Opioid painkillers and heroin are at the top of the list when it comes to the epidemic rises in addictions, overdoses, deaths, and treatment needs. Addiction is a chronic and relapsing brain disease that, according to the Committee on the Neurobiology of Addictive Disorders, The Scripps Research Institute “ worsens over time, is subject to significant environmental influences (e.g., external stressors), and leaves a residual neural trace that allows rapid “re-addiction” even months and years after detoxification and abstinence.”
When combined with counseling, behavioral therapies, and supportive services, opioid agonist therapies with methadone or buprenorphine have proven helpful in keeping a struggling opioid dependent in treatment long enough for them to find relief from the persistent desire and conditioned needs for short-acting opioids like heroin and opioid painkillers.
From Abuse to Addiction
According to the Institute of Medicine (US), “An individual cannot know beforehand exactly how a drug will affect him or her because there is great variability in this response, depending on the drug and the specific dose exposure, the individual’s biological and psychological state, and the social circumstances.” Hardly any drug is more readily adaptive than opioids to endogenous receptors that work in concert with important brain areas, circuits, and neurotransmissions designed to keep us well.
According to the National Institute on Drug Abuse, “Dependence develops when the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug.” From abuse to addiction, it’s difficult to stop the progressive effects that opioids can have in a person including:
- Tolerance that leads to more opioid consumptions for desired effects
- Frequent intoxications to avoid or alleviate withdrawals
- Relapses after attempts to quit
- Abuse via smoking, snorting, or injecting for a quicker and more intense high
- Abuse with other substances
- Diseases, infections, and other physical health deteriorations
- Mood, attitude, or disparaging and dangerous behavioral changes
- Unpredictable overdose that may fatal or non-fatal in even the most chronic or habitual user
The Basis for Agonist Opioid Therapies
According to the University of California, “Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids.”
It’s helpful to know that medications such as methadone and buprenorphine used in opioid addiction treatment programs help to normalize imbalances in brain systems and functioning by working at a steady rate with longer half-lives and slower rates of metabolism. Buprenorphine, like methadone, can help an opioid dependent block the effects of other opioids to deter their abuse, reduce cravings and withdrawals, and improve overall health and social functioning capabilities. Agonist opioid therapies are also effective in reducing the risk behaviors that lead to infections and the transmission of hepatitis, HIV, or AIDs through needle injections. These situations not only harm the opioid user, but, also make others susceptible to the risks.
Recognizing the Benefits
Whether it’s a long term detox (up to 6months) or a maintenance program that can last indefinitely, opioid addicts can remain in a program for the time it takes to regain stability in abstinence and accustom themselves to living without illicit opioid use. According to the SAMHSA, “If a person is addicted, medication allows him or her to regain a normal state of mind, free of drug-induced highs and lows. It frees the person from thinking all the time about the drug. It can reduce problems of withdrawal and craving. These changes can give the person the chance to focus on the lifestyle changes that lead back to healthy living.”
Although there remains controversy over treating opioid dependencies with opioid agonist drugs such as methadone or buprenorphine, these treatments are highly beneficial in reducing problematic behaviors and harms of illicit opioid use if not completely eliminating them. When combined with appropriate services to address medical, psychological, and social needs, these programs reduce illicit opioid abuse, overdoses, deaths, crimes, the spread of diseases and infections, and improve overall functioning capabilities by giving these individuals hope and opportunities they would otherwise lack.