Does Drug Substitution Work?
For opiate addicts, the painful physical withdrawal is a massive barrier to getting and staying clean. During the detox process, many opiate addicts receive opioid replacement drugs, such as Subutex or Suboxone. These drugs reduce and eliminate your cravings by binding to the same receptors as heroin as well as other opiate drugs.
Some addicts choose to remain on these drugs for long periods of time, utilizing a treatment method called "drug replacement therapy." Taking opiate replacement drugs for a long period of time can benefit addicts in certain ways, but there are also serious dangers associated with this form of treatment.
Drug replacement and maintenance therapy have a long history of providing individuals struggling with problematic drug use with legal access to drugs that would otherwise be obtained through illegal means.
What Is Drug Substitution Therapy?
Using drug substitution therapy or drug replacement therapy for replacing the use of drugs is frequently done to help treat addiction to drugs and substances. Addiction to drugs can be quite strong, especially when you are addicted to opioids. It can be so strong as to change how the brain functions. Treating the addiction to opioid replacement therapy is done under medical supervision.
As the addict goes through the withdrawal from the use of, say, opioids, the craving for the drug is overwhelming and this makes it very difficult to stop using them. It can be quite uncomfortable and very painful to stop the use of opioids.
By using opioid replacement therapy, the addict will have fewer, subtler symptoms. The symptoms that persist will be a lot more manageable. This will allow the addict to focus on recovery, and not have to wrestle with heavy drug cravings.
How Does Drug Replacement Work?
Drug replacement treatment addresses the two most vexing problems associated with opioid dependence and addiction: withdrawals and cravings. Withdrawal is often an agonizing experience which triggers severe cravings. The process is often so excruciating that many people relapse.
Drug substitution works by stabilizing the brain's opioid receptors. The drugs suppress withdrawal symptoms and eliminate cravings without producing a high.
With this said, drug replacement therapy is not a magic pill which cures addiction. It works best when combined with intensive behavioral therapy, counseling and support. This combination approach is known as medication-assisted treatment.
Who Needs Replacement Therapy?
Many people in detox for substance addiction receive replacement drugs on a short-term basis to help with their withdrawal process. However, some people take these drugs long-term under supervision by a doctor.
For some patients who wish to control their opiate addiction, they choose to be in a Suboxone or Methadone program, which administers a daily, weekly, or monthly dose of their medication. In order to utilize in these programs, patients generally have to see a specialized doctor who can prescribe these medications, or enroll in a clinic program. Addicts may have to take urinalysis screens to stay in such a program or attend therapy or groups as a condition of their continued prescription.
There are two camps, with regard to drug substitution:
a) Those who are for it - These people believe that in order to recover in the long term, drug substitution therapy is unavoidable. They believe that there are possible alternatives which are available for these people struggling with dependence because the withdrawal symptoms would simply be too severe.
Many believe that the long-term abuse of opioids has caused the patient to damage their body and mind in such drastic ways that a "normal" life may not be attainable. Many of these people believe that denying this treatment is condemning users to a lifetime of continuous addiction and premature death.
b) Those that are against it - The belief here is that drug substitution is nothing more than swapping an illegal drug for a legal one. Considering that both substances are highly addictive, oftentimes the dependence on the substance slowly -ramps up' instead of becoming less. The people who speak out against drug substitution believe that this is not the way to help a person but rather to perpetuate the addiction.
So, which one is it? Does drug substitution work or do things just keep going downhill when it comes into play? The best way to do this is by examining popular medications used in drug substitution/replacement therapy as well as how they've been scientifically proven to affect the brain and body. Only then can we figure out which camp has valid pointers and which one is basing their arguments on misconceptions.
What Medications Are Used in Opioid Replacement Therapy?
There are typically 4 different medications that may be used in opioid Replacement Therapy. Doctors will choose which particular medication to use based on personal experience, how long the addict has been addicted, the level of addiction that the addict has and the particular medication that they feel will work best for the particular opioid that the addict was using.
Some of the medications used in opioid replacement therapy include but are not limited to:
The medication Suboxone has both Naloxone and Buprenorphine in the medication. The naloxone works as a deterrent to drug abuse and the buprenorphine works on the withdrawal symptoms that the addict is struggling with.
Since naloxone is antagonist, it works very well to deter the use of drugs. While some addicts will try to abuse Suboxone, it does block the addict from getting high and can quell the cravings that they are struggling with. As long as the addict is following their regimen for taking their Suboxone, they tend to do very well on Suboxone.
Naltrexone is another medication that is used in opioid replacement therapy. It is used in conjunction with counseling and behavioral contracts as well as lifestyle changes. It's not used for addicts who are still using opiates or for those who are taking methadone. This would cause too sudden of a withdrawal.
Naltrexone is in the drug classification of opioid antagonists as well. It works directly on the brain to stop the sensation of euphoria or well-being in the addict. It also reduces the desire or drive to use opiates. Naltrexone is also used in the treatment of alcoholism. It helps the alcoholic or addict to use less alcohol or even stop drinking entirely.
iii) Methadone Replacement Therapy
Perhaps the most well-known opioid antagonist, methadone is used often as an opioid replacement therapy. Methadone is a synthetic opioid and it's very long-lasting. It works to reduce the cravings in the addict and to keep them from suffering from withdrawal symptoms.
Taken as prescribed, it is effective and safe according to the SAMHSA or Substance Abuse and Mental Health Services Administration. Methadone blocks the painful withdrawal symptoms of opioid addiction and it doesn't give any euphoric effects.
It is taken as a pill with water or it can also be in a liquid form. It's taken once per day. Many addicts actually remain on methadone for several years. They will be tapered off of the methadone gradually until they no longer carve or desire any opioids.
The other medication that is used in opioid replacement therapy is Buprenorphine. There are many differences in the way that buprenorphine is distributed and used. It can be given out as a prescription by a physician that has been specially trained. It's more readily available than methadone and it also works to stop the cravings for opioids.
Buprenorphine has what is called a "ceiling effect" wherein even if the dose is increased, the effects will not change. For this reason, Buprenorphine is far less likely to be abused even though there are a few addicts who will abuse it.
Does Drug Substitution Work?
With all the factual information included here, it is apparent that drug substitution does indeed work. At the very least, it prevents the patient from having to grapple with brutal withdrawal effects, all the while blunting his or her craving for drugs. It is also apparent that those who oppose drug substitution are working off of misconceptions. It is necessary to examine the most prevalent ones.
There are some who believe that a person isn't really sober if they are receiving replacement therapy. Others view it as a moral flaw if someone cannot conquer their addiction through sheer willpower. Another misconception is that medication-assisted treatment swaps one addiction for another.
Notice how none of this is backed up by any science. Addiction is a chronic brain disease — and like other diseases it often requires treatment with medications. Just as a diabetic cannot control their illness without insulin, people suffering from an addiction often cannot manage their disease without the help of medications. Would it make sense to advice a diabetic to bite down on their gum shield and get through it via sheer willpower?
The drugs used in opioid replacement therapy don't make a person high. Rather, they stabilize the individual and prepare them for recovery. With medication-assisted therapy, people are able to get back to work and function normally. Their lives no longer revolve around compulsive drug-seeking and dope sickness.
To find out if opioid replacement therapy is right for you, contact a drug rehab center today. They can create a treatment plan tailored to your needs that will put you on the path to recovery.
Addiction counselors are familiar with the many types of programs offered and what is available in your area. They also can do an assessment with you and determine what treatment would be best for you or your loved one.
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