Preventing Opioid Dependence Relapse
A randomized, placebo-controlled trial suggested that an injectable, sustained-release form of naltrexone increased retention of patients in treatment for opioid abuse. Further studies are necessary to evaluate the efficacy of this treatment modality.
FDA approval of extended-release IM naltrexone for the prevention of relapse to opioid dependence was based on data from a 6-month, multicenter, randomized, phase 3 study, which met its primary efficacy endpoint and all secondary efficacy endpoints. Once monthly treatment with extended-release IM naltrexone showed statistically significant higher rates of opioid-free urine screens compared with placebo .
A study of 150 opioid-dependent individuals examined the efficacy of two methods of outpatient opioid detoxification for induction to extended-release naltrexone .naltrexone-assisted detoxification and a buprenorphine taper. The trial demonstrated that naltrexone-assisted detoxification increased the likelihood of a successful transition to extended-release injection naltrexone by almost threefold compared with those given a buprenorphine taper. Study findings support the development of a detoxification regimen of ascending doses of oral naltrexone for transitioning opioid-dependent patients seeking induction onto XR-naltrexone for the prevention of relapse.
Because decision-making deficits are common, individuals with more prominent deficits may particularly benefit from treatment in a residential setting.
On A Mission For The Governor
Connecticut Governor Dannel P. Malloy unveils opioid crisis plan during a press conference at Yale School of Medicine.
During the press conference, Gov. Malloy said, Connecticut spends over $65 million a year on treatment for opioid dependency. This plan will help ensure that those dollars are spent on the best and most effective ways possible. The CORE teams plan proposes six strategies for addressing the opioid epidemic, including increasing access to high-quality treatment with methadone and buprenorphine and increasing access to naloxone.
Gov. Malloy reached out to Dr. Fiellin last spring, asking him to study treatment and policy options and make recommendations that could help shape Connecticuts response to the opioid epidemic. Fiellin recruited Dr. DOnofrio, Yale School of Medicine faculty member William C. Becker, MD, and Yale School of Public Health faculty member Robert Heimer. The team raced to prepare a report within 90 days, jumping on weekly conference calls with commissioners, state agencies, and the governors office and traveling all over the state to meet with representatives of local organizations working on the crisis.
While Dr. Fiellin is emerging as one of the leading advocates globally for the use of medicine-based treatments for prescription opioid addiction, another Yale School of Medicine faculty member aims to dramatically reduce the use of opioids as painkillershelping individuals to avoid becoming addicted.
Treating Opioid Addiction Begins With Admitting Theres A Problem
If youve gotten hooked on painkillers , it might not be so easy to get off of them. Whether you or someone close to you started taking opioids after surgery or an injury, or youve gotten the medication from someone else, for some people the pain-relieving feeling is so euphoric that after just one or two doses, they become completely dependent and wanting more. And for some of those people, that dependencyof needing to have the drug in the body to feel comfortableturns into full-blown .
Not ready to make the call?
Opioid addiction is often characterized by:
- Misuse or overuse of the drug
- Mixing it with other drugs or alcohol for heightened effect
- Going to different prescribers to try to get more
- Crushing the pills so it can be snorted, injected or mixed with other substances
- Mentally craving or obsessing about the next dose of opioids
Going cold turkey to get off of opioids is not an option for most people when it comes to treating opioid addiction. The withdrawal symptoms can be severe as the drug leaves the body, which can take up to 10 days. And many people who have reached this stage of addiction to opioids require medical oversight, which may include medication-assisted treatment , when appropriate, as well as .
If youre concerned about your own opioid addiction or that of someone you love, then its .
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How Many People Get Treatment For Drug Addiction
According to SAMHSA’s National Survey on Drug Use and Health, 22.5 million people aged 12 or older needed treatment for an illicit* drug or alcohol use problem in 2014. Only 4.2 million received any substance use treatment in the same year. Of these, about 2.6 million people received treatment at specialty treatment programs .
*The term “illicit” refers to the use of illegal drugs, including marijuana according to federal law, and misuse of prescription medications.
Who Provides Medication Assisted Treatment
MAT is a popular, effective treatment that can be found rather easily. Most addiction treatment professionals suggest MAT as a top choice due to its success rate. In many instances, you can discuss your options with your regular medical provider. Your provider may suggest a source of MAT near your residence.
For those who prefer a more serene environment to a rigid hospital setting, most recovery centers offer medication-assisted treatment options. These centers often offer all the tools a person needs to find long-term success. This includes carefully tailored medications paired with behavioral therapy, counseling, art therapy, and more. As a result, a professional addiction treatment facility is often the best choice for holistic healing that incorporates MAT.
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Opioid Treatment Options & Rehab
People with an opioid use disorder can be treated with medications combined with behavioral counseling. The first step of treatment is dealing with the uncomfortable process of opioid withdrawal. For someone who is physically dependent on opioids, symptoms of withdrawal may appear within 6 hours to a couple of days, depending on what type of opioids have been used.17
Symptoms may include:17, 23
- Tearing eyes.
While opioid withdrawal can be painful and uncomfortable, it generally is not life-threatening.23 A medical detox allows medical staff to monitor for potentially dangerous and uncomfortable complications that can develop quickly, lower the risk of relapse, and ensure the safety of the individual during withdrawal.23 In addition, medications can be provided to reduce symptoms of withdrawal. This is known as medication-assisted treatment.23
Opioid withdrawal is generally managed with either methadone or buprenorphine, both of which reduce symptoms of withdrawal and reduce cravings to allow the person to detoxify comfortably and safely.4, 6, 16, 27 Because detox doesnt address the underlying causes of addiction, behavioral counseling is strongly recommended. This may include inpatient or outpatient treatment, where counseling is provided, along with additional medication-assisted treatment if needed.16
Treatment Approaches For Drug Addiction Drugfacts
NOTE: This fact sheet discusses research findings on effective treatment approaches for drug abuse and addiction. If youre seeking treatment, you can call the Substance Abuse and Mental Health Services Administration’s National Helpline at 1-800-662-HELP or go to for information on hotlines, counseling services, or treatment options in your state.
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Mat For Opioid Addiction
Opioid addiction is a serious health issue in the United States. In particular, opioid addiction can change the way a person thinks or behaves, leading to potential criminal activity, broken relationships, and severe depression and anxiety. Worse, opioid addiction is highly detrimental to the health and wellbeing of those who are addicted, causing severe health issues and death.
Opioids continue to be prescribed by physicians to alleviate pain associated with injuries or routine surgeries. While prescription medications can help relieve pain and discomfort, they can also cause a serious addiction that can alter the course of the individuals life. Prescription opioid addiction can often lead to illegal opioid options, furthering the social and economic repercussions of this addiction. For those seeking treatment for their addiction, medical-assisted treatment, or MAT, can be a viable option.
Finding Alternatives To Addictive Painkillers
Stephen Waxman, MD, director of the Center for Neuroscience and Regeneration Research at Yale School of Medicine, has spent over a decade researching effective non-addictive painkillers as alternatives to opioids. To do this, Dr. Waxman has been working with patients suffering from a debilitating genetic illness called “man on fire” syndrome, which causes searing pain in response to even moderate heat, pressure, exertion or stress. By studying these patients, Dr. Waxman has pinpointed the genetic mutation that causes an increased sensitivity in pain-signaling neurons. A similar sensitivity causes chronic pain in normal individuals without man on fire syndrome.
Medicines that target specific nerves and prevent them from sending pain signals without affecting the brain are now entering clinical trials. The initial results are promising. If approved, these drugs could become widely used, non-addictive painkillers.
Over the last couple of years, Dr. Waxman has fielded dozens of phone calls from parents of children suffering excruciating pain from man on fire syndrome. Their stories have given Dr. Waxman a sense of personal responsibility for finding a solution to pain. It was a transformative moment when I could change my response from Please know were trying to help your child, to saying Im reasonably confident that at some point we can help your child, he says.
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Treatment Of Opiate Addiction
One of the best ways to treat opiate addiction is using medication. This is known as medication-assisted treatment or MATs. Typically, this will use one of three medications that will help reduce the amount of withdrawals and their symptoms.
Lets take a look at the following types of medications that are used in MATs:
What Causes Opioid Addiction
Opioid drugs alter your brain by creating artificial endorphins. Besides blocking pain, these endorphins make you feel good. Too much opioid use can cause your brain to rely on these artificial endorphins. Once your brain does this, it can even stop producing its own endorphins. The longer you use opioids, the more likely this is to happen. You also will need more opioids over time because of drug tolerance.
Drug tolerance is when your body, over time, gets used to the effects of a drug. As this happens, you may need to take a higher dose of the drug to get the same effect. When you take opioids over time, you need a higher dose to get the same pain relief.
If you stop using an opioid for a period of time, your tolerance will begin to fade. If you need to begin taking it again, you most likely will not need your former higher dose. That can be too much for the body to take. If you stop taking a medication, and then resume, talk to your doctor about dosage.
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Sleep Dysfunction As A Core Feature Of Opioid Use Disorder And Recovery
The NIH HEAL Initiative will support research using genomic, molecular, pharmacological, and clinical approaches to better understand sleep and circadian factors relevant to addiction and how these factors influence one another. This research could open new avenues for therapeutic strategies, OUD prevention, and treatment approaches.
How Does Counseling Treat Opioid Misuse And Addiction
Counseling for opioid misuse and addiction can help you:
- Change your attitudes and behaviors related to drug use
- Build healthy life skills
- Stick with other forms of treatment, such as medicines
There are different types of counseling to treat opioid misuse and addiction, including:
- Individual counseling, which may include setting goals, talking about setbacks, and celebrating progress. You may also talk about legal concerns and family problems. Counseling often includes specific behavioral therapies, such as
- Cognitive-behavioral therapy helps you recognize and stop negative patterns of thinking and behavior. It teaches you coping skills, including how to manage stress and change the thoughts that cause you to want to misuse opioids.
- Motivational enhancement therapy helps you build up motivation to stick with your treatment plan
- Contingency management focuses on giving you incentives for positive behaviors such as staying off the opioids
- Group counseling, which can help you feel that you are not alone with your issues. You get a chance to hear about the difficulties and successes of others who have the same challenges. This can help you to learn new strategies for dealing with the situations you may come across.
- Family counseling/ includes partners or spouses and other family members who are close to you. It can help to repair and improve your family relationships.
Counselors can also refer you to other resources that you might need, such as:
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How Should You Respond To An Opioid Overdose
If you think someone may be experiencing an opioid overdose, take the following actions immediately:
If You Get Little or No Response
If lightly tapping, shaking, and shouting at the person or rubbing your knuckles on the personâs breastbone do not elicit a response , take the following actions:
Group Counseling And Other Forms Of Support
Counseling, which can include individual, groups, and family counseling, can also be beneficial when one is undergoing treatment for opioid dependence.
Individual counseling may consist of setting goals, talking about setbacks, and celebrating progress. It can include cognitive behavioral therapy, as well as motivational enhancement therapy, which helps build motivation to stick with a treatment plan and contingency management, which focuses on incentives for positive behaviors, like staying off opioids.
Group counseling consisting of others dealing with opioid dependence can help you feel like you are not alone in your struggle. You will hear others stories of difficulties and successes, which can in turn help you learn new strategies for dealing with your own situation.
Finally, family counseling can help improve your interpersonal relationships by making your spouse and other close family members part of your treatment plan.
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Opioids And The Brain
Opioids are often abused because of the various effects that they can have on the brain. Ballantyne, J. C. . The brain on opioids. Pain, 159, S24-S30. Retrieved 4/14/2022 at Opioids activate the reward centers located in the brain responsible for the release of endorphins. These neurotransmitters provide a feel-good effect, responsible for numbing the perception of pain and enhancing feelings of pleasure. They provide a sense of well-being, though short-lived.
Unfortunately, long-term use can lead to the body slowing its natural production of endorphins, which in turn raises an individuals tolerance level to the opioid drug. This means that a person will need a higher dose to experience the same effects, increasing the risk of overdose, which can be fatal.
Stopping opioid use can be extremely difficult because of the way it alters the brain and body. When a person doesnt have enough of the addictive substance in their system to maintain the chemical balance the brain has become used to, they can experience withdrawal. Symptoms of withdrawal can include agitation, anxiety, insomnia, abdominal cramping, nausea, and vomiting. Withdrawal symptoms can be extreme and potentially life-threatening. This is why it is so important to seek professional medical care when trying to overcome opioid dependence.
How Moud Can Help
When people become dependent on opioids, they feel sick when there are no or fewer opioids in the body. This sickness is known as withdrawal. Along with intense cravings, withdrawal is a hallmark of opioid addiction, and can make recovery especially difficult.
In addition to tailoring medications to address cravings and withdrawal, a comprehensive treatment approach may also include therapy or counseling to address behavioral issues, support recovery and prevent relapse. Family therapy is especially effective for teens and young adults to address substance use along with other issues that often affect youth who are at risk, such as mental health problems.
We sat down with a variety of addiction treatment professionals to learn more about medication-assisted treatment options including naltrexone , buprenorphine and methadone.
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What Should You Do If You Or Someone You Know Is Addicted
If you or a loved one is ready to seek help for an addiction, the first step is to find a physician or other health professional who can help. Ask your physician for a referral to a medical professional in addiction medicine. Or search the American Society of Addiction Medicineâs website for addiction specialists in your area. The American Academy of Addiction Psychiatry also has a Patient Referral Program.
Another resource is the Substance Abuse and Mental Health Services Administration toll-free help line to find drug treatment near you: 1-800-662-HELP . Or you can visit SAHMSAâs Behavioral Health Treatment Services Locator. Thereâs also a State Agencies webpage that helps you find state agencies that might have special programs for you or a loved one.
If you or a loved one is ready to seek assistance for an addiction, the first step is to find a physician or other health professional who can help.
If you are supporting a friend or loved one in overcoming addiction, the National Institute on Drug Abuse offers the following advice: Assure your friend or loved one that addiction can be managed successfully, but acknowledge that it may take several attempts at treatment to find the best approach. If your friend or loved one refuses to seek help, a confrontational âinterventionâ is not recommended. These encounters can escalate into violence or backfire in other ways. Try to convince the person to consult with a physician.