The Devastating Effects of Opioids

For patients who plan to detox fully from opioids, injectable Naltrexone sold under the trade name VIVITROL®, a form of long-term blocker, can be especially helpful. naltrexone/VIVITROL® are opioid “antagonists,” meaning they blocks the effects of opioid medications.  VIVITROL® binds to the receptor that opioids use to provide pleasurable feelings and does not allow the opioid to have its effect. In fact, it’s strength in binding to the receptor is so much greater than the opioids ability, it will knock the opioid off the receptions even if they were there first.  Therefore, you should have 1-2 weeks without any opioid use to start VIVITROL® as using it will put an active opioid user into complete withdrawal.  It has also been shown to decrease cravings for both alcohol and opioids. For patients who start with detoxification/treatment and find that complete abstinence is not tolerable for them due to cravings or difficulty functioning without medication, opioid replacement therapy is another method of ensuring that the opioid receptors remain at least partially engaged in a measured way while reducing these symptoms. This includes the medications suboxone and methadone. The main/active ingredient in Suboxone is buprenorphine.  Buprenorphine is a partial agonist.  An agonist is a medication that binds to the receptor site – oxycodone, heroin and other opioids are “full agonists,” they bind to the receptors and activate them fully producing the euphoria users seek.  Suboxone is a partial agonist, it binds to and activates the same receptors as other opioids, but has only part of the effect that a full agonist such as oxycodone will have on the user. Suboxone remains active in the bloodstream for longer and does not produce quite the same euphoric effects as full agonists like oxycodone. The “high” is not as intense if these partial agonists are taken in higher doses, and buprenorphine even has a ceiling so that after a certain amount is taken, it no longer increases in effect. Interestingly, Suboxone also contains the medication naloxone (that’s where the “oxone” portion of its name comes from). Naloxone, when given alone, is an opioid antagonist (completely blocks the effects of an opioid). If the Suboxone is taken as prescribed, the Naloxone will be inert (cause no effect).  If, in an effort to get all the medication into the bloodstream at one time the user crushes and injects the sublingual tablet, the naloxone effect dominates, and the medication blocks the receptors causing opioid withdrawal.  This decreases the likelihood that the Suboxone will be abused. Methadone is another form of medication for addiction treatment.  A synthetic opioid, methadone is a longer-acting opioid replacement medication, it binds with the opiate receptors but without quite the euphoria as heroin and other opioids. Methadone is typically taken as a liquid medication and people taking it generally report to a clinic specializing in medication for addiction treatment at least 5 days per week. Among other benefits, methadone maintenance gives users a daily, stable dose of opioids, decreases the likelihood that users will be injecting drugs, therefore getting Hepatitis or HIV, eliminates the need to find ways to pay for their opioids and helps people take the first steps toward getting back to normal life.  Although it is not entirely without its own health concerns, and dependence that is similar in strength to heroin, methadone is considered effective and safe and is included in the World Health Organization’s (WHO) list of Essential Medications.  One thing all treatment providers agree on – medications alone are not the complete answer for achieving long-term abstinence. Addiction is a brain disease that affects many aspects of a person’s physical and mental well-being as well as their personal, family and social relationships. RCA also includes behavioral therapies, pragmatic workshops, counseling sessions, and long-term support groups when helping those with opioid abuse and dependency issues.