An overview of the different types of addiction treatment offered to heroin addicts.
Medical Detox (Also Sometimes Known as Rapid Detox)
Heroin withdrawal symptoms begin within about 12 hours of a last dose, peak in intensity after 2 or 3 days and last for a week or longer. Although heroin withdrawal symptoms are very rarely dangerous, the detox period is very tough.
Medically supervised opiate detox programs use medications to minimize the severity of withdrawal symptoms and keep patients under 24 hour a day observation, to ensure safety and maximal comfort. Many medical detox programs will use drugs such as Subutex or methadone to help transition away from illicit opiates.
Ultra Rapid Detox
During an ultra rapid detox, opiate addicts are placed under anesthesia and administered medications that accelerate the withdrawal process. Narcotic opiate-based subtances that can be treated through the rapid detoxification process include:
- Oxycontin ®
In theory, opiate addicts wake up from the anesthesia having passed through the worst of the pains while unconscious, and are ready after a day or two of recuperation, to get back to work. In reality, ultra rapid detox can be dangerous (people have died) whereas a medical detox is almost never dangerous. It is far more expensive than a medically supervised withdrawal and clinical observations indicate that patients undergoing the procedure still endure considerable discomfort.
Additionally, very few ultra rapid detox practitioners combine the medical procedure with any substantial behavioral therapy or continuing support, leaving those in recovery very vulnerable to opiate (or other drug) relapse.
While the American Society of Addiction Medicine does not explicitly condemn the practice, it advises people to consider the procedure only after comparing the dangers and advantages of ultra rapid detox with a conventional medical detox and to submit to the anesthesia only in an environment equipped with life saving medical equipment at the ready and with trained medical staff.
Although methadone treatment has some drawbacks, no treatment works better than methadone in keeping people free from opiate relapse.
Methadone maintenance is a form of opiate substitution therapy; you switch from heroin, a drug of abuse that causes negative health and behavioral effects onto methadone, a legal opiate that allows you to function normally in society. Since you do not switch off opiates completely, you do not feel any withdrawal symptoms while on methadone.
Methadone is a generally well tolerated medication that does not damage any of the body’s organs or systems, even if used over a long period of time.
Taking an appropriate dosage of methadone once a day removes drug cravings and withdrawal symptoms entirely. Unfortunately, because taking a very high dosage of methadone can lead to intoxication, access to the medication is tightly controlled. When starting out in methadone treatment, you will have to travel daily to a methadone clinic to take your dose under supervision. Over time, patients who comply with clinic rules can earn greater take home doses, eventually earning the right of monthly visits.
Methadone removes drug cravings and allows people to participate fully in behavioral therapies, to get back on track at work or school, or with family, and to regain health and well being. Some people choose to continue taking methadone indefinitely, others eventually decide to gradually reduce their dosage of the medication and ultimately quit entirely.
Problematically, although methadone works very well, it is not an easy drug to quit using. Many people consider the withdrawal off methadone more difficult than a heroin withdrawal; it certainly takes longer. Many methadone users now transition onto buprenorphine (which has an easier withdrawal syndrome) prior to quitting opiates entirely.
Buprenorphine works similarly to methadone, as an opiate substitution medication; once you take buprenorphine, you feel no drug cravings or symptoms of heroin withdrawal.
Buprenorphine is FDA approved for the treatment of heroin addiction when sold as Suboxone or Subutex. Suboxone contains 2 active ingredients, buprenorphine and naloxone. The buprenorphine binds to opiate receptors in the brain (similarly to methadone) and keeps you from feeling withdrawal symptoms and the naloxone is added to make the drug difficult to abuse.
Because Suboxone is less easily abused than methadone, it can be prescribed in month long doses – people taking Suboxone do not have to travel to a methadone clinic each day like users of methadone do. Additionally, the eventual syndrome of withdrawal off Suboxone is considered far milder when compared to methadone. Unfortunately, some people cannot get full withdrawal symptoms relief from Suboxone. People who had very heavy heroin habits often need to take the much stronger drug, methadone, to feel real relief.
Naltrexone is another medication that can be used in the treatment of opiate addiction. Naltrexone works by binding to opiate receptors in the brain, essentially plugging these receptors up. If you take heroin after taking naltrexone, the heroin cannot access the opiate receptors in the brain and so causes no effect.
Naltrexone can help very motivated people stay abstinent. Problematically, only oral forms of the medication are FDA approved for the treatment of opiate addiction and so should an addict in recovery wish to use again, all she needs to do is stop taking the naltrexone pills. Some clinics advertise the use of an injectable pellet of very slow release naltrexone, which can provide much longer lasting effects, but these naltrexone pellets are not yet FDA approved for the treatment of opiate addiction.
Naltrexone (unlike methadone and buprenorphine) will not reduce the severity of withdrawal symptoms. Clinical studies show that both methadone and buprenorphine work better than naltrexone in keeping people from opiate relapse. Naltrexone is less widely used than either buprenorphine or methadone.
Behavioral therapies, such as cognitive behavioral therapy or contingency management, have shown some efficacy in helping people break free from opiate addiction. For best chances of success though, the National Institute on Drug Addiction (NIDA) recommends combining behavioral therapies with pharmacological therapies (such as methadone or buprenorphine treatment) in one comprehensive treatment plan.
Cognitive behavioral therapy (CBT) is an evidence based treatment that teaches those in recovery new strategies for maintaining abstinence. Addicts learn what environmental factors put them at risk of relapse, are taught to avoid these “triggers” if at all possible and taught strategies for overcoming temptation that does inevitably occur.
Behavioral therapies such as CBT require engagement in the therapeutic process and a practicing of the techniques learned. People stabilized on medications like methadone or buprenorphine are much more able to engage in this process than people struggling to overcome drug cravings and withdrawal symptoms.
Many opiate addicts in recovery find that attendance and participation in support groups, such as 12 steps based programs, can be helpful. People who attend meetings can access viable drug-free social support systems, can make sober friendships, and can discuss the trials and tribulations of opiate recovery with others who truly understand the journey.
Some opiate addicts in recovery find Narcotics Anonymous (NA) helpful, while others prefer Methadone Anonymous (MA) or other non step based support groups.
Meetings are free, easily found in most urban centers and can complement a more comprehensive recovery program.
What Heroin Treatment Is Best for You?
The best form of treatment is one that meets your needs and works for you, and no form of treatment is best for everyone.
In general, people seem to have the best success when combining methadone or Suboxone maintenance therapies with behavioral therapy and other treatment elements, such as participation in support groups or regular attendance at 12 steps meetings.
Some people prefer to break free completely from opiates and choose instead a medical detox followed by a comprehensive program of behavioral therapies and other addiction treatments.
A heroin addiction is difficult but beatable. Whatever route to sobriety you choose, know that treatment works, but that it takes time – there are no quick and easy fixes; and that people that stay involved in treatment for a year or longer have a much better chance of staying clean for good.