For many, the opioid epidemic that is sweeping the United States and the wider world is top of mind.
News of danger and death related to opiates dominates the media, and many have been personally affected by the rise of these drugs. However, some facts do not get the same airtime. For instance:
- In 2015, two million people had a substance use disorder involving prescription opioids, and 591,000 had a substance use disorder involving heroin. This accounts for 12.6 percent of all substance use disorders in that year.
- 23 percent of all people who use heroin eventually develop a substance use disorder.
- The top cause of accidental death in the United States is drug-related. In 2015, 59.7 percent of lethal overdoses involved opioids and the overdose rate quadrupled between 1999 and 2008. Every day, 91 Americans die from an opioid overdose.
- On an average day in the United States, 3,900 people begin to misuse prescription opioids and 580 people begin to use heroin.
It’s clear that we need a comprehensive strategy to combat opioid use disorders, but what is the best course of action? With so many options, how can you decide which will be most effective or best suit your lifestyle? To help you determine your next steps, examine different treatment options with their rates of efficacy, as well as some pros and cons associated with each.
What are Opiates?
Opiates are central nervous system depressants derived from the poppy plant, while opioids are a classification of drugs that encompass both opiates and similar, synthetically made substances. Both opiates and opioids act on the same regions of the brain and produce the same effects. Opium, morphine, heroin and codeine are made from the poppy plant itself while oxycodone, hydrocodone and fentanyl are synthetic. All, however, are equally dangerous in terms of potential for abuse.
Most opiates are taken orally, although some, such as heroin, are injected or snorted. The intended effects include pain relief, euphoria and tranquility.
What Are the Dangers of Opioids?
Not every effect of opiates is pleasurable. Other side-effects include:
- Increased tolerance to pain
- Infection due to needle sharing, including contracting HIV
- Poisoning due to the drug being “cut” with another substance
- Psychological dependence
- Slowed breathing, heart rate, and brain activity
- Spontaneous abortion, breech delivery, premature birth, increased risk of SIDS and stillbirth in pregnant mothers
- Watery eyes
What Is Withdrawal Like?
Opiate withdrawal comes in stages. Early symptoms include:
- Aching muscles
- Runny nose
Later symptoms include:
- Abdominal cramps
Symptoms usually start within 12–30 hours of the last exposure and can last anywhere between a month and several months.
How Can You Minimize Withdrawal Symptoms?
There are many medications to treat the symptoms of withdrawal:
- Abdominal cramps can be treated with Propantheline or Hyoscine Butylbromide
- Agitation and anxiety can be treated with diazepam
- Depression can be treated with antidepressants
- Diarrhea can be treated with a Kaolin mixture or Loperamide
- Insomnia can be treated with Temazepam or Promethazine
- Muscle aches can be treated with Quinine Sulphate
- Nausea and vomiting can be treated with Metoclopramide or Prochlorperazine
The Top 10 Ways to Recover From Opioid Abuse
With so much at stake, it’s important to know the facts about the different types of treatment.
Outpatient Treatment Programs
Outpatient programs vary in terms of cost, type, and intensity, but they are generally cheaper than inpatient programs and easier to attend for people who work or who have family commitments. These programs educate patients about the effects of drugs and nearly always provide group counseling, but some are more intensive and may include:
- Cognitive behavioral therapy
- Family therapy
- Individual counseling
- Job therapy and training
- Marriage counseling
- Peer support systems
Outpatient treatment programs also tend to have more staff members with advanced degrees than methadone maintenance programs do, though fewer staff members when compared to more intensive forms of treatment.
Narcotics Anonymous (NA) is a 12-step program, meaning that it’s based on conforming to the ideas of accepting that:
- Substance use disorders are chronic, relapsing-remitting diseases
- Individuals have no control over their diseases
- Willpower alone isn’t enough to help a person recover
- Surrendering to a higher power is crucial to recovery, as is the support structure of the 12-step community
- Being actively involved in NA is key
Some people might be turned off by the religious aspects or the strict adherence to abstinence, but there is evidence that the longer one stays in NA, the more likely they are to remain sober.
The important takeaway is that if you want to make NA a part of your recovery plan, three or more meetings per week are often associated with complete abstinence, while two meetings per week are associated with major increases in abstinence. In essence, when it comes to NA, more is more.
Ibogaine is a psychoactive drug that comes from the West African shrub iboga. In small doses, it is a mild stimulant, but in larger doses, it’s a psychedelic that sometimes helps people withdraw from opioids and eliminate cravings.
In the United States, ibogaine is a Schedule I drug, meaning that it has no accepted medical use and a high potential for abuse. However, international studies have shown its efficacy. A Mexican study showed that 13 percent of people treated with ibogaine made it more than six months but less than a year without aftercare and relapsing. About 19 percent abstained from opioid abuse for over a year. Self-medicating an addiction with another substance can be dangerous, though. Talk to your doctor or a medical professional about alternative options or medication-assisted treatment before taking action on your own.
Inpatient treatment takes place in a hospital or other treatment center and often involves supervised detox by a medical team. Traditionally, it lasts roughly 28 days, but recent developments in substance use research have allowed for stays as short as three days and for much longer stays. Usually, people who undergo inpatient treatment meet several criteria, including:
- Freebasing opioids or using them intravenously
- Using other substances concurrently
- Having medical or psychiatric illnesses
- Having failed at outpatient treatment
Some programs are therapy-based, meaning they focus on counseling, individual and family education and behavioral training. These programs usually last 4–12 weeks but can last longer. Multimodal programs use a variety of services and techniques to help achieve recovery, including medical care, job training, family therapy, drug education and group and individual psychotherapy, among other coping techniques.
Not everyone benefits from such treatment. Single parents have difficulty because many of these programs do not offer childcare. People without health insurance and with a low income can also be deterred by the high price tag.
Methadone is an opiate itself and can be used as a pain reliever, but it can be used to treat opiate use disorders by preventing withdrawal. It also produces similar effects as opiates without some of the harmful side-effects.
It does produce side-effects of its own, such as:
- A sore tongue
- Change/changes in your mood
- Dry mouth
- Sleep problems
- Stomach pain
- Trouble urinating
- Vision trouble
- Weight gain
Buprenorphine is a partial opioid agonist, meaning that it acts on the same receptors in the brain as drugs like heroin and prescription narcotics, but, much like methadone, it doesn’t produce the same high or the same side-effects. It does produce euphoria and respiratory depression, but these effects level off at a certain point, which lowers the risk of misuse and dependency. Also, unlike methadone, it doesn’t have to be dispensed in clinics but can be prescribed by doctors and taken at home.
There are side-effects, such as:
- Difficulty sleeping
- Muscle aches
However, buprenorphine does decrease withdrawal symptoms and cravings and increases your safety in case of accidental overdose. Buprenorphine also has fewer drug interactions than methadone, especially HIV medications. Because of this, buprenorphine might be a better treatment option for you than methadone, even though methadone has a more established treatment history.
Contingency management (CM) focuses on rewarding people for negative drug screens with either vouchers or the chance to win cash prizes. The vouchers can be exchanged for tangible prizes that promote a drug-free lifestyle, while the cash-based incentives are essentially lottery tickets to win a jackpot. Generally, the value of the vouchers and the number of tickets you receive starts small but increases over time.
Ultra-Rapid Opioid Detoxification
Usually, detox isn’t a treatment in and of itself, but ultra-rapid opioid detoxification (UROD) can be a successful measure on its own. Over the course of two days, a patient is sedated with general anesthesia and given Naltrexone, an opioid antagonist. This allows the symptoms and process of withdrawal to speed up while the patient skips the uncomfortable side-effects. However, this method can be risky, and it’s important to keep in mind that the American Society of Addiction Medicine (ASAM) does not officially support UROD as a treatment for opiate use disorders unless another form of treatment is taken.
Probuphine, four buprenorphine-containing rods implanted under the skin of the inner arm, is a new treatment for opioid abuse. The first patients to use it were treated in June 2016. While the fact that this is a new treatment might put off some people who would prefer tried-and-true techniques, Probuphine has some serious advantages.
For instance, since the implants last six months, it can help patients stay on their medications with greater regularity. It also prevents people from selling their medications or misusing them. However, there are also drawbacks. There is the risk of the implant migrating, protruding or being ejected from the body, but these risks are low.
Therapeutic communities are long-term residential facilities that encourage people to help themselves. The rationale behind the “self-help” method is that drug use is a result of a culmination of personal, psychological, and educational problems rather than a disease-based issue. The combination of supportive and confrontational techniques allow people to become aware of their specific areas of growth so they can learn how to re-enter society and live drug-free.
The communities are highly structured, mainly because the majority of people who come to therapeutic communities have not found success in other types of treatment. The staff is mostly composed of people who have recovered from substance use disorders, as well as some psychologists. New residents are assigned to basic work duties but can earn better jobs based on time spent in the community and personal growth.
The main drawback to therapeutic communities is that they are demanding, both physically and psychologically. This results in a high drop-out rate. However, for people who are able to thrive in a therapeutic community, it can be an effective way to stay in recovery.
Ultimately, the best way to treat opioid abuse is to combine therapies. These methods don’t need to exist in a vacuum or be used one at a time. Medication can be taken alongside different forms of therapy, detox, community and inpatient services, providing you with the best combination of care available. Take the facts and find the method that works for you. In the end, that’s the best way to succeed in recovery.