How Is Opioid Use Disorder Treated?
If you have ever experienced severe pain, chances are you were prescribed an opioid (e.g., morphine, codeine) for the pain. Research shows opioids are used often…and misused as often. For instance, in 2018, health providers in California dispensed 35 prescriptions for opioids per 100 persons. At the same time, opioids were involved in nearly 45% of drug overdose fatalities (more than 2,400 deaths). Some people with problematic opioid use meet the criteria for a condition called opioid use disorder. As described in the diagnostic manual of the American Psychiatric Association (DSM-5), people with this condition have trouble controlling their drug use, experience personal and social problems, continue to use the drug even in risky situations, develop tolerance (reduced response to the drug after repeated use), and experience withdrawal symptoms (unpleasant and distressing reactions) if they reduce or stop their use. Opioid disorder treatment options are categorized into two main methods: medicinal and psychological approaches.
How is opioid use disorder treated?
Let us consider treatments, starting with pharmacological interventions (i.e. medications).
Pharmacological treatments
Pharmacological treatments typically involve three FDA-approved drugs for opioid dependence: buprenorphine, naltrexone, and methadone.
Naltrexone is available in the pill form (ReVia) and an injectable extended-release form (Vivitrol). Unlike the two medications discussed below, naltrexone is an opioid antagonist, meaning it reduces the pleasurable effects of opioids. As long as one keeps taking naltrexone, using opioids will not result in getting high. Thus, taking naltrexone discourages opioid use.
Buprenorphine (Subutex), in contrast, is a partial opioid agonist. This means it can act as both an opioid agonist and antagonist (both facilitate and inhibit the euphoric effects of opioids). Therefore, buprenorphine has less abuse and dependency potential than many opioids. In fact, increasing the dose of this drug will not produce additional opioid effects beyond a certain point. At the right dose, it helps suppress opioid craving and withdrawal without producing intoxication (feeling high). Because buprenorphine has a long duration of action, it can replace shorter-acting opioids.
The third medication, methadone (Dolophine), is an opioid agonist that suppresses withdrawal symptoms and the urge to use opioids. Like other opioids, it activates the receptors responsible for the pleasurable effect of opioids. Compared to other opioids, however, it activates opioid receptors more slowly. Because methadone is a longer-acting opioid, it can replace short-acting drugs (e.g., oxycodone, heroin) that are taken multiple times a day and have higher abuse potential. Nevertheless, as an opioid agonist, methadone has considerable potential for abuse. Therefore, it is usually prescribed for people with a stronger addiction to opioids and is mainly available through specialized clinics.
Psychological treatments
Let us now consider a few psychosocial interventions, such as 12-step facilitation therapy, cognitive-behavioral therapy (CBT), motivational interventions, contingency management, and family treatment. The 12-step facilitation therapy encourages individuals already in treatment to participate in mutual support groups (i.e. 12-step programs) to help them sustain long-term recovery. CBT helps patients identify and correct dysfunctional thought patterns, learn and apply healthy coping strategies, and set realistic and healthy goals.
Motivational interventions address people’s ambivalence toward change by eliciting and enhancing the motivation to adhere to the treatment. They also motivate patients to engage in non-drug activities.
Contingency management is a behavioral treatment based on the principles of operant conditioning (i.e. reinforcement). It rewards desired behaviors, such as abstinence, using rewards (e.g., money, chances to win prizes). Of course, over time, the individual might find more naturally occurring benefits of abstinence (e.g., better relationships, success at work) even more rewarding. Last, family treatments are particularly helpful for adolescents. They address a variety of factors (e.g., conflict in the family or at school) that might contribute to drug use.
This article is provided by Dr. Anthony Mele. Dr. Mele is specialized in the use of dialectical behavior therapy (DBT), motivational interviewing (MI), and attachment theory-based interventions to treat individuals who struggle with multiple addictions, long-standing depression and anxiety, and those who seek to integrate spirituality into their psychological treatment.
References
1. https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/california-opioid-involved-deaths-related-harms
2. https://www.ncbi.nlm.nih.gov/books/NBK558205/
