Treating opioid disorder without meds more harmful than no treatment at all

Delays to access can increase people’s risk of discharging themselves early against medical advice. As of 2023, the Waiver Elimination (MAT Act), also known as the “Omnibus Bill”, removed the federal requirement for medical providers to obtain a waiver to prescribe buprenorphine, in an attempt to increase access to OUD treatment. Opioid replacement therapy (ORT), also known as opioid substitution therapy (OST), Medication for Addiction Treatment (MAT), or Medications for Opioid Use Disorder (MOUD), involves replacing an opioid, such as heroin. Withdrawal management alone is strongly discouraged, because of its association with elevated risks of HIV and hepatitis C transmission, high rates of overdose deaths, and nearly universal relapse. Opioid use disorders typically require long-term treatment and care with the goal of reducing the person’s risks and improving their long-term physical and psychological condition.

The use of CBT alone for OUD has declined due to lack of efficacy, and many rely on medication therapy or medication therapy with CBT, since both were found to be more efficacious than CBT alone. Paralleling the variety of medical treatments, there are many forms of psychotherapy and community support for treating OUD. Buprenorphine use correlates with a lower risk of adverse neonatal outcomes, with similar risks of adverse maternal outcomes as methadone.

“FDA approves first buprenorphine implant for treatment of opioid dependence.” These treatments include several kinds of counseling or behavioral therapy as well as medications. Buprenorphine is another medication that is approved for the treatment of opioid dependence. The correct dose prevents withdrawal symptoms and eases drug cravings. Heroin and street fentanyl are also opioids, and addiction to them is treated similarly to prescription drug addiction.

Medications for Opioid Use Disorder

A strong association between adverse childhood experiences and opioid abuse later in life has been identified, suggesting that a high adverse childhood experiences score should be considered a risk factor for opioid abuse. Addiction and dependence are components of a substance use disorder; addiction is the more severe form. The DSM-5 guidelines for the diagnosis of opioid use disorder require that the individual has a significant impairment or distress related to opioid uses. There have been mixed results for the MCR2 gene, encoding melanocortin receptor type 2, implicating both protection and risk to heroin addiction. In theory, all these functional changes would reduce the impact of exogenous opioids, requiring a higher dose to achieve the same therapeutic effect.

Prevention

After the intense initial symptoms subside, some physical and mental discomfort may linger for weeks. It depends on which drug you were taking, how long you were taking it, and how much. Opioid withdrawal lasts hours to days — and sometimes weeks. Opioid addiction leads to changes in certain areas of your brain. It takes much more than willpower to break free of prescription drug misuse, but you can escape the cycle of detox and relapse. Opioid addiction is a chronic medical condition.

Opioid Use Disorder

Overexpression of the gene transcription factor ΔFosB in the nucleus accumbens plays a crucial role in the development of an addiction to opioids and other addictive drugs by sensitizing drug reward and amplifying compulsive drug-seeking behavior. People with opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine. Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids.

Management

In October 2021, New York Governor Kathy Hochul signed legislation to combat the opioid crisis. Since March 2020, as a result of the COVID-19 pandemic, buprenorphine may be dispensed via telemedicine in the U.S. Women are more likely to be prescribed pain relievers, be given higher doses, use them for longer durations, and become dependent upon them faster. Rates of opioid use and dependency vary by age, sex, race, and socioeconomic status.

NIDA is a biomedical research organization and does not provide personalized medical advice, treatment, counseling, or legal consultation. Opioid use disorder is a complex, treatable chronic medical condition from which people can recover.

Medication for Opioid Addiction

ORT is endorsed by the World Health Organization, United Nations Office on Drugs and Crime, and UNAIDS as effective at reducing injection, lowering risk for HIV/AIDS, and promoting adherence to antiretroviral therapy.
It was the top prescribed controlled medication in Maine last year, according to the state’s Prescription Monitoring Program.
Among the common treatment options for opioid use disorder are medications and abstinence-based programs.
Methadone is an opioid medication that has been used for more than 50 years to treat opioid use disorder.4 It binds to and activates the same molecules on neurons (nerve cells), called mu-opioid receptors, as heroin, fentanyl, and other opioid drugs.

The medications buprenorphine and methadone, specifically, prevent health-threatening withdrawal symptoms and quell cravings, reducing the desire for illicit opioids. However, when taken as prescribed by people with opioid use disorder, methadone and buprenorphine prevent drug cravings and withdrawal symptoms without causing the intense feelings of pleasure (or “high”) that other opioid drugs produce. The medication lofexidine (Lucemyra®) is approved for treatment of withdrawal symptoms that can happen when people suddenly stop taking opioids.

Methadone and buprenorphine can be equally effective in helping people reduce opioid use.10 Both medications help people stay in treatment. Even as more older adults are seeking treatment, it can be difficult for them to continue taking opioid treatment medications when they need higher levels of care for other health problems. To keep people in remission and save lives, priority should be placed on getting those with problematic opioid use started on medications and helping them remain in treatment, he added. One reason abstinence-based treatment might lead to more fatal overdoses, Heimer said, is because when people stop using opioids throughout those treatment programs, they lose their tolerance to opioids. When the researchers calculated the risk of fatal overdose death for each treatment, they found that, compared with no treatment at all, methadone and buprenorphine reduced the risk of death by 38% and 34%, respectively.

Compared to methadone, it consistently results in improved birth weight and gestational age, though these findings should be interpreted with caution due to potential biases. Other countries where it is available include Spain, Denmark, Belgium, Canada, and Luxembourg. Evidence of effects of heroin maintenance compared to methadone are unclear as of 2010. In this form, buprenorphine’s bioavailability remains robust (35–55%), while naloxone’s is significantly reduced (~10%).

Opioid dependence can manifest as physical dependence, psychological dependence, or both. Opioid dependence can occur as physical dependence, psychological dependence, or both. Addiction surpasses mere avoidance of withdrawal, involving cues and stress that reactivate reward-driven behaviors. In addiction, substances overactivate this circuit, substance use and co-occurring mental disorders national institute of mental health nimh causing compulsive behavior due to changes in brain synapses.

However, starting naltrexone treatment may be harder for people using opioid drugs than starting buprenorphine or methadone treatment. Naltrexone treatment is typically started after the person has completely stopped taking other opioid drugs; otherwise, the medication may cause withdrawal symptoms.16 Like methadone, buprenorphine can reduce cravings and withdrawal symptoms without producing intense feelings of pleasure and intoxication in people who have opioid use disorder. As a result, methadone produces less intense feelings of pleasure in people with opioid use disorder while reducing their withdrawal symptoms and drug cravings.5

The tolerance and withdrawal criteria are not considered to be met for individuals taking opioids solely under appropriate medical supervision. A scale was developed to compare the harm and dependence liability of 20 drugs. The differences in the genetic regions encoding the dopamine receptors for each individual may help to elucidate part of the risk for opioid addiction and general substance abuse. Many studies of patients with chronic pain have failed to show any sustained improvement in their pain or ability to function with long-term opioid use.

Multiple providers told The Monitor that nursing homes and assisted living facilities are not equipped to handle people with opioid addictions. The facility’s total number of Aroostook County patients in treatment for opioid use decreased 12% between fiscal years in 2020 and 2025, but clients who were 65 and older increased slightly from 14% to 21%. There isn’t good data currently about how many older patients are pathologically addicted to opioids, he said. He said he suspected family physicians might be less likely to do random drug screens on a 75-year-old who has been on opioids for 10 years than a 40-year-old who has been on them for five years. Primary care doctors sometimes struggle to start conversations with older patients about opioid use because they don’t want to offend people in their care.

In the guidelines, WHO recommends the use of a range of treatment options for opioid dependence. While some 64 million people globally are estimated to live with drug use disorders, access to treatment remains very limited, with less than 10% having access to it. Completing detox eases the physical effects of narcotic addiction and opioid withdrawal. Clonidine is similar to lofexadine and also used to treat symptoms of opioid withdrawal. Successful, lifelong therapy to stay opioid-free usually involves long-term medication as well as counseling or talk therapy programs.

While previous research studies have compared the effectiveness of these two treatment categories in preventing the resumption of illicit drug use, as well as opioid overdoses and death, they have not compared how these two options fare against no treatment at all. The findings, the researchers say, emphasize the importance of ongoing medication treatment for opioid use disorder and should inform how opioid settlement funds earmarked for addressing the crisis are spent. Overdoses from opioids are highest among people between the ages of 40 and 50, in contrast to heroin overdoses, which are highest among people between the ages of 20 and 30. Over the past decade, the uptake of medications for opioid use disorder has increased, but there are still many regions with a prevalence of opioid use disorder and lack of medical support. Studies done in the U.S. from 2010 to 2019 revealed that about 86.6% of people in the U.S. who could have benefited from opioid use disorder treatment were not receiving it. While medical treatment may help with the initial symptoms of opioid withdrawal, once the first stages of withdrawal are through, a method for long-term preventative care is attendance at 12-step groups such as Narcotics Anonymous (NA).