Medications for Heroin and Opioid Addiction
What They Do
Medications can be used to lessen withdrawal symptoms, prevent relapse, and treat both addiction and related mental health issues.
Withdrawal: One reason people keep taking opioids is to avoid the discomfort of withdrawal. Medications help reduce withdrawal symptoms when you start the process of detoxification. But detoxification is only the first step in stopping opioid use. If you do not receive treatment after detoxification you are more likely to start using the drug again.
Relapse prevention: Medications can be used to decrease cravings and help your brain and body return to normal once you have stopped using drugs. Each drug, such as heroin and prescription opioid drugs, is treated by a specific medication. People who use more than one drug need treatment for each of the drugs they use.
Co-occurring conditions: Other medications are available to treat mental health conditions, such as depression or anxiety, that may be contributing to opioid addiction.
See our page on Medications for Heroin & Pain Pill Addiction for specific information on drugs currently in use.
To learn more about the treatment approaches to drug addiction visit the National Institute on Drug Abuse website.
How They Work
Opioid agonists (methadone) and partial opioid agonists (buprenorphine)
Methadone is a man-made narcotic drug. It is an “opioid agonist”, meaning that it acts on opioid receptors in the brain – the same receptors that other opioids such as heroin, morphine and opioid medications turn on. Methadone binds to and turns on these receptors, but it does so more slowly than other opioids. In a person addicted to opioids it does not produce a high, eliminates withdrawal symptoms, and relieves drug cravings. It has been used successfully for more than 40 years to treat opioid addiction. It is dispensed through specialized opioid treatment programs.
Buprenorphine is a “partial opioid agonist”, meaning that it binds to the same opioid receptors as methadone but turns them on less strongly. It reduces cravings and withdrawal symptoms in a person addicted to opioids without producing a high, and has few side effects. It is as effective as methadone when given at the right dosage and taken for a long enough period of time.
Buprenorphine can be prescribed by certified physicians in their office. Since 2002 it has been available as a tablet and since 2010 as a film put under the tongue. In May 2016 the FDA approved a 6-month under the skin buprenorphine implant and in November 2017 a once-a-month buprenorphine injection. Both are available to patients stabilized on buprenorphine, so daily doses are not needed.
Opioid antagonist (Naltrexone)
Naltrexone is an “opioid antagonist”, which means it works by blocking opioid receptors in the brain from being turned on. Instead of controlling withdrawal and cravings, it prevents any opioid drug from producing a high. People have trouble staying on Naltrexone. Because of its possible side effects (nausea and vomiting, stomach pain, headache, dizziness, sadness, nervousness, sleepiness) its use for treating addiction has been limited. But in 2010 an injectable, long-acting form of naltrexone (called Vivitrol®) was FDA-approved for treating opioid addiction. The effects of Vivitrol® last for weeks, making it a good choice for people who do not have easy access to healthcare or who struggle with taking their medications regularly.
Do They Work?
Strong evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and help people stay in treatment.
Buprenorphine and methadone do not produce a "high" and lessen withdrawal symptoms and cravings. People are able to function normally while taking these medications. They can work, go to school, and take part in other forms of treatment or recovery support to help them become free of addiction over time.
If the goal is to wean off the maintenance medication, it should be done slowly while working with a treatment provider. It may take months or even years for brain circuits to recover from long-term drug use. These medications provide the support that is needed during this time. In cases of serious and long-term opioid use, a patient may need these supports indefinitely.