Educational Article 

Treatment options include detoxification and medications that can be used to treat opioid use disorder (OUD) include buprenorphine (Suboxone®, Subutex®), methadone, and extended-release naltrexone (Vivitrol®), are effective for the treatment of opioid use disorders.

 

Detoxification is the process of taking a person off an opioid on which he or she is physically dependent. Goals of detox are:

 

• May decrease physical dependence on opioid drugs

• May lessen or relieve the pain of withdrawal

• Address any other medical problems

• May prevent relapse by:

  • Providing help during the most difficult parts of withdrawal

  • Connecting patients with continued treatments

  • Educating patients about their risk of relapse and ways to stay healthy, to help prevent relapse

 

Outpatient Detox: Patients come to a treatment center for medications, counseling, and medical treatment during detoxification, but still live at home.

 

Pros

• Less Expensive

• Patients can continue working and carry on with life

• Patients are forced to avoid/ find alternatives to drug use in their everyday life during the treatment process, helping prevent relapse after treatment ends

• Daily treatment, often group-based, is sometimes available, along with drug testing

 

Cons

• Slower process

• It can be harder to stay away from drugs in an outpatient setting. Patients have immediate access to drugs at the time of their worst cravings/ during withdrawal.

• Physicians aren’t able to address a patient’s medical needs as quickly when patients are at home

 

Inpatient Detox: Patients live in a treatment center during the entire detoxification process, where they receive medical care and counseling. 

 

Pros 

• Faster detoxification process

• Safe environment: No access to drugs/ situations that led to past drug use

• Medical issues can be quickly addressed

• More intensive counseling is often available

Cons

• Higher Cost: Finances/ Insurance may limit the length of stay

• Inconvenient. Patients are taken away from work and home for a time

• High dropout rates after detoxification

• Discharge from a controlled environment without help from continued medication has a larger risk for overdose and death

 

Buprenorphine Products

 

Advantages of buprenorphine products are:

 

• You are unlikely to overdose on buprenorphine if you take it properly.

• Buprenorphine is long-acting. This means that after an initial period, your doctor may have you take the pill every other day rather than once a day

• Doctors can prescribe buprenorphine so that you can take doses at home.

 

Risks associated with buprenorphine products: 

 

Common side effects and simple ways to reduce them

 

• Body aches, headaches, and cold- or flu-like symptoms—Check with your doctor about over-the-counter medicines you may take.

• Dizziness—Stand up slowly. Call your doctor if problems persist.

• Constipation—Drink more water and juice. Eat food with fiber. Exercise more.

• Sweating—Shower often. Dress in layers.

• Sleep problems, including tiredness—Take the pill in the morning. Avoid naps. Go to bed at the same time every night. Exercise. Do not drink caffeine after lunchtime.

• Upset stomach or vomiting—Take the pill after you have eaten. Take an antacid product as directed by your doctor.

• Mood swings—Exercise more. Do fun things that do not involve the old drug lifestyle. Relax. Talk to your substance abuse treatment provider.

• Serious side effects—For extreme stomach pain, vomiting, or diarrhea, contact your doctor right away. Also, seek help if the following side effects appear, because they may indicate serious liver problems:

  • Dark or tea-colored urine

  • Bad stomachache

  • Light-colored bowel movements

  • Yellowing in the whites of the eyes

  • Yellow skin

Methadone

 

Advantages of Methadone are:

 

Methadone is widely used to treat opioid dependence for the following reasons:

 

• It is highly effective when taken orally, making it more convenient to use.

• It prevents or reduces opioid withdrawal symptoms and reduces the use of additional opioids (illicit or pharmaceutical).

• It is longer lasting than other opioids, such as morphine and heroin, with a single dose usually effective for 24 hours or longer.

• Health problems are reduced or avoided, especially those related to injecting, such as HIV, hepatitis B, and hepatitis C viruses, skin infections, and vein problems.

 

Those participating in a methadone treatment program are generally provided with a daily dose of the drug in an oral solution or syrup, which is swallowed. Methadone is prescribed by a doctor as part of a treatment plan, with dose and treatment duration based on the characteristics of the individual.

 

Risks associated with Methadone are:

 

As with all opioids, methadone has been associated with non-medical use and fatal overdoses. Methadone (like other opioids) will depress respiration, particularly in higher doses or in people who are not tolerant to opioids. This risk is increased when methadone is combined with other sedatives, like sleeping pills or alcohol.

 

Vivitrol®

 

Advantages of extended-release naltrexone (Vivitrol®)

 

Naltrexone therapy doesn’t require a drug taper when discontinuing and because the drug is long-lasting, Vivitrol is a convenient treatment tool for people in recovery. It doesn’t require a person to remember to take a pill each day, nor does it require a person to commute to a clinic or treatment facility numerous times per week.

 

Risks associated with extended-release naltrexone (Vivitrol®)

 

If patients on naltrexone discontinue use, they may have reduced tolerance to opioids and may be unaware of their potential sensitivity to the same, or lower, doses of opioids that they used to take. If patients who are treated with naltrexone relapse after a period of abstinence, it is possible that the dosage of opioid that was previously used may have life-threatening consequences, including respiratory arrest and circulatory collapse. Also, extended-release injectable naltrexone has a higher pharmacy cost than buprenorphine and methadone. To avoid sudden opioid withdrawal, you must stop taking any type of opioid, including street drugs; prescription pain medicines; cough, cold, or diarrhea medicines that contain opioids; or opioid-dependence treatments, including buprenorphine or methadone, for at least 7 to 14 days before starting Vivitrol.

What are opioids?

Opioids bind to specific receptors in the brain that reduce the transmission of pain signals throughout the body. Opioids include:

• heroin

• prescription pain medications like:

  • hydrocodone (Vicodin)

  • hydromorphone (Dilaudid)

  • meperidine (Demerol)

  • morphine (MS Contin)

  • oxycodone (OxyContin, Percocet)

  • codeine

  • fentanyl

  • methadone

What causes overdose?

When there is too much opioid in the body, a person can lose consciousness and stop breathing – this is an overdose. An opioid overdose can happen suddenly or come on slowly over a few hours. Without oxygen, a person can die.

Risks for an opioid overdose include:

• Using opioids again after your tolerance has dropped (e.g., like after being in treatment, a hospital, or jail). After a break from opioids, the body can’t handle as much as it did before.

• Taking prescription pain medication more often or in higher doses than prescribed-or using someone else’s prescription pain medication. The dose could be too much.

• Using heroin or pills bought on the street. Heroin and street pills often contain other substances that can be dangerously toxic.

• Using opioids with alcohol or other drugs including sleeping pills, benzodiazepines (“benzos” like Valium and Xanax), cocaine and methamphetamine.

• Any current or chronic illness that weakens the heart or makes it harder to breathe.

• Using opioids alone. You are more likely to die from an overdose if no one is there to help.

• Previous overdose. A person who has overdosed before is more likely to overdose again. 

What to do in an opioid overdose

Minutes count in an opioid overdose. If you think someone has overdosed, follow these steps:

1. Check for signs of overdose:

• Won’t wake up. Try rubbing your knuckles hard on their sternum.

• Slow or no breathing

• Pale, ashy, cool skin

• Blue lips or fingernails

2. Call 911. Tell the dispatcher where you are and that someone is not breathing or is unconscious.

If you are trying to help in an overdose, The Tennessee Addiction Treatment Act protects you and any person who in good faith seeks medical assistance for a person experiencing or believed to be experiencing a drug overdose, the person for whom such medical assistance is requested, or any person experiencing a drug overdose who in good faith seeks medical assistance will not be subject to the following if related to the seeking of medical assistance:

Don’t be afraid to call 911 for help!

If you can’t stay until 911 help arrives:

Place the person on their side and where first responders can find them 

3. Give naloxone and rescue breaths.

Rescue Breathing:

• Tilt head back. Lift chin. Pinch nose.

• Give a full breath. Their chest should rise when you exhale.

• Give a breath every 5 seconds.

Naloxone:

Naloxone is used to treat an opioid overdose if someone has taken too much. Naloxone only works for opioids. If you have naloxone, give one dose. Naloxone can take 2-3 minutes to work, so start giving rescue breaths. If the person is still not breathing after 2-3 minutes, give a second dose of naloxone. Continue rescue breathes until the person wakes up or medical help arrives. It may need to be given more than once for an opioid overdose since its effects may wear off before the opioid does.

What is hepatitis C?

 

• Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). 

 

• HCV can be a short-term (acute) or a long-term (chronic) illness:

 

• Acute HCV occurs within 6 months after a person is exposed to HCV. In most people, acute HCV becomes chronic HCV.

 

• Chronic HCV can last a lifetime. Without treatment, chronic HCV can cause liver cancer or severe liver damage that can lead to liver failure.

 

• HCV is a contagious infection that can spread from person to person.

 

How does HCV spread from person to person?

 

• HCV is spread mainly through contact with the blood of a person who has HCV. In the United States, HCV is spread mainly by sharing needles or other injection drug equipment (works) with someone who has HCV. HCV can also be spread through sexual contact. While the risk of transmission through sexual contact is low, the risk is increased in people with HIV.

 

What is the treatment for HCV?

 

• HCV is treated with antiviral medicines. Many newer HCV medicines are more effective and have fewer side effects than older medicines. The newer medicines can cure HCV in most people.

 

• People with HIV/HCV coinfection may be treated for both infections. However, when to start each treatment and what medicines to take depends on the person. For example, some HIV and HCV medicines can’t be safely used together.

 

• Health care providers prescribe HIV and HCV medicines carefully to avoid drug-drug interactions and closely monitor those taking the medicines for any side effects.

 

What is HIV/AIDS?

 

• HIV stands for human immunodeficiency virus, which is the virus that causes HIV infection. The abbreviation “HIV” can refer to the virus or to HIV infection. 

 

• AIDS stands for acquired immunodeficiency syndrome. AIDS is the most advanced stage of HIV infection.

 

• HIV attacks and destroys the infection-fighting CD4 cells of the immune system. The loss of CD4 cells makes it difficult for the body to fight off infections and certain cancers. Without treatment, HIV can gradually destroy the immune system and advance to AIDS.

 

How is HIV spread?

 

The spread of HIV from person to person is called HIV transmission. HIV is spread only in certain body fluids from a person who has HIV. These body fluids include:

• Blood

• Semen

• Pre-seminal fluid

• Vaginal fluids

• Rectal fluids

• Breast milk

 

HIV transmission is only possible through contact with HIV-infected body fluids. In the United States, HIV is spread mainly by:

 

• Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV

• Sharing injection drug equipment (works), such as needles, with someone who has HIV

• The spread of HIV from a woman with HIV to her child during pregnancy, childbirth, or breastfeeding is called mother-to-child transmission of HIV. 

 

You can’t get HIV by shaking hands or hugging a person who has HIV. You also can’t get HIV from contact with objects such as dishes, toilet seats, or doorknobs used by a person with HIV. HIV is not spread through the air or in water or by mosquitoes, ticks, or other blood-sucking insects.

 

What is the treatment for HIV?

 

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. People on ART take a combination of HIV medicines (called an HIV treatment regimen) every day.

 

ART is recommended for everyone who has HIV. ART prevents HIV from multiplying, which reduces the amount of HIV in the body (called the viral load). Having less HIV in the body protects the immune system and prevents HIV infection from advancing to AIDS. ART can’t cure HIV, but HIV medicines help people with HIV live longer, healthier lives.

 

ART also reduces the risk of HIV transmission. The main goal of ART is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partner through sex.