How Opioid Use Disorder Is Treated Today
“The great thing about these meds is that their outcomes are really positive.”
Opioid use disorder affects millions of people in the United States, and in 2016, only about 17.5 percent of those people received treatment, according to the National Institute on Drug Abuse. This is devastating—not only because the risk of fatal overdose is so high, but also because the treatments for opioid use disorder can be incredibly effective.
“The thing that's tricky about opioid use disorder is it's very hard to stop just sort of cold turkey and on your own,” says Jonathan Avery, MD, director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital. “The relapse rates at one year approximate 100 percent if you're trying to just quit [without help].”
Medications for Opioid Use Disorder
“There are a number of medications for opioid use disorder, often classified as medication-assisted treatment for opioid use disorder,” says Dr. Avery. “For folks with opioid use disorder, their opioid system has been dysregulated because of their use, and so they need to be on one of these meds to stabilize things.”
The three primary medications for opioid use disorder are buprenorphine, methadone, and naltrexone.
Buprenorphine is a partial opioid agonist, which means that it binds to opioid receptors in the brain but doesn’t activate them as strongly. It helps to reduce cravings and withdrawal symptoms, without producing the euphoric intoxication state.
Methadone is an opioid agonist. Like buprenorphine, it binds to opioid receptors, and it reduces cravings and withdrawal symptoms. However, it activates these receptors more slowly than heroin or morphine would, and the low dose helps prevent euphoria.
Naltrexone is an opioid antagonist, so instead of activating the opioid receptors, it blocks the activation. Naltrexone is an injectable, non-addictive, long-acting medication that is used to prevent the rewarding effects of an opioid.
“The great thing about these meds is that their outcomes are really positive,” says Dr. Avery. “It decreases the relapse rates, it decreases the overdose rates, it improves mental health outcomes, it improves functional outcomes, and so they're some of the best medications we have in medicine.”
Other Components of Treatment for Opioid Use Disorder
While medication is necessary for treating opioid use disorder and re-regulating the opioid system of the brain, it’s only one component of treatment. Effective treatment may also include psychotherapy, support groups, and treatment for co-occurring disorders.
Some common therapy approaches to opioid use disorder include cognitive behavioral therapy, dialectic behavioral therapy, family therapy, and 12-step programs. These can all help get to the underlying issue that may lead a person to use narcotics, as well as give them coping strategies to use in the long run.
“One key with treating substance use disorders in general, and certainly opioid use disorders, is you can't do it in isolation,” says Dr. Avery. “Various self-help groups can augment medications as well, including Narcotics Anonymous, [and] any sort of treatment that involves more of your family members, more of your community, is certainly recommended.”
Dr. Avery is the director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital.
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The thing that's tricky about opioid use disorder is it's very hard to stop
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just sort of cold turkey and on your own,
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and the relapse rates at one year approximate 100 percent
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if you're trying to just quit and do it cold turkey and get better.
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And so, opioid use disorder versus other substances,
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we think is different because of the death risk,
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and also because in the treatment, and so the best treatment
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for opioid use disorder is to be on medications that decrease your risk
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of overdose and improve outcomes.
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There are a number of medications for opioid use disorder,
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often classified as medication-assisted treatment for opioid use disorder
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that really improve outcomes.
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And we are arguing that for anyone with a substance use disorder,
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they should be on these medications that have been shown
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to really improve outcomes.
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And there are three medications that have been studied:
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buprenorphine, methadone, and long-acting injectable naltrexone.
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And the idea is that for folks with opioid use disorder,
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their opioid system has been dysregulated because of their use,
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and so they need to be on one of these meds to stabilize things,
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and the great thing about these meds is that their outcomes
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are really positive, some of the best outcomes we have in medicine.
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It decreases the relapse rates, it decreases the overdose rates,
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it improves mental health outcomes, it improves functional outcomes,
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and so they're some of the best medications we have in medicine,
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and certainly necessary for those struggling with opioid use disorder
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in this landscape in order to prevent deaths,
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and so any of the medications classified as medication-assisted treatment
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really lead the treatments.
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That being said, it's just one aspect of a good treatment
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for opioid use disorder.
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Often you need to get to the underlying root of why one uses,
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and different psychosocial treatments like CBT,
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cognitive behavioral therapy, to address anxiety, depression,
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dialectical behavioral therapy, to address coping,
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and then certainly meds and treatments
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that address any co-occurring disorders.
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Various self-help groups can augment medications as well,
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including Narcotics Anonymous, Alcoholics Anonymous.
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And it's best to have the support of one's family as well,
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and so, one key with treating substance use disorder in general,
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and certainly opioid use disorder, is you can't do it in isolation.
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And so any sort of treatment that involves
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more of your community members, more of your family,
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is certainly recommended.
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How do medications treat opioid addiction? U.S. Department of Health and Human Services. (Accessed on April 15, 2020 at https://www.hhs.gov/opioids/treatment/medications-to-treat-opioid-addiction/index.html.)
Medications to treat opioid use disorder. Bethesda, MD: National Institute on Drug Abuse, 2018. (Accessed on April 15, 2020 at https://www.drugabuse.gov/node/pdf/21349/medications-to-treat-opioid-use-disorder.)
Psychosocial interventions for opioid use disorder. Waltham, MA: UpToDate, 2020. (Accessed on April 15, 2020 at https://www.uptodate.com/contents/psychosocial-interventions-for-opioid-use-disorder.)