Heroin Treatment Drugs (and Their Risks) Explained
Approximately 33 million people worldwide use opioids, according to the 2016 World Drug Report by the United Nations Office on Drugs and Crime. In the U.S., the heroin crisis has reached epidemic proportions with a reported 145% increase in heroin users since 2007. And with opioid-related deaths on the rise, addiction science is scrambling to catch up with the dire need for effective interventions to treat a condition with relapse rates hovering around 90%.
The three most commonly prescribed pharmacological therapies for opioid and heroin addiction have had some success in making a dent in the sobering opiate abuse statistics. Medication alone is not a cure for the underlying issues and situational factors that often perpetuate drug use and lead to relapse, but it can provide the physical comfort needed to focus on behavioral therapy and relapse-prevention training.
Buprenorphine and Suboxone
Buprenorphine, also known as Subutex, is a partial opioid agonist. This means that users won’t achieve the intense euphoria that heroin produces, although it acts on the brain in the same way as heroin, helping to prevent cravings. Buprenorphine also helps alleviate dangerous withdrawal symptoms of painkiller and heroin abuse by keeping opioid receptors from fully depleting their “feel-good” neurotransmitter supply — a risk when you abruptly quit heroin use. Buprenorphine is an approved opioid dependence pharmaceutical by the Food and Drug Administration (FDA), so you can obtain a prescription through most physicians (unlike methadone, which can be dispensed only by special clinics).
Suboxone is a unique form of buprenorphine that contains a small amount of naloxone. Naloxone is an opioid antagonist, which means if you attempt to abuse this form of buprenorphine by snorting or injecting it, naloxone kicks in, blocking the effects and causing immediate withdrawal symptoms. This helps prevent you from abusing buprenorphine because the “ceiling effect” of Suboxone means the euphoric qualities are relatively low no matter how much you ingest.
While Suboxone can help ease withdrawal from heroin, misuse or long-term use can lead to dependence and its own set of withdrawal symptoms, including nausea, respiratory depression, fatigue and confusion. The Substance Abuse and Mental Health Services Administration reported that emergency department visits involving the misuse of buprenorphine went from 4,440 visits in 2006 to 15,778 visits in 2010, a 255% increase.
Naltrexone and Vivitrol
Naltrexone is an opioid antagonist that binds to opioid receptors in the brain to block the euphoric effects of heroin and other opiates. Naltrexone is also known by the brand names Depade or Revia and has been approved by the FDA to treat both heroin and alcoholism. Naltrexone can be taken once a day in pill form or in an injectable, extended-release form called Vivitrol. Though Vivitrol can be an easier medication regimen to adhere to since it is injected once a month, it comes with a much heftier price tag than naltrexone. In any regard, this medication-assisted treatment for opiate addiction impedes the effects of opiates. Some naltrexone users also report reduced heroin cravings, but more research is needed to validate that claim. Similarly, more research on the long-term effectiveness of the drug is needed, but a recent promising study showed naltrexone helped prevent relapse in high-risk populations such as recently released prisoners.
In order to take naltrexone safely, your body must be free of opiates, buprenorphine and methadone for seven days. This can be particularly difficult if you aren’t in medical detox and suffer from intense heroin withdrawal symptoms during that time period. The temptation to use again in order to alleviate withdrawal symptoms can be overwhelming. Occasionally people who’ve taken high doses of naltrexone or have used it long term experience acute hepatitis or liver failure. Additionally, naltrexone decreases your tolerance for opioids so if you use heroin after naltrexone therapy, you could be at greater risk of overdosing.
One of the first heroin addiction treatments, methadone is a slow-acting, full opioid agonist. Like buprenorphine and naltrexone, it is also approved by the FDA for the treatment of opioid addiction. However, you must obtain methadone at a specially licensed medical clinic because it’s categorized as a Schedule II drug — a substance at high risk for abuse — by the Drug Enforcement Administration.
Because it’s a full opioid agonist (like heroin) versus Suboxone, which is a partial agonist, methadone affects the brain’s opioid receptors more strongly. The benefit is that methadone can be particularly helpful for heavy heroin users in the early stages of withdrawal and recovery. The downside is that methadone has a high propensity for misuse and users of the drug will ultimately need to detox from it, similarly to heroin detoxification. Still, research has shown methadone to be an effective treatment for heroin addiction despite the risk of abuse and mortalities when misused — such as in combination with other substances. It’s important that methadone medication treatment be closely monitored and users receive proper education about its risks.
The Most Effective Heroin Treatment
Despite the discouraging stories and statistics about the death grip heroin and opiates seem to have on those who get caught in its destructive cycle, people do recover. While there is no miracle cure, some research shows that long-term treatment (90 days or more) in congruence with medication-assisted therapy and continued aftercare and follow-up offer the best chances for full recovery from heroin and opiate abuse.