Treatment for Opioid Addiction

Opioids carry a serious risk of addiction and overdose, and the widespread use of prescription opioids has contributed to what health experts call an opioid crisis. Overdoses caused by prescription opioids increased by 16% between 2019 and 2020, with an average of 44 people dying each day from an overdose of prescription opioids.

While opioid addiction is serious and challenging, treatments that address the physical, psychological, and social aspects of substance use disorders can help.

This article explores the available treatments and discusses which opioid addiction treatments are most effective. A multifaceted approach that combines therapy, medication, and social support can be the most beneficial in many cases.

Evidence-Based Addiction Treatment

Addiction is a complex, long-term condition that develops in people who are specifically vulnerable to it. Likewise, the treatment necessary for overcoming addictions is also complex and multifaceted.

When considering addiction treatment, it's crucial to establish that it's evidence-based, which means that the treatment has been studied and shown to be effective for many people with the condition.

The treatments discussed in this article are supported by scientific evidence that demonstrates their effectiveness. However, keep in mind that a particular treatment won't necessarily work for everyone, particularly when it's used apart from other necessary treatments.

If all of the physical, social, and mental health aspects of opioid addiction are not addressed, the treatment is less likely to be successful, and the person may relapse.

Therefore, these treatments should be part of a comprehensive treatment plan that is consistently followed before, during, and after the person quits opioids.

Harm Reduction

Harm reduction is an approach to helping people with opioid use disorder and is often one of the first interventions tried.

The harm reduction approach is especially helpful for people who inject opioids. It includes strategies such as needle exchange programs, safe injection sites, opioid replacement therapies (such as methadone maintenance programs), and naloxone as a tool for overdose reversals.

Harm reduction saves the lives of people who may otherwise die of blood-borne infections such as human immunodeficiency virus (HIV), hepatitis, and overdose. It also helps connect people with professionals, resources, and information to help them once they seek treatment and stop using opioids.

Medical Treatments for Opioid Addiction

While treatment options have mainly remained the same over the past decade, some recent changes have helped improve the availability of treatment medications. These include changes to prescribing requirements and alternative formulations of certain medicines, explains Ryan Wade, MD, a psychiatrist and the director of addiction services at Silver Hill Hospital in New Canaan, Connecticut.

Buprenorphine

Buprenorphine is a medication that works by blocking opioid receptors in the brain, which prevents opioid withdrawal symptoms without causing the same amount of sedation or euphoria experienced with pure opioid agonists.

Buprenorphine maintenance therapy is administered through a clinic or individual clinician. In the past, providers were required to possess a DEA license to prescribe controlled substances and complete a certain amount of training to prescribe this medication. Providers were also limited in the number of patients they could prescribe buprenorphine to.

DEA policy changes have removed this "X-waiver" requirement and the cap on how many patients a provider could treat with buprenorphine. Wade says that these moves should help increase the accessibility of this treatment.

"Hopefully, this results in more providers prescribing to individuals with opioid use disorder in need of buprenorphine, as well as allowing those providers who are already prescribing to be able to treat more people without a strict cap on the number of current patients," Wade says.

Wade also explains that changes in the available formulations can help improve its delivery and medication adherence. Previously, buprenorphine was only available as a sublingual tablet or film that dissolves under the tongue. This formulation typically had to be taken two to three times daily.

Buprenorphine is now available as a transdermal patch, a once-a-month injection, or an implant. The implant slowly releases medication and needs to be replaced every six months. 

Methadone

Methadone is a synthetic opioid that alters the effects of pain on the nervous system without the euphoria and sedation associated with heroin and opioid drugs.

Methadone is an effective treatment for withdrawal from opioids and is used in medication-assisted treatment of serious opioid addiction. It is usually taken orally, in liquid form, or as a tablet or wafer. It is typically dispensed through a government-approved program.

Naltrexone

Naltrexone is another first-line pharmacological therapy for opioid dependence. The long-acting injection, Vivitrol, is a form of naltrexone that eases compliance. It requires monthly injections.

This medication binds to opioid receptors, which then blocks opioids from binding and stimulating the receptors. "By occupying these receptors, the signaling in the brain that is thought to yield cravings or urges for opioids is reduced, theoretically leading the individual to be in less distress and have less physiologic drive to pursue opioids," Wade says.

In other words, since naltrexone blocks opioid effects, it reduces the reinforcing effects of opioids even when they are ingested. Because people find that opioids are no longer reinforcing, they may be less likely to use them.

However, naltrexone isn't always 100% effective. Some opioids have such a strong affinity for opioid receptors that they can overcome naltrexone and displace it, allowing them to exert their effects anyways, Wade explains.

Psychological Treatments for Opioid Addiction

In the last few decades, psychological treatments have become more sophisticated. The approaches focus on every stage of overcoming opioid addiction, from deciding to change and quitting or reducing opioid use to becoming abstinent and avoiding relapse.

Motivational Approaches

Motivation is the most important psychological predictor of effective treatment for opioid addiction. If someone is not motivated to quit opioids, they are at a high risk of relapse which in turn puts them at greater risk of death by overdose.

For this reason, motivational interviewing or motivational enhancement therapy is an important step in helping people who use opioids prepare to quit before they attempt to do so. The approach guides them through the various stages of change.

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) is one of the most effective treatments for opioid use disorder. It's also a highly effective treatment for other psychological disorders, including anxiety disorders, depression, and trauma—all of which can co-occur with opioid addiction.

The 2022 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 21.5 million adults in the U.S. have co-occurring substance use disorders and other mental health conditions.

Contingency Management

Contingency management is sometimes used when individuals with substance use disorders are mandated to get treatment by an employer or the court system.

In this system of contingency management, failure to comply with treatment results in job loss, imprisonment, and loss of reputation.

Contingency management can be coupled with positive or motivational incentives, whereby participants can earn money or vouchers for complying with the program.

Couples Therapy

Couples counseling (sometimes called couples or marital therapy) can be an important part of a treatment plan for someone with a substance use disorder, including opioid addiction. It is often used with other treatments.

Couples counseling can be helpful for couples who wish to stay together during and after recovery and those who choose to separate.

Family Therapy

Family therapy can help families with a member or members who are dealing with addiction, but it is especially effective for adolescents with substance use disorders.

The basic approach focuses on the dynamics of the family as a whole. Therapeutic attention is not just focused on the person using a substance; instead, a family member's substance use is considered the "symptom" of overall "disease" within the family.

Family therapy can also help family members support the person who wants to quit opioids and help each member become more aware of how they may have inadvertently contributed to difficulties that occurred in the past.

Twelve-Step Facilitation

Twelve-step facilitation is a strategy built on the premise that involvement in a mutual support group like Narcotics Anonymous (NA) or Alcoholics Anonymous (AA) can help individuals to achieve and maintain abstinence.

Groups may also pose some risks: because they are not formalized treatment, participants can be especially vulnerable to predatory individuals. These people may try to take advantage of members by selling drugs to the group or using the group to sell drugs.

However, groups can also be supportive, safe spaces for people in recovery. Many members benefit from new friendships and sober activities that take place in mutual support groups.

Two examples are NA and AA, which are programs based on acceptance of the chronicity of a substance use disorder as a disease, surrender to a higher power, and fellowship among abstinent peers. Meetings are free to attend and are held every day in locations all over the world.

Other Approaches

There are also a few other therapeutic approaches that may sometimes be used in the treatment of opioid addiction. Such treatments have less of an evidence-base, but some people may find them useful in addition to other proven treatments.

Hypnotherapy

Hypnotherapy is a type of psychological therapy that uses naturally occurring mental states and therapeutic suggestions to help people with addictions to think differently about change.

Some people find hypnosis effective in helping them break through their psychological barriers to change. Hypnotherapy can be empowering and relaxing, helping someone feel more in control of their thoughts without drugs.

However, hypnotherapy is a poorly understood therapy and can be controversial. In addition, its research base for efficacy in addictions is much less than for other established treatments. If you want to try the method, find a therapist who is qualified in hypnotherapy. Keep in mind that certification requirements vary by jurisdiction.

Neurotherapy

Neurotherapy is less commonly used, but there is some research on its use in addictions and might be a consideration—particularly for people who haven't found talk therapy helpful.

If you are considering neurotherapy, choose a practitioner who is certified by the Biofeedback Certification International Alliance (BCIA).

Choosing a Specialist

If you are dealing with opioid use disorder, a mental health or addiction medicine specialist can help you determine the next steps. Your chances of success depend a great deal on your motivation to change.

In some jurisdictions and states, there are few (if any) requirements for education and training in treating substance use disorders. Professionals may not be required to receive training for addiction counseling.

Several websites provide resources you can use to find treatment services, including resource lists maintained by government agencies like SAMSHA.

Doctors who certify with the American Board of Addiction Medicine, or those who train for years in a general psychiatry residency, have a good understanding of the disease of addiction.

Opioid Addiction Discussion Guide

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Additionally, there may be primary care physicians, particularly those who work in communities with high rates of opioid use disorders, who are highly knowledgeable and competent in treating opioid use disorder.

A thorough assessment by a professional trained in the evaluation of substance use disorders should include exploration of your patterns of use, the quantity of substance used, the consequences of your use, blackouts, legal or job-related problems, and ancillary data that can include genetic factors, family history, trauma, coping skills, and support systems.

Some addiction professionals ask to talk to family members or close friends, to get a more objective viewpoint of the patient’s usage pattern. There are many factors that can guide a healthcare professional to find the best individual treatment plan. It is important to tailor a plan to the individual’s beliefs and to medical science.