Yesterday I listened to Preet Bharara’s podcast, Stay Tuned with Preet. The topic was the opioid crisis. The guests were Susan Salomone, a parent advocate and Dr. Abigail Herron, a psychiatrist who works with addicts.
Part of the discussion was on treatment and what is available to help addicts. Salomone believes that currently there are not enough days for treatments. When I worked in an inpatient detox unit, the addicts were only there for 5 days and then placed in outpatient care.
Dr. Herron discussed the medical treatments that are available. There are three.
Methadone is the oldest treatment available. It is dispensed in licensed clinics and the clients usually attend every day. After a certain number of clean random drug screens, some people can get take-home privileges and reduce the number of days they have to attend the clinic.
Because methadone is an opioid and can be abused, methadone as treatment for addiction is controversial. If a person wants to stop taking methadone they will suffer withdrawal symptoms just like heroin. However, when I worked at a methadone clinic I saw many people whose lives were saved by being on methadone
Naltrexone is an opioid inhibitor. It can be used for alcohol addiction as well as opioid addiction. It reduces cravings. Unlike methadone which stays in the body for a long time, naltrexone only works if you take it. There are no withdrawal symptoms. It is available as a pill or inject-able. The injection, which is very expensive, is supposed to last for thirty days but often wears off before that period is up.
50 mg is the usual dosage for the oral medication. Low dose naltrexone, approximately 4.5 mg, is used for a variety of illness including ALS, urinary issues and Crohn’s disease.
Buprenorphine is an opioid but only partially attaches to opioid receptors. With this drug there is supposedly no euphoria. Physicians are required to take a special course before prescribing buprenorphine. Because it is an opioid, stopping the drug does cause withdrawal symptoms.
All three of these treatments have some negative aspects. It is clear that a drug alone will not prevent a relapse. I think you would have to also be under the care of a therapist and attend support groups regularly. Many people believe that addiction causes brain changes that are difficult to undo. Addiction is a disease of relapse. Just ask anyone who has tried to stop smoking.