Treatment for opioid addiction is best suited with a combination of medications and psychotherapy. Unfortunately, “quitting cold turkey” has a poor success rate; fewer than 25 percent of individuals are able to remain abstinent for a full year. This is where medication-assisted treatment options like methadone, naltrexone, and Suboxone can be used to help treat opioid dependence by alleviating the withdrawal side effects and curbing future cravings. According to The National Alliance of Advocates for Buprenorphine Treatment, treating opioid addiction with medication-assisted treatment has been ongoing for over thirty years. Initially methadone was the treatment of choice for opioid addiction however in 2002; the FDA approved the use of the combination of buprenorphine/naloxone (Suboxone) to manage opioid dependence. Buprenorphine is an opioid itself and naloxone is known to block opioids at their receptors Therefore, Suboxone is an opioid antagonist/agonist and is known to induce opioid withdrawals if taken with other opioids such as heroin or morphine.
When not taken in conjunction with other opioids, this medication aims to ease the withdrawal effects and prevent future cravings. According to the 2013 National Pain Report on Suboxone, over three million Americans with opioid dependence have been treated with Suboxone and this drug is now the 41st most prescribed drug in the U.S. Five years ago, it was the 196th most prescribed; causing a predicament among prescribing physicians because now Suboxone is being sold on the street in order to get high from the buprenorphine, an opioid in itself. The cycle of addiction is viscous; the treatment for narcotic dependence is now coming full circle and treatments are now being abused. Methadone, an opioid agonist, was the first pharmacologic treatment for opioid addiction and works to ease the symptoms of withdrawal. Since methadone, like Suboxone, has opioid agonist effects and therefore can be abused if not monitored closely. Intranasal or injectable naloxone, an opioid receptor blocker, is used to prevent opioid overdose by rapidly reversing the respiratory depression and sedation caused by opioid intoxication. This is an emergency medication that is often used by first responders and ER doctors when individuals overdose from opioids.
Other options for pain management
Opioids are not the only answer for pain, especially for chronic pain. When an individual who has a past history of opioid abuse and is in current pain, whether acute or chronic, close care should be taken when trying to appropriately treat this pain. This could be a large potential for relapse if this individual is given opioids. In some instances such as trauma and severe acute pain, opioids are necessary but in general, this class of pain medications can and should be avoided. Other mechanisms such as nerve blocks, acetaminophen (Tylenol) and non-steroidal anti-inflammatory (NSAIDS) such a Ibuprofen or Advil are alternative non-narcotic pain medications that can be used for acute and chronic pain. Ibuprofen and acetaminophen should be used to treat pain before narcotics are prescribed. These alternative therapies should also be used for chronic pain. Anti-depressants such as selective seratonin re-uptake inhibitors (SSRI’s) such as fluoxetine and tricyclic antidepressants such as amitriptyline are used to treat chronic pain and depression simultaneously as depression is the most common emotion associated with chronic pain. Gabapentin, commonly known as Neurontin is used to treat neuropathic pain such as in diabetes neuralgia, phantom limb syndrome or fibromyalgia. Physical therapy is another option to help alleviate pain.