Treatment for Opioid Addiction

In 2020, approximately 9.5 million people in the U.S. misused an opioid drug. Close to 3 million adults ages 12 and older had an opioid use disorder. 

Opioid abuse and addiction have reached pandemic status in the United States. Almost 70,000 people died from an opioid-involved overdose in 2020, which is 8.5 times the number of opioid-involved overdose deaths in 1999. 

Opioid drugs include prescription painkillers, such as oxycodone (OxyContin) and hydrocodone (Vicodin), as well as illicit opioids like heroin and synthetic opioids such as fentanyl. These drugs are extremely addictive and can lead to drug tolerance and dependence in a matter of weeks even when taken for medical reasons exactly as prescribed. 

Most opioid drugs are classified as Schedule II controlled substances by the Drug Enforcement Administration (DEA) due to their high potential for diversion, misuse, and dependency.

Opioid addiction is a disease involving compromised brain pathways, altered brain chemistry, behavioral changes, and compulsive drug-seeking behaviors. 

What Is Opioid Use Disorder?

Opioid use disorder (OUD) impacts more than 16 million people around the world. It involves the chronic and compulsive use of opioid drugs, causing impairment, distress, and impacting quality of life. 

Addiction is classified as a disease with social, emotional, and physical ramifications and implications. Symptoms of opioid use disorder include the following:

• Taking more of the drug at a time or taking it for longer than intended
• Drug tolerance (needing more of the drug to feel the effects)
• A lot of time spent thinking about getting the drug, using it, and recovering from its use
• Shirking responsibilities
• Use of the drug in physically hazardous situations
• Using the drug despite knowing it will have negative emotional, interpersonal, social, or physical consequences
• Cravings for opioids
• Multiple unsuccessful attempts to stop using opioids
• Drug dependence and withdrawal symptoms when the drug wears off
• Reducing or giving up activities due to opioid use

How Opioids Lead to Addiction

Opioids are a class of drugs that bind to opioid receptors in the brain. In doing so, they block pain sensations, which is why they are prescribed as effective painkillers. 

They also are central nervous system depressants, which means they slow down things like breathing and heart rate while lowering body temperature and blood pressure. They can make you feel drowsy. 

Opioids also change the chemical makeup of the brain, leading to an increase in “happy” neurotransmitters and impacting the reward and motivation pathways of the brain. This is what causes the mellow and euphoric high that makes it so desirable to keep taking opioids. 

With repeated use, opioids can create a kind of shortcut to pleasure, and it can become hard to feel happiness or motivation to do things without taking opioids. When opioids wear off, intense drug cravings and withdrawal symptoms can occur. This can include low moods, irritability, anxiety, insomnia, difficulty thinking clearly and focusing, and flu-like physical symptoms. 

Treatment for opioid addiction often requires both medications to offset drug cravings and withdrawal symptoms and allow the brain a chance to stabilize as well as therapeutic interventions. Behavioral therapies and counseling can be combined with medications for a comprehensive approach to opioid addiction treatment.

What Treatment Options Are Available for Opioid Addiction?

Opioid addiction treatment should be tailored to each individual and focus on their specific needs. This can mean dual diagnosis treatment when another mental health issue, such as anxiety or depression, is present. 

With dual diagnosis treatment, both conditions are managed at the same time with a simultaneous and comprehensive approach. Each condition can contribute to the other, and they are often complexly intertwined. 

There are different levels of care for opioid addiction treatment, which ranges from flexible outpatient programs for mild opioid addiction to more intensive and structured inpatient treatment programs for more severe addictions. 

Opioid addiction treatment often follows a continuum of care that allows you to move between levels of treatment as needed during treatment and recovery. Opioid addiction treatment can include detox, medications, inpatient or outpatient programs, and sober living situations.

Detox

Often, the first stage in an opioid addiction treatment program is medical detox with the goal to achieve physical stability. 

Opioid withdrawal can be particularly difficult and even potentially dangerous as it comes with significant physical and emotional symptoms. Medications are often used during detox to help stabilize the brain and manage withdrawal symptoms and opioid cravings. 

Medical detox may be provided in a specialized facility or detox center that can offer around-the-clock medical care and supervision as well as mental health support. 

Detox is not a standalone treatment. It should be used as part of a comprehensive program and plan.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is often recommended for opioid use disorders. Medications like buprenorphine and methadone are often first-line treatment options for opioid use disorder. As part of MAT, these medications are effectively combined with behavioral therapies for a comprehensive approach to recovery. 

These medications can help to manage opioid cravings and withdrawal symptoms, allowing the brain to stabilize, so individuals can focus on the work they’re doing in therapy. MAT can promote treatment retention, lower illicit opioid use and instances of relapse, and reduce the risk for overdose while enhancing overall recovery rates.

Inpatient Rehab

Inpatient opioid addiction treatment programs offer the highest level of care and 24/7 monitoring and support. An inpatient rehab program provides necessary medical monitoring and care as well as medication management and a highly structured environment. Medical and mental health professionals are on site to offer care and support. 

Components of an inpatient rehab program can include the following:

• Group and individual therapy and counseling sessions
• Medication management
• Educational programs
• Life skills training and workshops
• Support group meetings
• Dual diagnosis treatment for underlying medical or mental health conditions
• Recovery support and planning

Inpatient programs may also offer nutritional planning and healthy meals, a set sleep/wake schedule, sober recreational activities, exercise programs, spa services, and mindfulness activities depending on the program and offered amenities and services. Inpatient programs often provide the most comprehensive treatment model, which can be particularly helpful in cases of severe or long-term addiction.

Outpatient Treatment

Outpatient treatment programs vary in the amount of structure and services provided. They often offer many of the same services as inpatient rehab with the main difference being that you will go home every night. Intensive outpatient programs provide several structured hours of services multiple days each week, for example. 

An outpatient program can be beneficial if you have a high level of support at home and a lower level of opioid addiction. These services can be more flexible with your existing schedule when you need to attend to work, school, or family obligations while in treatment. 

Sober Living 

Sober living environments can provide intermediate housing arrangements in recovery, serving as a transitional option between an inpatient addiction treatment program and full reintegration into society. These are generally homes where multiple people in recovery can live together and support each other in recovery. 

Sober living homes often require drug tests. The residents must keep up with house chores and rules, and continued participation in outpatient treatment services (such as counseling, therapy, and support group meetings) is required. 

A sober living environment can offer a higher level of structure and protection against potential triggers when a person is in early recovery. This can be a better choice than returning directly home for many people. Residents have a chance to solidify the lifestyle changes and habits they learned in rehab in a supportive environment.

What Can You Expect During Opioid Treatment?

Opioid addiction treatment is going to look different for each person. Care can depend on factors such as these:

• Type of drug used and how (swallowing, snorting, smoking, or injection drug use)
• Length of time and average amount of drug used
• Family or personal history of addiction
• Concurrent medical or mental health conditions
• Level of stress and/or support at home 
• Polysubstance abuse

In general, opioid addiction treatment will begin with detox or starting on MAT. Then, the person may transition to inpatient rehab or outpatient services. Once those are completed, it’s common to progress to aftercare programs, which can include transitional living environments. 

Since opioid addiction treatment commonly involves the use of medications to control cravings and manage withdrawal symptoms, MAT can be safely continued into recovery. It’s common for people to remain on methadone or buprenorphine for years. 

In recovery, attending support group meetings and 12-step programs can be beneficial in helping to minimize relapse and foster positive peer connections. While support groups don’t replace individual and group therapy sessions, they can augment the overall recovery experience, offering another avenue of vital support. 

What Therapy Options Are Available for Opioid Addiction Treatment?

There are several different types of therapies used during opioid addiction treatment, and these are generally behavioral therapies. Behavioral therapies work to positively change behaviors. 

Therapies for opioid addiction can include the following:

• Cognitive behavioral therapy (CBT): CBT uses mindfulness to help you recognize negative thoughts and emotions and how they affect your behaviors. Using both group and individual therapy sessions, CBT can explore the root causes of opioid misuse, helping to identify triggers that lead to opioid misuse.
  
  With the help of your therapist, you can develop healthy coping mechanisms for stress and learn how to successfully manage triggers to minimize relapse. CBT helps to improve your mindset and make you more self-aware, so you can better make positive lifestyle changes that can carry you into recovery.
  
• Contingency management (CM): With CM, you are offered incentives for negative drug tests and positive behaviors, such as attending and participating in counseling sessions and taking necessary treatment medications, which can serve as motivation to stay sober. Regardless of the reason for the initial motivation, once you are working toward recovery, you can see positive changes and results with CM.
  
• Motivational enhancement therapy: This form of therapy uses strategies to build motivation to stick with opioid addiction treatment and make positive behavioral changes. Motivational enhancement can help you to find and increase motivation to remain in treatment and make the necessary changes for recovery.
  
• Family therapy: Spouses, partners, parents of children or adolescents, and additional family members can be included in therapy sessions to improve the overall family unit and learn how to best support each other. Family therapy can help to improve communication and ensure that entire families are on the same page in recovery.

Which Medications Are Used to Treat Opioid Use Disorder?

There are three MAT medications that are FDA-approved to treat opioid addiction: buprenorphine, methadone, and naltrexone. 

Buprenorphine and methadone are long-acting opioid medications, which means that they will stay in your system longer than most opioid drugs of abuse. Because of this, they can help to manage drug cravings and withdrawal symptoms. 

These medications can be taken during detox and also long term to reduce illicit opioid use and rates of relapse. Ultimately, these medications help to sustain recovery. 

• Methadone: Available under the brand names Methadose or Dolophine, methadone is typically dispensed in specialized clinics once per day. Methadone cannot be prescribed for at-home use due to its high potential for abuse.
  
• Buprenorphine: Buprenorphine can be prescribed by a licensed medical professional and picked up at your chosen pharmacy in many different formulations, including as Subutex, Bunavail, and Probuphine.
  
  As a partial opioid agonist, buprenorphine activates opioid receptors in the brain like other opioids, but it does so to a lesser extent, not creating the same euphoric high. It also has a ceiling effect, so its effects do not increase with very high doses. Buprenorphine is often combined with naloxone, an opioid antagonist, in combination medications like Suboxone and Zubsolv. Naloxone serves as an abuse-deterrent in these medications. While it generally remains inactive, naloxone will take effect to precipitate withdrawal if the medication is misused and injected.

• Naltrexone: This medication is prescribed as Vivitrol, an extended-release injection that is used in MAT after all opioids are out of the system. Naltrexone blocks the effects of opioid drugs like heroin and morphine. As a result, it can be used to help maintain recovery and prevent relapse. 

Telehealth & Its Impact on Recovery From OUD

The COVID-19 pandemic brought many changes to the health care industry, including a rise in demand for telehealth services. Numerous telehealth providers now offer opioid addiction treatment, including counseling and therapy sessions via online video calls, text, chat, and phone. Telehealth services also offer MAT and instant access to a variety of resources. 

Telehealth for opioid addiction is changing the landscape of opioid addiction treatment and recovery, providing greater access to care for more people. Studies have shown its effectiveness in helping people stay in treatment and reducing the risk of overdose. 

Telehealth services can offer continuing support into addiction recovery, providing an extra platform that is available right at your fingertips whenever you need it. Through telehealth, you are able to connect with peers in recovery and providers that are not necessarily geographically close to you, which can expand treatment and support options. 

Since medications for MAT can be prescribed and effectively managed through telehealth, many people can access all their needed addiction treatment services virtually. This increases the likelihood that people will stick with treatment and achieve long-term recovery. 

Life After Rehab

Addiction is a chronic and relapsing disease. Rehab provides a strong foundation for recovery, but it is up to you to keep working to sustain a long and healthy recovery from opioid addiction. 

A transitional living situation immediately after rehab can help. In a supportive environment of like-minded peers, you can solidify what you learned in rehab, helping you to maintain your sobriety during the early days of your recovery when you are most vulnerable. You’ll have a chance to build on the new habits and coping skills learned in rehab before heading straight back into all of the stressors associated with everyday life.

Continuing to participate in therapy and counseling as well as regularly attending support group meetings will help in ongoing recovery. Reach out to friends, family members, mentors, counselors, or therapists when needed. Do not be afraid to ask for help when you need it. 

It is also vital to continue to take care of yourself. Eating healthy, getting enough exercise and sleep, and surrounding yourself with positive people can all help. Stay away from those who do not support your recovery along with people, places, and things that can be triggers for drug use. 

Remember your why during recovery — the goals or people that motivate you to stay sober. This can provide you with the motivation to remain in recovery.

Support Groups for People Recovering From Opioid Addiction

Support groups can be a vital part of opioid addiction, as they can provide you with a peer connection with others who understand how you feel. Many of the people in these groups have been where you are and made it through. 

There are many different options for support groups, including 12-step programs. These groups often have options for specialty populations, such as groups for specific genders, ages, sexual orientations, and faiths. 

These are examples of support groups for opioid addiction:

• Narcotics Anonymous (NA): This 12-step program is free to join. They offer multiple chapters all over the world with meetings in a variety of locations and formats.
• SMART Recovery: This stands for Self-Management And Recovery Training. SMART offers a variety of options and tools for sustaining recovery, including mutual support meetings and the option to use the SMART Recovery app for online meetings.

Opioid Addiction Treatment FAQs

What can be done to reduce opioid addiction?

Prevention is the first step toward minimizing opioid addiction. Education on the hazards of opioid abuse and the addictive potential of opioids can be vital in these efforts. Increased access to resources and treatment for opioid addiction, including MAT, can help to reduce the number of people struggling with active opioid use disorder.

What is the first line of treatment for opioid use disorder?

The first line of treatment for OUD is medication-assisted treatment, such as the use of Suboxone (buprenorphine/naloxone) or methadone. These medications minimize withdrawal symptoms and cravings, helping to sustain recovery.

Medications work best when combined with behavioral therapies as part of a complete treatment program.

Which treatment is most effective for treating opioid addiction?

Treatment methods vary based on each person, but medication-assisted treatment is often part of treatment for opioid use disorder. Most often, opioid addiction treatment includes the use of medications, group and individual therapy, and ongoing support.

Is there a cure for opioid addiction?

There is no cure for opioid addiction, but it can be effectively managed on a long-term basis. Like other chronic conditions, addiction requires ongoing maintenance treatment as relapse is always a risk.