What are Opioids?
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Opioids come from a family of drugs that include:
- Natural opioids: morphine and codeine
- Semi-synthetic opioids: oxycodone, hydrocodone, hydromorphone, and oxymorphone
- Methadone: a synthetic opioid that is usually categorized on its own in official data
- Synthetic opioids other than methadone: tramadol and fentanyl
- Heroin: an illegally manufactured synthetic opioid made from morphine
They all share one common trait: they activate opioid receptors in the brain stem which causes feelings of euphoria and relaxation. The more opioid receptors are activated by opioid abuse, the more intense the high will be. Opioid addiction occurs when people continue using opioids to avoid the symptoms of withdrawal.
Medications prescribed in opioid substitution therapy are not opioid drugs. They include:
These medications are used to reduce withdrawal symptoms during opioid detoxification. Opioids are chemicals that can produce euphoric effects because they act on the same areas of the brain as endorphins, which are natural pain relievers produced by the body.
What are Some Opioid Withdrawal Symptoms?
Opioid withdrawals can be quite difficult to overcome. Opioid replacement therapy is an invaluable resource to combat these symptoms. Symptoms of opioid withdrawal can include:
- Chills and goosebumps
- Muscle tremors or cramps
- Watery eyes/nose/mouth
- Poor concentration
- Mood swings
What is Opioid Replacement Therapy? How Can it Help Those Who are Seeking to Recover from Opioid Abuse?
Opioid replacement therapy, or opioid substitution therapy, is a drug treatment used to help those who are addicted to opioids. Opioid addiction is a very difficult condition to overcome as opioid drugs have been known to cause serious withdrawal symptoms and even death if the addict does not receive proper care. It’s estimated that nearly 2 million people in the United States have opioid addictions, with approximately 20% of these individuals receiving opioid substitution therapy for their addiction.
People recovering from opioids can be affected by opioid replacement therapy by significantly increasing their quality of life. As a result, it allows them to have a normal existence without having to worry about opioid withdrawal symptoms or opioid cravings. In collaboration with psychological support from therapists, individuals can become productive members of society.
In opioid replacement therapy, a synthetic opioid is administered in place of a natural opiate such as heroin. This allows the patient to slowly reduce his or her dosage until he or she no longer needs treatment for opioid addiction.
How Effective is Opioid Substitution Therapy? What is the Timeline for Opioid Replacement Therapy?
The effectiveness of opioid replacement therapy is dependent on how successful the patient is at opioid substitution. One study found that this therapy succeeded in stabilizing drug users’ lives within two weeks of starting the maintenance dose of hydromorphone (Dilaudid). A NIDA study showed that once treatment is initiated, a buprenorphine/naloxone combination and an extended-release naltrexone formulation are similarly effective in treating opioid use disorder.
Why Opioid Replacement Therapy?
Opioid replacement therapy mimics the effects of opioid drugs. Patches are applied to the skin where they slowly release a specific dose of medication over time. For example, buprenorphine is taken orally as small tablets that dissolve under the tongue. It can also be given as a dissolvable film that adheres to the inside of the cheek. Methadone is usually dispensed in liquid form and is taken daily at home or work by drinking from an approved measuring device.
How Much is Opioid Replacement Therapy?
The cost of opioid replacement therapy (ORT) can range from $11 to $22 per day. There are several opioid medications prescribed for opioid substitution therapy, however, the opioid medication most commonly used in this type of therapy is methadone.
- Methadone treatment, including medication and integrated psychosocial and medical support services (assumes daily visits): $126.00 per week or $6,552.00 per year
- Buprenorphine for a stable patient provided in a certified opioid treatment program (OTP), including medication and twice-weekly visits: $115.00 per week or $5,980.00 per year
- Naltrexone provided in an OTP, including drug, drug administration, and related services: $1,176.50 per month or $14,112.00 per year
Methadone has been used since 1965 and was designed to be a full opioid agonist of the mu-receptor, which means that it occupies the opioid receptor fully but has no significant activity at that site.
This is different than other opioids such as heroin, oxycodone, morphine, etc., which all occupy opioid receptors, but not completely. So they lead to more euphoric effects than methadone does. All these drugs compete for opioid receptor binding sites on cells in the brain, causing various pharmacological effects including analgesia.
Will My Insurance Cover Opioid Substitution Therapy?
Opioid replacement therapy has been shown to be effective for individuals suffering from opioid dependency, but many insurance companies are not willing to cover this medication because the medicine falls under the same category as an opiate. Opiates are considered Schedule II controlled substances even though methadone is not an opiate at all, but has similar effects on the body, which accounts for it being categorized with other opioid drugs.
This type of therapy is a patient-centered treatment that allows opioid addicts access to opioid replacement medications. The goal of opioid substitution therapy is to reduce the withdrawal symptoms and cravings associated with opioid addiction while allowing patients to function normally in society.
What is the Harm Reduction Model for Addiction Recovery?
The opioid replacement therapy (ORT) model of addiction recovery is considered harm reduction. Harm reduction is the idea that opioid addiction can be managed without abstinence or an immediate change in lifestyle. Although opioid substitution therapy is not intended to lead to abstinence, it has still proven effective at helping patients put down the opioid substances and learn to live with their disease instead of struggling against it.
This form of treatment for opioid dependency does not necessarily help the addict recover, but it makes their quality of life much more manageable so they are able to function normally. Abstinence-based treatment programs may also work for opioid addiction, but many individuals who struggle with opioid dependence do not see results until they try opioid substitution therapy.
Opioid Abuse Trends
The opioid crisis has steadily risen, beginning with opioid prescriptions in the 1990s to treat pain. However, opioid medications are highly addictive, and opioid abusers often move on to heroin if their opioid prescription is not available. Almost 50,000 people die every year from an opioid overdose. Prescription opioid abuse costs $78.5 billion annually in the form of healthcare, legal programs, and lost productivity.
Opioids are a factor in at least 7 out of every 10 overdose deaths. 48,006 people overdosed on opioids in 2020. 3.8% of American adults abuse opioids each year. 68.0% of all OD deaths are attributed to synthetic opioids. Fentanyl and fentanyl analogs are a factor in 19.8% of all overdose deaths. Also, 3.10 million people abused opioids in the past month, an average of 103,333 people using them per day.
People with some college or an associate’s degree are most likely to use opioids, with 4.2% using in 2019. Also in 2019, opioid use increased among college graduates (+12% from 2018) and those who did not complete high school 8.1%.
Fentanyl overdose rates are rising 2.5 times faster than heroin ODs. 1 kilogram of fentanyl contains 250,000 lethal doses. 15,000 annual opioid overdoses involve heroin. In Washington, 737 people die from opioid overdose in one year. Prescription opioids are a factor in 40.8% of opioid overdose deaths. Heroin is a factor in 44.5% of deaths. 30% of deaths involved synthetic opioids.
What are the Long-Term Effects of Opioids?
The long-term effects of opioids include opioid addiction, opioid overdose, and opioid withdrawal. Opioid addiction is characterized by compulsive drug seeking and use, even in the face of negative health and social consequences. Opioids are substances that relieve pain; they also produce euphoria by increasing the levels of dopamine in the brain’s reward system.
When opioid medications like morphine or Vicodin enter the bloodstream, they cause opioid receptors to release more dopamine into nearby nerve cells than usual; this creates a chain reaction that ultimately heightens feelings of pleasure and excitement. As opioid doses increase over time, tolerance to opioids will develop. Tolerance causes people to need higher doses of opioid medication to experience relief from their pain as well as drug cravings.
What are Other Treatment Options for Opioid Recovery?
Treatment options for opioid addiction are available at opioid treatment programs (OTPs). These programs can provide opioid replacement therapy, one of the powerful opioid medications, methadone or buprenorphine.
Opioid addiction is a chronic illness that needs long-term treatment after detoxification to prevent relapse even after opioid cravings have subsided. Without further treatment, including opioid substitution therapy or opioid dependence counseling, people recovering from opioid addiction will likely only find themselves back at square one where they began their struggles with drug abuse and addiction.
Detoxification is the process of opioid drug withdrawal. Opioid drugs like heroin and opioid pain medications are highly addictive, so when opioid-dependent people stop using these drugs they go through withdrawal.
Methadone Maintenance Treatment (MMT)
Methadone maintenance therapy is an opioid replacement therapy that uses methadone, another opioid medication, instead of illicit opioid drugs like heroin or other opioid pain medications, which are used illegally. Methadone works very well for some opioid addicts, but not all opioid addicts can use MMT successfully.
Residential treatment is the most intensive opioid addiction treatment option. Patients live in a drug-free, opioid-free environment for 30 to 90 days. During their stay, individuals visit with counselors every day to discuss opioid abuse issues and learn how to cope without opioid drugs.
Outpatient treatment is the least intensive type of opioid dependency treatment because it takes place outside of a residential treatment center or hospital. It is likely that outpatient opioid alternative therapies may be less expensive than opioid medication options. But recovering individuals in outpatient opioid replacement therapy should still consider going through residential treatment first. This may ensure that they do not remain opioid-dependent and eliminate the high likelihood of relapse.
Opioid replacement therapy also tends to be an outpatient treatment option that offers patients more privacy over inpatient care options. Inpatient may be necessary for those suffering from severe opioid addiction.
Aftercare programs for addiction recovery are normally available for people struggling with opioids, who are enrolled in opioid replacement therapies like opioid replacement therapy programs. Aftercare treatments may include additional opioid dependency treatments like opioid dependence counseling or further opioid substitution therapies, especially for those who fail to make it through opioid detox procedures.
Support groups for opioid addiction provide a valuable service for recovering individuals and their loved ones. These groups provide them with the opportunity to receive constructive feedback from others who have been through opioid addiction struggles. This gives them a chance to share personal stories and talk about coping mechanisms to use to help prevent relapse.
Since opioid dependence counseling is often a part-time pursuit, people recovering from opioid addiction can find support group meetings close to where they live. This can make it easier for them to attend multiple meetings each week if desired.
Discover Recovery at Free By the Sea
If opioid addiction has impacted your life, consider entering treatment before it’s too late. You may find yourself at the mercy of opioid withdrawals and psychological stress. Think about the healthy life you could live with the resources and support you need. Free By the Sea is dedicated to providing the best solutions for addiction recovery. With our trained staff and committed efforts, you deserve the utmost quality for a new beginning. If you or a loved one are struggling with addiction, contact our facility today.
Dr. Richard Crabbe joined our team in 2019 as our psychiatrist and medical director. He attended the University of Ghana Medical School where he became a Medical Doctor in 1977. From 1978 through 1984, he was a medical officer in the Ghana Navy and provided a variety of services from general medicine to surgeries. He received his Certificate in General Psychology from the American Board of Psychology and Neurology in 2002.