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A variety of effective treatments
are available for heroin
addiction. Treatment
tends to be more effective when
heroin abuse is identified early.
The treatments that follow vary
depending on the individual, but
methadone, a synthetic opiate
that blocks the effects of heroin
and eliminates withdrawal
symptoms, has a proven record
of success for people addicted
to heroin. Other pharmaceutical
approaches, such as buprenorphine,
and many behavioral
therapies also are used for treating
heroin addiction. Buprenorphine
is a recent addition to the array
of medications now available for
treating addiction to heroin and
other opiates. This medication
is different from methadone
in that it offers less risk of
addiction and can be prescribed
in the privacy of a doctor's
office. Buprenorphine/naloxone
(Suboxone) is a combination
drug product formulated to
minimize abuse.
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States highlighted currently have CTN Nodes in place. |
Detoxification
Detoxification programs aim
to achieve safe and humane
withdrawal from opiates by minimizing
the severity of withdrawal
symptoms and other medical
complications. The primary
objective of detoxification is to
relieve withdrawal symptoms
while patients adjust to a drug-free
state. Not in itself a treatment
for addiction, detoxification is a
useful step only when it leads
into long-term treatment that is
either drug-free (residential or
outpatient) or uses medications
as part of the treatment. The best
documented drug-free treatments
are the therapeutic community
residential programs lasting 3 to
6 months.
Opiate withdrawal is rarely
fatal. It is characterized by acute withdrawal symptoms which
peak 48 to 72 hours after the last
opiate dose and disappear within
7 to 10 days, to be followed by a
longer term abstinence syndrome
of general malaise and opioid
craving.
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A New Medication for Treating Opiate Addiction
- First medication developed to treat opiate addiction in the privacy of a physician's office.
- Binds to same receptors as morphine, but does not produce the same effects.
- Offers a valuable tool for physicians in treating the nearly 900,000 chronic heroin users in the U.S.
- As of March 2004, 3,951 U.S. physicians were eligible to prescribe buprenorphine to patients.
The Story of Discovery
- First synthesized as an analgesic in England, 1969.
- Recognized as a potential addiction treatment by NIDA researchers in the 1970s.
- NIDA created Medications Development Division to focus on developing drug treatments for addiction, 1990.
- NIDA formed an agreement with the original developer to bring buprenorphine to market in the U.S., 1994.
- Buprenorphine tablets approved by the FDA, 2002.
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Methadone programs
Methadone treatment has been
used for more than 30 years to
effectively and safely treat opioid
addiction. Properly prescribed
methadone is not intoxicating or
sedating, and its effects do not
interfere with ordinary activities
such as driving a car. The medication
is taken orally and it
suppresses narcotic withdrawal
for 24 to 36 hours. Patients
are able to perceive pain and
have emotional reactions. Most
important, methadone relieves
the craving associated with heroin
addiction; craving is a major
reason for relapse. Among
methadone patients, it has been
found that normal street doses
of heroin are ineffective at producing
euphoria, thus making
the use of heroin more easily
extinguishable.
Methadone's effects last four
to six times as long as those of
heroin, so people in treatment
need to take it only once a day.
Also, methadone is medically safe
even when used continuously
for 10 years or more. Combined
with behavioral therapies or
counseling and other supportive
services, methadone enables
patients to stop using heroin
(and other opiates) and return to
more stable and productive lives.
Methadone dosages must be
carefully monitored in patients
who are receiving antiviral therapy
for HIV infection, to avoid
potential medication interactions.
Buprenorphine and other medications
Buprenorphine is a particularly
attractive treatment for heroin
addiction because, compared
with other medications, such as
methadone, it causes weaker
opiate effects and is less likely
to cause overdose problems.
Buprenorphine also produces
a lower level of physical dependence,
so patients who discontinue
the medication generally
have fewer withdrawal symptoms
than do those who stop taking
methadone. Because of these
advantages, buprenorphine
may be appropriate for use in
a wider variety of treatment settings
than the currently available
medications. Several other medications
with potential for treating
heroin overdose or addiction
are currently under investigation
by NIDA.
In addition to methadone
and buprenorphine, other drugs
aimed at reducing the severity of
the withdrawal symptoms can be
prescribed. Clonidine is of some
benefit but its use is limited due
to side effects of sedation and
hypotension. Lofexidine, a centrally
acting alpha-2 adrenergic
agonist, was launched in 1992
specifically for symptomatic
relief in patients undergoing
opiate withdrawal. Naloxone
and naltrexone are medications
that also block the effects of morphine, heroin, and other
opiates. As antagonists, they are
especially useful as antidotes.
Naltrexone has long-lasting
effects, ranging from 1 to 3 days,
depending on the dose.
Naltrexone blocks the pleasurable
effects of heroin and is useful in
treating some highly motivated
individuals. Naltrexone has also
been found to be successful in
preventing relapse by former
opiate addicts released from
prison on probation.
Behavioral therapies
Although behavioral and
pharmacologic treatments can be
extremely useful when employed
alone, science has taught us that
integrating both types of treatments
will ultimately be the
most effective approach. There
are many effective behavioral
treatments available for heroin
addiction. These can include
residential and outpatient
approaches. An important task
is to match the best treatment
approach to meet the particular
needs of the patient. Moreover,
several new behavioral therapies,
such as contingency management
therapy and cognitive-behavioral
interventions, show particular
promise as treatments for heroin
addiction, especially when
applied in concert with pharmacotherapies.
Contingency
management therapy uses a
voucher-based system, where
patients earn "points" based
on negative drug tests, which
they can exchange for items
that encourage healthy living.
Cognitive-behavioral interventions
are designed to help
modify the patient's expectations
and behaviors related to drug
use, and to increase skills in
coping with various life stressors.
Both behavioral and pharmacological
treatments help to restore
a degree of normalcy to brain
function and behavior, with
increased employment rates
and lower risk of HIV and other
diseases and criminal behavior.
What are the opioid analogs
and their dangers?
Drug analogs are chemical
compounds that are similar
to other drugs in their
effects but differ slightly in their
chemical structure. Some analogs
are produced by pharmaceutical
companies for legitimate medical
reasons. Other analogs, sometimes
referred to as "designer"
drugs, can be produced in illegal
laboratories and are often more
dangerous and potent than the
original drug. Two of the most
commonly known opioid
analogs are fentanyl and meperidine
(marketed under the brand
name Demerol, for example).
Fentanyl was introduced in
1968 by a Belgian pharmaceutical
company as a synthetic narcotic
to be used as an analgesic in
surgical procedures because of
its minimal effects on the heart.
Fentanyl is particularly dangerous
because it is 50 times more
potent than heroin and can
rapidly stop respiration. This is
not a problem during surgical
procedures because machines
are used to help patients breathe.
On the street, however, users
have been found dead with the
needle used to inject the drug
still in his or her arm.
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