Why Choose Medication?

MEDICATION TREATMENT FOR OPIOID ADDICTION

What is opioid addiction?
Opioid addiction is a long-term treatable medical condition that causes changes in the brain.
These changes lead to a loss of control over opioid use, even when this is causing serious harm.
Opioids include some prescribed pain pills, heroin, fentanyl and other drugs. The medical term
for opioid addiction is Opioid Use Disorder (OUD for short). There are risk factors that increase
the chance of becoming addicted, including if it runs in a person’s family.

Why use medications for opioid addiction?
Most people with opioid addiction who are treated without medication return to using drugs.
Over 80,000 Americans died in 2021 from opioid overdoses. People who are taking a stable dose
of medication for opioid addiction are half as likely to die as those who are not. On average,
people who receive treatment with methadone or buprenorphine are less likely to use dangerous
drugs, get HIV or hepatitis or commit suicide, and are more likely to be employed, have an
improved quality of life and live longer compared to people who do not use these medicines.
These benefits are more likely with longer periods of medication treatment.

What medications are helpful?
Methadone and buprenorphine are opioid medications that are important tools to help people
regain control over drug use. They allow people to feel normal and to function normally, without
withdrawal symptoms, cravings or feeling high. And medications don’t get in the way of
working, taking care of family or other responsibilities. People on methadone or buprenorphine
can have essentially any job, including many that involve driving. Reaction time is not affected.
On the right dose, drowsiness does not occur unless other drugs are also taken.

Injectable naltrexone (brand name: Vivitrol) is a non-opioid used to treat opioid addiction.
Unlike methadone or buprenorphine, naltrexone has not been shown to reduce overdose or
death. With less evidence of effectiveness, it is considered by many to be a second-line option,
compared to first-line methadone or buprenorphine, for most individuals with moderate or
severe OUD. However, injectable naltrexone is an important option that may be preferred in
some circumstances.

Is medication for opioid addiction just “trading one addiction for another”?
NO. Methadone and buprenorphine are opioids, and if you stop taking them suddenly, you do
have withdrawal symptoms. The medical term for this is “physical dependence.” But addiction
is much more than just withdrawal symptoms. There are long-term changes in the brain and
psychological cravings for more and more of a drug even when this is causing serious harms.
Patients on methadone and buprenorphine can be free of cravings and can regain control.

How long should these medications be used?
People should typically remain on medication until they are in long-term recovery for at least several years because of the very high risk of relapse. Some people come off slowly after several
years and do well. But many or most people who do well stay on medication for many years or
decades. People have the right to gradually come off of medication even if the doctor
recommends against it. People are not congratulated for coming off of medication; the goal of
treatment is recovery with whatever tools a person chooses.

What are risks of taking these medications long term?
Opioids including methadone, if used with alcohol or sedatives, can cause drowsiness or
overdose. A methadone overdose could occur if it is increased too quickly. Any opioids,
including methadone, can cause or worsen sleep apnea, and can be more risky with certain
medical conditions. Any opioids could potentially reduce testosterone in men, which can cause
sexual problems. Low testosterone could also cause low bone density, especially with other risk
factors such as tobacco or alcohol use, HIV or poor nutrition. As a precaution, an EKG is done at
certain doses of methadone, to see if there is any risk of a very rare irregular heart rhythm. All of
these risks are lower with buprenorphine compared with methadone or other opioids.
Otherwise, there are no significant long-term health risks from methadone or buprenorphine.

SOURCE: Stop Stigma Now (www.stopstigmanow.org)