Almost all addiction recovery programs use medications at one point or another, and the use of medication in heroin addiction treatment is quite common. People recovering from an alcohol addiction, for example, might need medications during detoxification to keep seizures at bay. Those with addictions to cocaine might need antidepressant medications as they adjust to the lack of active drug in the bloodstream. In most cases, these medications are given for a short period of time, and they’re discontinued as the recovery strengthens. There are some exceptions to this basic rule, however. People who are recovering from a heroin addiction, for example, might need medications for months or even for years in order to truly heal.
Heroin and the Brain
Heroin is one of the most addictive substances in the world. According to research explained by PBS, heroin can cross into the brain in a disguised form. The brain believes that the heroin is actually a natural substance the brain has produced. Since the heroin seems natural, it’s considered benign and the brain doesn’t try to dilute or remove the drug from the system. The drug, in its unimpeded form, begins to latch onto specific receptor sites in the brain, triggering chain reactions that can cause the user to feel absolutely flooded with joy. Soon, these changes wear off and the user feels normal once more, but that tiny moment of joy comes at a high price.
Over time, if the person continues to abuse heroin, the brain begins to respond. The brain may turn receptors inward, meaning that higher doses of drugs are needed to cause the same effect. The brain might also stop producing specific chemicals, since the user is supplying those chemicals via heroin. These changes can be beneficial, as they allow the user to take higher doses of heroin without facing such a high risk of overdose, but they can be devastating changes to deal with when the user attempts to stop taking heroin. Without any heroin available, the body can respond with unpleasant physical symptoms such as nausea, sweating and jerking of the muscles. Those symptoms can last for days, or the user can stop them with one shot of heroin. It’s easy to see how the addictive behaviors are built on the back of these physical issues.
The heroin-related damage doesn’t stop with physical pain and discomfort. The conscious and subconscious mind of the user is also changed. A body that has adjusted to heroin isn’t making chemicals, and it needs high levels of chemicals to function. This need can be translated into strong, persistent cravings for heroin. The body believes the drug is vital, and it will call out for heroin in conscious and subconscious ways. The craving for heroin can be overwhelming, consuming the person’s thoughts and making rational thinking difficult, if not impossible. These cravings can quickly lead to a relapse, and in some people, the cravings can last for years.
Since a heroin addict is dealing with a chemical issue, medications have a key role to play. While therapy sessions and group meetings might help a heroin addict learn how to adjust thoughts or behavior, medications can influence the chemical changes that are taking place in the person’s body. With physical discomfort eased, and cravings quelled, the person is much more able to participate in therapy in a meaningful way. The chemical balance has been restored. There are many medications that can be used in the recovery from heroin, but common medications include methadone, buprenorphine and naltrexone.
According to the National Institute on Drug Abuse (NIDA), methadone has been used for more than 30 years in the fight against heroin addiction. This medication links to the same sites used by heroin, but its effects tend to come on slowly and be relatively mild. Unlike heroin, which causes overwhelming feelings of pleasure almost immediately, people who take methadone may not feel any effect from the drug at all. They can still go to work, drive or spend time with their families without seeming impaired. They simply have a reduced sensation of cravings, and they are able to get through the day without being tempted to resort to heroin use.
Methadone has been studied extensively, and in study after study, it’s been shown to be an effective treatment that helps people recover from their devastating addictions. For example, a study published in the Cochrane Database of Systematic Reviews found that people who were offered methadone as part of their recovery program tended to stay enrolled in the program, where people who were not offered methadone tended to drop out early. While it’s impossible to say why each and every person studied made the choice to stay engaged or drop out, it’s clear that methadone helped many of these people to resist the temptation to revert to heroin use. This is a meaningful outcome by almost any measure.
- Stigma. Many people know what methadone is, and they may judge those who use methadone, or label them as “addicts.”
- Inconvenience. Methadone is often offered in liquid form, and it must be taken in a clinic.
- Abuse potential. People who are allowed to take methadone home may be able to achieve a mild euphoria by taking a large dose.
- Difficulty in obtaining treatment. The dosing of this drug must be handled carefully, and some doctors don’t feel comfortable handling this delicate process.
Methadone should be a last resort in heroin addiction treatment due to it’s addictive properties. Most quality rehab centers do not use methadone as a form of treatment.
The medication buprenorphine was designed to address some of the above concerns regarding methadone. This drug also works on the same receptors as heroin, but it produces symptoms very slowly, and those symptoms may be quite muted. In fact, people who use buprenorphine may find that they feel no side effects of the drug at all. Buprenorphine is provided in pill form, and sometimes, those pills contain another ingredient that will become active if the user attempts to abuse the medication. Since the drug is effective, with a low risk of abuse potential, it can be given to people on a completely outpatient basis. They may be able to reduce the stigma and hassle of going to a clinic every day to get the medication help they need. Instead, they can take the drug in the privacy of their own home.
Buprenorphine has also been proven effective in studies. For example, a study highlighted by the NIDA found that 74 percent of participants who were given buprenorphine after detoxification produced clean urine samples on follow-up, but only 39 percent of people who were not given buprenorphine could do the same. It seems that the medication truly allowed people to kick their cravings and see the benefit of staying in therapy.
The drug does have some drawbacks as well. For example, not everyone seems to respond to this form of therapy. The medication tends to be mild, and people who are accustomed to taking in high doses of heroin may not benefit from buprenorphine therapy, as they might need a medication like methadone that is much stronger. In addition, people who use buprenorphine must have no active heroin in their systems when the treatment begins. Buprenorphine tends to knock heroin off its receptors, which could cause users to go into sudden, severe withdrawal if they’ve used heroin in the days prior.
This medication works a bit differently than methadone or buprenorphine. Unlike those two medications, naltrexone doesn’t work to replicate the sensation of taking heroin. Instead, naltrexone works a bit like a cap over the receptors, preventing drugs from being activated in the user’s system. This can be quite beneficial in helping people to break the habit of using heroin. For some users, this can be an important step.
They’ve become accustomed to the following scenario:
- I feel a need for heroin.
- I take the drug.
- I feel an immediate sensation.
- The craving goes away.
Naltrexone can break this cycle. The user feels a need to take the drug, but when the user does take the drug, nothing happens. There is no sense of euphoria. There’s just blankness. Instead of resorting to drugs to ease cravings, the addict must learn a different way to cope.
While this medication has been proven effective in some people, it doesn’t help to quell cravings for heroin. Some people may simply choose to stop taking naltrexone, and then they can return to their heroin use with no impediment. For this reason, it’s not given to people with long-standing addiction issues or a prior history of heroin addiction treatment.
How Therapy Works
Most heroin medication programs follow similar steps. A user begins by submitting a urine sample and providing a complete history of his/her drug use. With this information in hand, doctors can determine what sort of therapy will be most beneficial and design a dosing program that will help to meet those needs. Often, doctors begin by providing a low dose of medications, and then watching the person carefully to see how that dose was tolerated. If the person reports withdrawal symptoms or cravings, the dose might be bumped up. If the person reports feeling sedated or sleepy, the dose might be adjusted down.
As the therapy progresses, the person might be required to submit urine samples before the next dose is given. As mentioned, some of these medications can cause nasty side effects if they’re given when there is active heroin in the person’s system. But in addition, doctors will want to spot a relapse as quickly as possible, as it means the therapy isn’t working. When heroin or other drugs are spotted in the urine, the doctor will need to change the design of the therapy program. It’s an important signal and doctors will want to make sure they pick up on it.
According to the Alabama Department of Mental Health, many medication programs also provide other services for people in recovery. They might provide counseling that can help people find and keep good jobs. They might perform blood screenings for diseases such as hepatitis or HIV/AIDS. They might also help people find affordable housing. These programs can help to stabilize all areas of the person’s life, which can also make a relapse to heroin use that much less likely.
Heroin medication therapy programs don’t have specific end dates. In fact, most programs end only when the doctor, the person and the person’s therapist decide that it’s best for the person to stop using medications. For some people, this end date can come quite quickly. For others, it can take years to achieve. In any case, when people decide that they’re ready to take this step, they must slowly taper off the medications they use. These are powerful medications that the body has become accustomed to using. People who try to stop using these medications abruptly may find themselves with unpleasant withdrawal symptoms.
The idea of using medications to assist with a recovery from addiction can make some people uncomfortable. They may believe that, by using medications, they’re simply substituting one addiction for another. A quick adjustment of thinking is in order here. The medications provided to treat a heroin addiction are used to correct a chemical imbalance. In a way, these medications are similar to those provided to people with diabetes. The medications keep a chronic condition in check. They’re a vital part of the recovery process.
These medications do work. If the samples provided above aren’t convincing enough, one more study might help to demonstrate the true value of medication therapy. In this study, according to Medscape, researchers studied the death rates of people who were given replacement therapy for heroin and people who were not given replacement therapy. People who received medication therapy reduced their overall mortality risk by 85 percent. The therapy kept them alive. This is one result that is hard to argue with.
Medication therapy shouldn’t be taken lightly, and you may have many questions you’d like to ask before you begin. If so, we’re here to help. At Axis, we’ve helped many people recover from their heroin addictions, and we’d love to help you. Please contact us to find out more.