Heroin & Opioid Addiction

(Buprenex®; Butrans™; Subutex®, Suboxone)

What it does: Buprenorphine was approved by the FDA October 9, 2002 as a new treatment for heroin and other opioid addictions. It can cause dependence and withdrawal symptoms when stopped and is the first narcotic drug approved for addictions that can be prescribed by physicians in their offices.

It has major advantages compared to methadone or naltrexone. Buprenorphine is more effective at reducing drug cravings than naltrexone. While methadone is typically prescribed daily, buprenorphine is only needed every other day and there is a lower risk of overdose occurrence compared to methadone.

Two formulations were approved. The first, Subutex, has only buprenorphine and is used in the first few days a patient starts treatment. The second, Suboxone, contains buprenorphine and naloxone. Naloxone blocks the effects of opioids and is likely to cause intense withdrawal if misused intravenously. It’s used for people on maintenance drug therapy.

How it works: Opioids attach to receptors in the brain. Buprenorphine works by stimulating the brain opioid receptors but only partially satisfying them by not being a perfect fit. Thus Buprenorphine helps to ease withdrawal symptoms and drug cravings by activating the opiate receptors but not in an intense enough way to produce the heightened feelings of euphoria that heroin would produce. If a user attempts to take another opiate such as heroin while taking buprenorphine, there will be no effect.

Side effects: Headaches, flu-like symptoms, dizziness, constipation, upset stomach, sleep problems.
For a more complete list of side effects visit this NIH page.

Availability: This medication can be obtained by a prescription from any physician who has taken the required 8-hour training. Physicians who are already certified as addiction specialists are exempt from the training requirements.

Research: Buprenorphine maintenance treatment (BMT) is used for individuals with opioid use disorders. Sixteen randomized controlled trials of BMT indicated a high level of evidence for its positive impact on treatment retention and illicit opioid use. Seven reviews showed that when the medication was dosed adequately, buprenorphine and methadone showed similar reduction in illicit opioid use, but BMT was associated with less risk of adverse events. BMT was also associated with improved maternal and fetal outcomes in pregnancy, compared with no medication-assisted treatment. Thomas CP, et al. Medication-assisted treatment with buprenorphine: assessing the evidence. Psychiatr Serv. 2014 Feb 1;65(2):158-70.

NIDA's Clinical Trials Network Prescription Opioid Addiction Treatment Study (POATS)
In this first large scale study on treatment of prescription opioid addiction, more than 600 outpatients addicted to prescription opioids received Suboxone in combination with brief standard medical management. Half of the participants also received varying intensities of addiction counseling as provided by trained substance abuse or mental health professionals. Results showed that approximately 49 percent of participants reduced prescription painkiller abuse during extended (at least 12-week) Suboxone treatment. This success rate dropped to 8.6 percent once Suboxone was discontinued. Participants who received intensive addiction counseling did not show better outcomes when compared to those who did not receive this additional counseling. "The study suggests that patients addicted to prescription opioid painkillers can be effectively treated in primary care settings using Suboxone," said NIDA Director Nora D. Volkow, M.D. November, 2011.

This helpful fact sheet answers many questions about taking buprenorphine and was written by a nurse who's been researching buprenorophine at Yale since 1997: What is Buprenorphine Treatment Like?

For more information: store.samhsa.gov/product/The-Facts-about-Buprenorphine-for-Treatment-of-Opioid-Addiction/SMA15-4442

SAMHSA Buprenorphine Physician & Treatment Program Locator
A nationwide registry of physicians who have taken this training is available at samhsa.gov/medication-assisted-treatment/physician-program-data/treatment-physician-locator. You can choose Physician List Search at the bottom of the page to search by city, county, zip code or state or just click on the state you want on the map.

Suboxone Assisted Treatment (SuboxoneAssistedTreatment.org)
A comprehensive site on buprenorphine containing clinic locators, state and federal regulations, patient success stories, patient forums,and a staff on call coast to coast 24/7 to help anyone in need. Other information on opiates and addiction are covered as well.


NALTREXONE (ReVia®; Vivitrol®)

What it does: Naltrexone is an opioid antagonist medication that binds to opioid receptors but does not activate them. It may be most useful for highly motivated recently detoxified patients who want total abstinence as well as individuals at the experimenting stage of opioid use or those who are in early stages of their addiction.

How it works: Naltrexone blocks the part of your brain that feels pleasure when taking narcotics. Because it blocks the opioid receptors it prevents the body from responding to opiates It can be taken by mouth once daily or every other day, has minimal side effects and is not addicting. A favorable treatment outcome requires some form of psychotherapy, careful monitoring of medication compliance and effective behavioral interventions.

Side effects: Nausea, vomiting, diarrhea, constipation, headache, dizziness.
For a more complete list of side effects visit this NIH page.

Cautions: www.fda.gov/downloads/Drugs/DrugSafety/UCM206669.pdf

Availability: Physician prescription

Research: A recent study on an injectiable long-acting form of naltrexone (Vivitrol) kept more addicts off opioids than placebo did. The six-month study of 250 patients found that 90% of those who received a monthly injection of naltrexone stayed off opioids, compared with 35% of those in the placebo group. (Krupitsky, 2011).

For more information: https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone


METHADONE (Dolophine®; Methadone Diskets®; Methadone Intensol™; Methadose®)

What it does: Methadone is a long acting medicine that reduces opiate craving and blocks the effect of opiates. It requires frequent visits to a network of clinics that can be found at www.atforum.com.

How it works: Methadone blocks the receptors in the brain that are affected by opiates such as heroin, enabling users to gradually detoxify from opiates without experiencing painful withdrawal symptoms. Methadone occupies the receptors in the brain that opiates use, blocking the high feeling that opiates provide and making the user feel more stable. This reduces the drug cravings and withdrawal symptoms that often lead to relapse. Because Methadone’s effects last between 24 and 36 hours, most patients can be maintained on one daily dose.

Side effects: Drowsiness, weakness, nausea, constipation, headache, loss of appetite.
For a more complete list of side effects visit this NIH page.

Availability: Physician prescription

Research: Madden LM, et al. An investigation of an open-access model for scaling up methadone maintenance treatment. Addiction, 2018. doi: 10.1111/add.14198.

This research study looked at patient and program outcomes following the use of an “open-access” model that rapidly enrolled patients in methadone maintenance treatment, irrespective of ability to pay. In the 9 years following the use of this open-access model, patient numbers increased by 183% from 1,431 to 4,051, and average wait-time days decreased from 21 days to same day without harmful effects on rates of retention, nonmedical opioid use, or mortality.

See the National Institute of Drug Abuse Research Summary on Methadone available here.

For more information: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682134.html

Medical Assisted Treatment (medicalassistedtreatment.org)
This national organization was founded by advocates for the medical treatment of addiction. It supports the idea of addiction as a medical illness rather than a social ill and acts as a mediator for patients to assure that quality treatment is available. Someone is available 24 hours a day for emergency calls at (770) 527-9119, (770) 428-8769 or office (770) 428-0871. Their web site provides a great deal of information on opiate drug treatment, patients' rights, methadone maintenance, legal issues, news, addiction science, an online forum, and over 30 online videos on various aspects of addiction. Click on Opiate Drug Treatment in the left hand menu to find information on methadone, buprenorphine, ibogaine and naltrexone.



What it does: Desipramine is a tricyclic antidepressant that may be useful in facilitating opioid abstinence in opioid maintained patients.

How it works: Long-term use of heroin suppresses the production of the neurotransmitters norepinephrine and dopamine which help regulate mood and are involved in the development of depression. Thus heroin users are likely to experience post-withdrawal depression which can be treated with an antidepressant such as desipramine that counteracts this suppression.

Side effects: Nausea, dry mouth, constipation, fatigue, nightmares, sweating.
For a more complete list of side effects visit this NIH page.

Availability: Physician prescription

Research: Nunes EV, Levin FR. Treatment of depression in patients with alcohol or other drug dependence: a meta-analysis. JAMA. 2004 Apr 21;291(15):1887-96
Antidepressant medication has a modest beneficial effect for patients with combined depressive- and substance-use disorders including opiate dependence. It is not a stand-alone treatment, and therapy directly targeting the addiction is also indicated.

For more information: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682387.html


Updated May 23, 2018