Every minute, someone dies from an opioid overdose in America. Every statistic represents an individual who is battling opioid use disorder, which was once known as opioid addiction or dependency. The hallmark of compulsive drug seeking and consumption, despite unfavorable consequences, is chronic opioid use disorder.
While it may seem hopeless for some, recovery from opioid use disorder is indeed possible.
There are evidence-based medical treatments that can help people regain control over their lives and stop the cycle of opioid misuse.
The most effective treatment for opioid use disorder is a combination of medicine and behavioral therapy, just like for other chronic conditions like diabetes or heart disease.
This article will explore the full spectrum of treatment options available today for opioid use disorder.
What are Opioids?
Opioids are a class of drugs that are both synthetically created and naturally occurring in plants that work in the body and brain.
Opioids work by binding to opioid receptors found primarily in the digestive system and brain. These receptors are involved in processes like pain perception, reward, and gastrointestinal motility.
When opioids attach to these receptors, they can have potent effects on pain perception and emotional responses.
In the brain, opioids strongly affect the areas controlling pain sensation and emotional processing. When bound to their receptors, opioids drive up levels of dopamine, the brain’s feel-good chemical. This surge of dopamine release in the brain’s reward pathways is what produces the sensations of pain relief and euphoria associated with opioid use.
Nevertheless, the brain adjusts to the elevated dopamine levels with repeated use, necessitating ever-higher dosages to produce the same result. For some people, this leads to intolerance, physical dependence, and an increased risk of addiction.
The global market for opioid medications was valued at an estimated $22.8 billion USD in 2022. Opioids are widely prescribed for the treatment of moderate to severe chronic pain conditions. Market analysts project the opioid drug market will experience a modest compound annual growth rate of 1.4% through 2030.
Key factors driving this expected growth include continued research and development efforts yielding new opioid analgesic approvals as pharmaceutical companies seek to meet the ongoing demand for pain management options.
What Is Opioid Use Disorder (OUD)?
Opioid use disorder (OUD) is a serious medical condition that affects a person’s brain and behavior. Individuals suffering from OUD often develop an intense focus on continued opioid use and experience severe withdrawal symptoms if they stop using.
Addiction to opioids, whether they are prescription painkillers or illegal drugs like heroin, can cause significant impairments in an individual’s daily life and responsibilities.
A person with OUD faces both mental and physical challenges associated with their condition. Their opioid addiction may interfere with major bodily functions and affect their ability to care for themselves properly. Cognitively, OUD can diminish cognitive abilities like thinking, learning, concentrating, and communicating.
It may also make it extremely difficult for an individual to maintain steady employment or attend school regularly. Importantly, prolonged opioid use rewires the brain’s reward system and changes how it responds to both the drugs and daily life without them.
For many individuals experiencing opioid use disorder, their condition is considered a disability under the Americans with Disabilities Act due to the types of impairments often associated with the disorder.
The disorder prevents them from fully participating in major life activities, similar to individuals with recognized physical or mental health conditions. With treatment and support, some people are able to manage their OUD, but for others, it will significantly limit their daily functioning without accommodation.
Available Treatments for OUD
Buprenorphine
Buprenorphine is an effective medication for treating opioid use disorder (OUD). In 2000, the Drug Addiction Treatment Act allowed doctors to prescribe buprenorphine in their offices for OUD, providing an alternative to methadone, which could only be administered in opioid treatment programs at that time.
Buprenorphine functions by partially binding to the opioid receptors in the brain, acting as an opioid agonist. This leads to two primary outcomes: decreasing cravings for opioids and relieving withdrawal symptoms. It also blocks the euphoric and respiratory depressive effects of opioids, lowering overdose risk if a person using it returns to opioid use.
Due to buprenorphine being a partial agonist, it displays a “limiting effect,” indicating that raising the amount does not cause stronger impacts past a specific dosage limit. This makes it safer than other opioids in terms of the risk of overdose from respiratory depression.
Studies also show that long-term buprenorphine treatment is more effective than short-term tapers at preventing return to opioid use and overdose deaths, as well as reducing all-cause mortality.
Buprenorphine is available in several FDA-approved formulations including sublingual tablets/films (such as Suboxone), which are placed under the tongue, as well as extended-release injections (like Sublocade) administered subcutaneously.
However, according to TruLaw, research has indicated a potential risk of tooth enamel damage from the acidity of sublingual buprenorphine formulations over long-term use.
Lawsuits such as the Suboxone tooth decay lawsuit have been filed against some manufacturers, alleging failure to warn of this dental risk adequately. Continued research is needed to characterize this potential side effect further.
Methadone
Methadone is a medication approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder (OUD). When used as directed, methadone can safely and effectively help individuals achieve and maintain recovery.
It works by reducing cravings for opioids and alleviating withdrawal symptoms, all while blocking the pleasurable effects of ongoing opioid misuse.
Methadone is just one part of a comprehensive treatment plan for OUD. This plan also includes counseling and other behavioral therapies. The goal is to address all aspects of a person’s health through a whole-person-centered approach.
Federal law requires those in opioid treatment programs (OTPs) to receive not just methadone but also counseling and additional services to support medical, vocational, educational, and other needs.
Methadone is a long-acting opioid agonist that binds to opioid receptors in the brain. This suppresses cravings and withdrawal symptoms over long periods, usually 24 hours or more.
It comes in liquid, powder, and diskette forms for daily dosing under medical supervision. The long-lasting effects help support recovery when someone is unable or unwilling to stop opioid misuse suddenly.
Patients receiving methadone to treat OUD must get their medication from a certified practitioner at an OTP. After demonstrating stability, compliance with the prescribed dose, and progress in treatment, some patients may qualify to take their doses at home between clinic visits.
The recommended minimum duration of methadone treatment is 12 months, according to research. However, some individuals may need long-term maintenance depending on their specific needs and recovery journey.
In all cases, any decision to reduce the methadone dose is made gradually with a treatment provider to avoid precipitating withdrawal.
With ongoing research into new treatment medications and the demonstrated success of medication-assisted treatment, there is hope that one day, the stigma surrounding opioid use disorder will fade.
In its place may come a wider understanding of OUD as a medical condition requiring the same care, respect, and support afforded to others struggling with chronic health challenges.