Painkillers to Heroin: the Pros and Cons of Treatments for Opioid Addiction

The U.S. currently faces an unprecedented epidemic of opioid addiction -- painkillers, heroin and other drugs made from the same base chemical. The current problem differs from the opioid addiction outbreaks of the past in that it is also prevalent in the middle and affluent classes. Virtually anyone you know could be fighting a battle with addiction right now, so it's important to know the signs of addiction and what you can do if you determine you or someone you love has an issue.

What's Causing the Current Epidemic?

Most experts agree that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians. Many people have developed their addiction while treating other medical problems, like a sports injury. Prolonged use leads to dependence and, once hooked, increasing amounts of drugs are required to prevent feelings of withdrawal. Addiction to painkillers frequently leads to heroin addiction because the black market drug is appreciably cheaper than black market painkillers.

Knowing the Signs and Symptoms of Addiction

The behaviors of people who've become dependent or addicted will often change as they begin taking higher and higher doses of the drug. Because this change happens slowly over time, it can be hard to spot in yourself and others. You don't necessarily need to find someone with a bottle of pills or a needle in their arm to suspect opioid abuse -- there are other signs:

-- Do they seem sleepy or difficult to arouse from sleep at odd hours during the day?

-- Do they seem unusually withdrawn, when they would normally be happy and outgoing?

-- Do they appear agitated at times, complain of nausea and be profusely sweating, but appear fine only an hour or so later?

Like many other forms of mental illness, opioid addiction is not well understood by most people and carries a stigma. People resist asking for help even when they suspect they have a problem, which can make matters worse and their recoveries more challenging.

Treatments for Opioid Addiction -- Know Your Options

Addiction to opioids involves medical and behavioral challenges. Early treatments for this condition often addressed only one of the two areas, leading to poor success rates. The Substance Abuse and Mental Health Services Administration now recommends integrating medically-assisted therapies with mental health support services, such as counseling and peer-recovery groups.

It's in everyone's best interest that a person understand the medical and practical consequences of a treatment before choosing one -- here are some basics:

Look for licensing. Before you consider any facility, even if it's a referral from your doctor or other authority, you want to look for certifications or licensures from organizations such as the American Society of Addiction Medicine or National Institute on Drug Abuse that validates their expertise in addiction medicine. Many clinics may indeed have mental health expertise, but only rudimentary expertise in addiction issues.

Practicalities of inpatient vs. outpatient settings. Inpatient settings, where people check in for stays of 30 days or more, are great to focus on recovery. Inpatient programs provide more frequent access to clinicians and stable environments, but wait times can be long and treatment costs substantially higher.

Outpatient treatment by comparison will be cheaper, but require more coordination -- traveling for medical procedures, doctor's visits and counseling meetings can add complexity to recovery. A person may have more difficulty finding support during a crisis in an outpatient setting, potentially increasing the likelihood of relapse. If opting for outpatient treatment, look for a program that also offers phone-based (telemedicine) services if they can't get in to see their counselor.

Medications. There are only three U.S. Food and Drug Administration-approved medications for the treatment of opioid addiction. Methadone and buprenorphine (also referred to by its branded formulations Suboxone and Subutex) are used in maintenance treatments. In maintenance treatments, doctors try to lower the dosage of these medications over time to make detoxification easier at some point in the future. It's important to understand that these medications are opioid painkillers, but they are regulated or engineered in a way that discourages their abuse or sale on the black market. Like all opioids, these medications can depress respiratory function, cause liver damage with prolonged use and if abused, lead to overdose. Maintenance treatment can be a good harm-reduction strategy for people who are not ready to quit and/or for individuals who are taking large quantities daily and need to lower their intake before attempting detoxification.

Naltrexone is the third FDA-approved medication and, by comparison, is not an opioid and not habit forming. Naltrexone helps people avoid relapse by decreasing cravings and, in sufficient dosages, preventing a person from getting high if they were to take more opiates. Naltrexone can only be used after a person has been detoxified, so people must either successfully stop using opioids for several weeks or opt for medically-assisted detoxification if they want to use it in their recovery.

Naloxone, also known as Narcan, is not a treatment for opioid addiction, but it can temporarily stop the effects of opioid use. Naloxone has been in the news a lot lately as municipalities approve it for use by first responders and law enforcement to save the lives of people that have overdosed. If someone has been given naloxone for overdose, it is very important to get them to an emergency room as soon as possible before the drug wears off.

Traditional vs. medically-assisted detoxification. Among the worst aspects of recovery from opioid addiction is suffering through natural detoxification -- a very painful process in which your body cleanses itself of opioids that lasts as long as a month or more. Medically-assisted detoxification by comparison makes the withdrawal process less painful by using medications to cleanse the body of opioids while the person is sedated. The procedure is sometimes used to make naltrexone therapy possible by helping a person achieve detoxification faster or to prepare for abstinence-based assistance programs. Programs like these will often use a formulation of naltrexone known as Vivitrol, because it stays in the body for several weeks and helps people get past moments of weakness early in their recovery. It's best to avoid facilities that offer so-called "rapid detox" as a standalone treatment -- if it's not integrated with mental health supports and other therapies, it is rarely a long-term solution by itself.

Addiction to opioids has been around for thousands of years and has always been challenging to society. The good news is that our treatment options to fight addiction are increasingly sophisticated and effective.

Dr. Ricardo Borrego, M.D ., is a Board Certified Anesthesiologist and Co-founder and Director for the Eagle Advancement Institute (EAI) in West Bloomfield, Mich. Dr. Borrego holds a medical degree from pecializes in addiction medicine and non-narcotic pain management. He is co-developer of EAI's Clarity^TM Intensive Outpatient Opiate Treatment (IOOT) and is an expert in medically-assisted detoxification therapies for opioid dependency and addiction through the use of minimal sedation techniques.