a set of spiritual principles—the steps—those suffering from addiction can help each other get and stay sober.
The model has been criticized, however, for its lack of empirical evidence and its spiritual component (although no one is required to believe anything in the 12-step model). Still, there’s no question that these programs offer critical support and bonding. Reach out to these organizations to see how they can complement your care. The most prevalent ones include: