Opiates, which include heroin, methadone, and many prescription painkillers such as oxycodone (Oxycontin, Percodan, Percocet), propoxyphene (Darvon, Darvocet), and codeine, are substances that create a powerful physiologic dependency that can be difficult, and for some near-impossible, to overcome.
The treatment of opiate dependency breaks down into three general approaches:
• Detoxification with opiates
• Detoxification without opiates
• Maintenance therapy with the use of opiates
Medications used for both opiate detoxification and maintenance treatment include:
• Buprenorphine/Naloxone (Suboxone). This combination medication, which can only be prescribed by physicians who have obtained additional training and have received approval by the Drug Enforcement Agency (DEA), is an office-based alternative to methadone maintenance. This pill is taken under the tongue (sublingually) and produces less euphoria while blocking symptoms of opiate withdrawal. Because the buprenorphine component blocks opiate receptors in the brain, if someone tries to use additional opiates on top of this medication, he will not obtain an additional “high.” The naloxone (Narcan) component has no effect when taken under the tongue. However, should someone attempt to inject the combination pill, the naloxone kicks in and will push the person into opiate withdrawal. At present, authorized physicians can only prescribe Suboxone for up to one hundred patients (only thirty if they’ve been prescribing it for less than a year). The clear advantage to this treatment is that an individual, once stabilized on maintenance therapy, does not need to attend a daily clinic, but can have a prescription with regular follow up appointments. One major limitation to this treatment is that individuals on higher doses of opiates (greater than 40–60mg/day of methadone or its equivalent) will experience withdrawal symptoms, and may not be suitable. An excellent source of information on Suboxone is available through the government’s Substance Abuse and Mental Health Service Administration (SAMSHA) web page: www.buprenorphine.SAMSHA.gov or by calling 1-866-287-2728.
• Buprenorphine (Subutex). As with buprenorphine/naloxone, buprenorphine provides relief from symptoms of withdrawal and can be used both for detoxification and maintenance treatment. It does not have the naloxone component, and just as with the combination pill Suboxone, can only be prescribed by physicians with specific DEA approval. It is also taken under the tongue. Because it is not combined with the naloxone, there is greater risk for this medication to be abused.
• Methadone (Methadose). Available only in FDA-approved treatment programs. These programs are heavily monitored and daily attendance for dosing is initially required. Individuals who are in these programs for extended periods and who are fully adherent to the rules may eventually take home some of their doses. Methadone programs will include mandatory treatment groups and frequent urine toxicology screens.