MedLock | June 19, 2023
Opioid use disorder (OUD) is a devastating affliction that affects more than 16 million people across the globe. OUD is a chronic condition characterized by the compulsive use of opioids despite negative consequences. Recovering from an addiction to opiates is extremely difficult and can be very disheartening for the afflicted individuals as well as their loved ones. However, there are evidence-based treatment options that can make a world of difference.
Medication-assisted treatment (MAT), for example, is a form of addiction treatment that relies on the use of other medications to decrease cravings for and dependence on opiates. MAT is also referred to as opioid substitution treatment.
A more specific type of MAT is Opioid agonist therapy (OAT). This treatment that involves the use of medications that bind to and activate opioid receptors in the brain. OAT is primarily used to treat opioid dependence. This article explores the most commonly used medications in MAT, how they work, treatment benefits, and limitations to consider.
Opioid Addiction and Treatment
In addition to heroin, most people are familiar with the name "Fentanyl"(also spelled "Fentanil"). This is largely due to the drug making more and more news headlines over the past few years due to its proliferation in the streets and numerous bouts of overdoses. However, Fentanyl is not the only pharmaceutical drug in the opioid category. In addition to heroin and fentanyl, opioids also include oxycodone (brand names OxyContin or Percocet), hydromorphone (brand name Dilaudid®), morphine, codeine (found in Tylenol 2, 3, and 4), hydrocodone (Vicodin), oxymorphone, and so on.
How Is Opioid Addiction Treated?
Most treatments for opioid use disorder include a mix of therapeutic treatments. Along with counselling, group therapy, psychotherapy, etc., medication-assisted treatments (MAT) are a popular form of therapy for a variety of ailments, including substance abuse. OAT is an effective option - and the most commonly used - for treating opioid addictions.
Medications Used in OAT
Opioid agonists and opioid antagonists are two types of medications that interact with the same receptors in the brain that opioids such as heroin or fentanyl bind to.
Opioid Agonists
An opioid agonist is a medication that binds to opioid receptors in the brain and activates them, producing effects similar to those of opioids. For example, methadone and buprenorphine are opioid agonists used in opioid agonist therapy to treat opioid dependence by reducing withdrawal symptoms and cravings. Opioid agonists can be full agonists, which produce a strong opioid effect, or partial agonists, which produce a weaker effect.
Opioid Antagonists
An opioid antagonist, on the other hand, is a medication that binds to opioid receptors in the brain and blocks the receptors thereby preventing the effects of opioids. Naltrexone is an example of an opioid antagonist that is used in the treatment of opioid dependence to prevent relapse by blocking the euphoric effects of opioids. Naloxone is another opioid antagonist used in emergency situations to quickly reverse the effects of an opioid overdose.
In summary, opioid agonists activate opioid receptors and produce effects similar to those of opioids, while opioid antagonists block the effects of opioids by binding to the same receptors without activating them.
There are several medications that may be used to treat OUD:
Methadone
Buprenorphine
Naloxone
Naltrexone
Methadone is a synthetic opioid and a full opioid agonist, which means it binds to the same receptors in the brain as opioids like heroin and morphine. However, unlike these drugs, methadone is long-acting, which means it can be taken once a day to prevent withdrawal symptoms and cravings. Some brand names include Methadose™, Metadol-D®, Dolophine®, Methadone Syrup®, Biodone Forte®, and others.
In countries such as Canada and Australia, methadone is administered through a variety of loocations, such as a dedicated methadone clinic, pharmacy, addiction treatment centre, inpatient program, outpatient program, and other similar settings . In contrast, the United States only allows methadone to be administered at government regulated methadone clinics.
Buprenorphine is a partial opioid agonist, which means it binds to the same receptors in the brain as opioids but produces less of an effect. Buprenorphine can also be taken once a day and is typically administered in a doctor's office or clinic.
Has similar effect as methadone, but is longer lasting. It can be taken daily or every second or third day due to its long-acting effects.
Taken orally in tablet form, often administered sublingually - dissolved under the tongue to reach bloodstream faster.
Sold under the brand name Subutex®.
Buprenorphine Long-Acting Injections (LAI) are another format available to clients looking for an alternative route of administration of the substance, especially since fewer doses are typically needed. This type of buprenorphine is injected subcutaneously (meaning, under the skin - not intravenously, meaning not directly into the bloodstream). Doses are often administered weekly or monthly depending on the client. Some brand names include Buvidal®, Brixadi™, and Sublocade®.
Naloxone is an opioid antagonist, meaning it blocks the effects of opioids on the brain. Naloxone is used to reverse overdoses as well as in medication assisted treatment. Sold under the brand name Narcan®. If you have an addict in your life, it is strongly advised to keep Naloxone on you when you are with your loved one.
Buprenorphine-Naloxone is commonly known as its brand name, Suboxone®. Unlike buprenorphine on its own, the combination of buprenorphine and naloxone often comes in the form of a sublingual tablet or film. There are some who recommend that the buprenorphine-naloxone combination should be prescribed in preference to buprenorphine on its own. Suboxone® is becoming more popular as a medication used to treat OUD. Other brand names include Bunavail® and Zubsolv®.
Naltrexone is an opioid antagonist, which means it blocks the effects of opioids in the brain. Naltrexone is typically taken once a day as a pill. This medication is also often used to treat alcohol addiction. Some brand names include Revia®, Vivitrol®, and Depade®.
Benefits
MAT has many benefits for individuals with opioid dependence. First and foremost, this treatment contributes to a safer withdrawal experience and reduced risk of overdose. In addition, MAT reduces withdrawal symptoms and cravings, which can be a significant barrier to recovery. This allows individuals to focus on other aspects of their recovery, such as therapy and support groups.
Secondly, MAT - especially OAT - has been shown to reduce the risk of overdose and other negative consequences associated with opioid use. Since medications used in OAT and MAT are taken in a controlled environment with frequent monitoring and measured doses, these medications mitigate the risk of relapse and increase treatment retention. All of this contributes to a reduced risk of fatal overdose.
One problem with OAT medications - especially methadone and buprenorphine - is medication diversion. This refers to the illegal distribution of these medications. However, if methadone prescriptions are stored in bottles with built-in tamper evident features, this can help maintain a clean dose of methadone. A clean dose means it hasn't been mixed/laced with another drug. So, in effect, even if a dose of methadone is sold on the street, there is the benefit of knowing it is a clean dose, free of stronger opiates like Fentanyl. This, in turn, reduces the risk of fatal overdose.
Limitations
Despite its clear benefits, OAT also has limitations that should be considered. One of the main limitations is that OAT is not a cure for opioid dependence. Individuals must continue to take OAT medications to manage their addiction, and they may experience withdrawal symptoms if they stop taking the medication. Additionally, OAT medications can have side effects, and some individuals may not be able to take certain medications due to medical reasons.
Potential side effects of OAT
All OAT medications can have side effects, although these side effects are typically mild and temporary. Common side effects of methadone and buprenorphine include constipation, nausea, and drowsiness.
Naltrexone can also cause side effects, including nausea, headache, and fatigue. In rare cases, naltrexone can cause liver damage, so individuals taking naltrexone should have regular liver function tests.
Limits on Take Away Methadone Doses
Depending on the country, state, or province you reside in, there are limits to the number of take-home methadone doses that are allowed. You must be considered a stable patient to qualify for the maximum number of carries. In countries like Canada, these individuals are allowed up to a month's worth of methadone carries whereas countries like Australia limit it to 6 carries. However, COVID-19 contributed to changes in the maximum number of allowed take-home doses across many countries, with the number of carries often being up to the provider' discretion.
OAT Drugs Can Be Harmful to Others
Given the nature of OAT medications, they can be lethal when not taken as prescribed. Drugs like methadone may look appealing to children given its liquid form, especially when they see their mom or dad drinking it. However, child resistant packaging and closures is required for controlled substances like methadone. Those undergoing methadone treatment can add another layer of protection by storing take-home doses in a secure methadone lock box. LiquiMedLock™ offers a secure methadone lock box with mini padlocks for our child resistant, tamper evident methadone bottles. This is a highly recommended way to keep your loved ones safe and to prevent others from attempting to steal your doses.
Conclusion
The opioid crisis is a far reaching epidemic affecting people across the globe. Addiction to opiates affects people from all walks of life and has devastating consequences for many people. Medication-assisted treatment (MAT) is an evidence-based treatment for opioid use disorder that has helped millions of people recover from their addiction.
Opioid agonist therapy (OAT) be an effective treatment for opioid dependence. This is because opioid agonists have the power to reduce withdrawal symptoms and cravings as well as reducing the risk of overdose and other negative consequences associated with opioid use. However, OAT is not a cure for opioid dependence, and individuals may experience side effects from OAT medications. Despite some of the limitations of OAT, this treatment is not only empirically supported, but many recovered addicts owe their lives to medication assisted treatment for opioid addiction.
LiquiMedLock™ is proud to offer best practice methadone bottles that enhance the safety of both addicts undergoing treatment and the people around them. Our child resistant caps have built-in tamper evident bands to support in tracking chain of custody. Contact us for pricing, MOQ, and more.
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