The medications most widely prescribed today for the treatment of opioid addiction are methadone, the combination medicine of buprenorphine/naloxone (most commonly known as Suboxone®), and naltrexone. Here’s what you need to know about these medications, how they are administered, and their effectiveness in treating opioid addiction.
The term “opiate” refers to natural substances derived from the opium poppy plant, such as heroin, morphine, and codeine. “Opioid” is a broader term that includes these natural substances as well as synthetic and semi-synthetic substances like fentanyl and oxycodone. While all opiates are opioids, not all opioids are opiates.
What Is Methadone?
Methadone has been used since the 1960s as a primary medication for opioid addiction treatment. It is an opioid agonist, meaning it activates opioid receptors in the brain and changes how the brain responds to pain.
Administration and Regulation
Methadone is available only through certified opioid treatment programs and methadone maintenance clinics. It is typically taken as a tablet, injectable solution, or oral solution. A single dose can last 24-36 hours, depending on the individual’s body weight and the severity of their opioid use disorder.
Benefits and Risks
Methadone helps relieve opioid cravings, decreases withdrawal symptoms, promotes abstinence from other substances, and helps individuals function in their daily lives. However, it is a Schedule II drug, meaning it has a high potential for misuse. Misuse can lead to intoxication and overdose, and methadone also has a considerable street value.
Side Effects
Common side effects of methadone include:
- Sleepiness
- Constipation
- Vomiting
- Headache
- Nausea
- Stomach pain
What Is Buprenorphine/Naloxone (Suboxone)?
In 2002, the FDA approved a combination product of buprenorphine and naloxone (Suboxone) for treating opioid addiction. Buprenorphine is a partial opioid agonist, meaning it activates opioid receptors but to a lesser degree than full agonists like methadone. Naloxone is an opioid antagonist that blocks the effects of opioids.
Mechanism and Benefits
Buprenorphine helps manage withdrawal symptoms, while naloxone deters misuse. Suboxone reduces opioid cravings, lowers the risk of relapse and overdose, and improves engagement in treatment. The combination product is generally safer due to buprenorphine’s ceiling effect, which limits the potential for misuse and dangerous side effects.
Administration
Suboxone is typically taken daily as a tablet or dissolvable film under the tongue. An extended-release form, Sublocade®, is available for monthly injection.
Side Effects
Common side effects include:
- Constipation
- Chills
- Diarrhea
- Dizziness
- Drowsiness
- Flushing
- Headache
- Insomnia
- Nausea
- Weakness
- Sweating
What Is Naltrexone?
Naltrexone is a non-addictive opioid antagonist that prevents the euphoric high associated with opioid use. It is most commonly given as an extended-release injection (Vivitrol®) once a month. Naltrexone decreases opioid cravings, reduces the risk of relapse and overdose, and supports long-term recovery.
Medication-Assisted Treatment (MAT)
MAT refers to the use of medications like methadone, Suboxone, and naltrexone in combination with psychosocial therapies to treat addiction. This comprehensive approach helps individuals manage withdrawal symptoms, reduce cravings, and maintain sobriety.
Comparing Methadone, Suboxone, and Naltrexone
Effectiveness
- Methadone: Effective for managing withdrawal symptoms and cravings but has a higher risk of misuse.
- Suboxone: Reduces cravings and relapse risk with a lower potential for misuse due to its ceiling effect.
- Naltrexone: Prevents the euphoric effects of opioids, reducing cravings and supporting long-term recovery.
Administration and Convenience
- Methadone: Requires daily visits to a clinic.
- Suboxone: Can be prescribed and taken at home.
- Naltrexone: Administered monthly as an injection.
Risks and Side Effects
- Methadone: High potential for misuse, overdose risk, and various side effects.
- Suboxone: Lower misuse potential, but side effects like constipation and dizziness.
- Naltrexone: No risk of misuse, but can cause nausea and other side effects.
Overdose Risks
Methadone Overdose
Methadone overdose is dangerous, with symptoms including:
- Respiratory distress
- Drowsiness
- Low blood pressure
- Cold, clammy skin
- Muscle weakness
- Stomach pain
- Slow pulse
- Extreme sedation, leading to coma
Mixing methadone with alcohol increases the risk of respiratory problems. If overdose symptoms occur, call 911 immediately. Naloxone (Narcan®) can reverse opioid overdose effects and save lives.
Methadone, Suboxone, and naltrexone are life-saving medications for opioid addiction treatment, each with its own benefits and risks. Understanding these medications can help support loved ones in their recovery journey. With proper medical supervision and a comprehensive treatment plan, individuals can achieve long-term recovery and improve their quality of life. If you or someone you know is struggling with opioid addiction, consult a healthcare professional to explore the most appropriate treatment options.
