Detoxification involves clearing the body of opioids, or any drug for that matter. The process is often extremely mentally taxing and physically painful. Because of this, some people pair detoxification with medicine to help cope with the pain (Goodman, n.d.). Detoxification should not be confused with treatment, as it only addresses the physical side of opioid addiction (National Institute on Drug Abuse, 2018).
Naloxone or Naltrexone Therapy
Naltrexone is a once monthly injection form of Naloxone. Naloxone and Naltrexone are opioid antagonists, meaning they bind to the receptors in the brain where opioids do damage and block the activity of the drug (The National Alliance of Advocates for Buprenorphine Treatment, n.d.). Naloxone and Naltrexone are very attractive, and they bind to the receptors so strongly that they remove the opioid and block it from re-binding (Bloom, 2018). This is why Naloxone works in an overdose (Harm Reduction Coalition, n.d.). If an addict tries to use heroin, fentanyl, or prescription pain relievers, they will not work if Naltrexone is in his or her system (Tate, 2018). Naloxone or Naltrexone Therapy are only successful in very motivated individuals who have a lot to lose if they continue to use or work in sectors where other Medically Assisted Treatment modalities are not acceptable, such as pilots or physicians (National Institute on Drug Abuse, 2018).
Methadone, at its core, is really just a substitution of one opioid for another in a controlled, safe, and monitored environment. Methadone is a long-acting opioid agonist. Because of its long duration of action, it doesn’t produce the same high and euphoria as heroin, oxycodone, fentanyl, etc. The goal is to give it at a dose that keeps the patient from feeling withdrawal and craving, but still allows them to function, hold a job, etc (Ambardekar, 2017).
The danger of the drug is that Methadone can be abused. For example, it can be crushed and injected. It doesn’t relieve the patient of their addiction, but refocuses their addiction on something less destructive (National Institute on Drug Abuse, 2018). Methadone maintenance therapy can be quite effective. It decreases homelessness and joblessness among users, as well as decreases the spread of HIV and Hepatitis C (Ambardekar, 2017).
Buprenorphine is commonly known as Suboxone. It binds the same receptors as other opioid and has some opioid properties; however, it produces about half the effect of other opioids. Buprenorphine is an opioid agonist-antagonist, as it binds the opioid receptors very strongly and out-competes the pure opioids. This provides some safety if a person with opioid use disorder tries to use heroin, fentanyl, or prescription pain relievers while on buprenorphine (National Institute on Drug Abuse, 2018). Also, buprenorphine does not have the same risk of respiratory depression that come with other drugs. People don’t seem to stop breathing when they misuse the buprenorphine, which is what kills almost all people who overdose (The National Alliance of Advocates for Buprenorphine Treatment, n.d.).
Suboxone is a formulation buprenorphine that contains a small amount of naloxone. Naloxone has no, or very little, activity when taken orally. However, if the patient tries to melt the suboxone and inject it to get high, the naloxone is active and prevents the user from feeling any rush, making it less likely to be used inappropriately. Buprenorphine has less abuse potential than methadone, but there have been cases of illicit use now that it is being used more frequently (The National Alliance of Advocates for Buprenorphine Treatment, n.d.).
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