Addiction Treatment Forum reports on substance abuse news of interest to opioid treatment programs and patients in methadone maintenance treatment.

FAQFrequently Asked Questions (FAQs) - and Answers

If you have repeated problems accessing any links, copy and paste the URL into your web browser. If problems persist, please notify the web site administrator at feedback@atforum.com


Disclaimer

Responses to Frequently Asked Questions (FAQs) were developed by the editorial staff of Addiction Treatment Forum and made possible by an educational grant from Mallinckrodt Pharmaceuticals, a manufacturer of methadone and naltrexone.

The contents of these FAQs are for informational purposes only and should not be used to diagnose or treat a health problem or disease. The contents are not intended to be nor should they be used in any way as a substitute for professional diagnosis or treatment.

Any information you find here or on websites that we link to should be verified with your professional healthcare provider, who should also be consulted regarding any specific medical questions or problems you may have. If you think you may have a medical emergency or any condition requiring immediate attention, call your doctor or 911 immediately.

Addiction Treatment Forum does not specifically recommend or endorse any specific tests, products, procedures, opinions, or other information mentioned in these FAQs. Reliance on any information appearing here is solely at your own risk. The users of this site shall indemnify and hold Addiction Treatment Forum, its employees, agents, and sponsors harmless from and against any and all damages, liabilities, losses, costs, and expenses, including reasonable attorney’s fees, arising out of or related to use of information, services, or products mentioned at this website.



Medication-Assisted Treatment (MAT) For Opioid Addiction

What Is Medication-Assisted Treatment?

Medication-assisted treatment (MAT) is any treatment for opioid addiction that includes a medication approved by the U.S. Food and Drug Administration. Three medications are currently approved for MAT: methadone, buprenorphine, and naltrexone.

MAT is usually provided in an outpatient opioid treatment program (OTP). OTPs offer a variety of comprehensive services including individual and group counseling, as well as provision or referral to medical psychological, and social services.  Methadone is the primary medication used in MAT.

Methadone has a success record of more than 45 years in treating opioid addiction. Although methadone    is an opioid medication, it acts in a different way from heroin and other opioids. It can be taken once daily, because it stays in the body longer than other opioids. The right individualized dose of methadone takes away the craving for opioids.

Buprenorphine, as an alternative to methadone, has been available since 2002. It, too, is an opioid medication. To date, buprenorphine is usually prescribed by doctors in an office-based practice.  Forthcoming legislation should ease restrictions on dispensing buprenorphine in OTPs.

A third medication, naltrexone, is not an opioid drug.  Instead, it blocks the effects of opioids such as heroin and morphine. People starting to experiment with opioids, and those in the early stages of addiction may benefit from naltrexone treatment.

Added July 2009

< Back to Contents >



How Does Medication-Assisted Treatment With Methadone Help Patients?

 Methadone is part of a comprehensive program, called medication-assisted treatment (MAT), for treating opioid addiction. Methadone treatment has been used successfully for more than 45 years. It has helped millions of people regain control of their lives and regain their ties with family and friends.

 Methadone treatment offers many benefits:

Sources:

Bell J, Zador D. A risk-benefit analysis of methadone maintenance treatment. Drug Saf. 2000;22(3)179-190.

Dole VP. Implications of methadone maintenance for theories of narcotic addiction. JAMA. 1988;260:3025-3029.

Joseph H, Stancliff S, Langrod J. Methadone maintenance treatment (MMT): a review of historical and clinical issues. Mt Sinai J Med. 2000;67(5-6):347-364.

For additional information and references, see Addiction Treatment Forum:

Leavitt SB. Methadone Dosing & Safety, available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/DosingandSafetyWP.pdf

Revised July 2009

< Back to Contents >



succeedHow Can I Succeed In Medication-Assisted Treatment?

The broad goal of medication-assisted treatment (MAT) is to help people stop using heroin or abusing other opioid drugs. These people will then be better able to lead more stable, productive lives in recovery. Staff at opioid treatment programs (OTPs) set goals to help patients in many ways. Staff members:

Recovery in MAT is an ongoing process. Full recovery may take many months or years. Methadone starts the recovery process, but the rest depends on how much the patient wants the recovery process to work. The patient needs to cooperate with the program staff, help the staff carry out their goals, and make the life changes necessary for recovery.

Revised July 2009

< Back to Contents >



Doesn’t Methadone Just Substitute One Addictive Drug For Another?

Methadone maintenance is a type of drug replacement treatment that counteracts the craving for abused opioids, such as heroin and prescription opioid drugs.

In many ways, methadone treatment for someone addicted to opioids is like insulin treatment for a diabetic patient. By injecting insulin, a diabetic patient replaces the body’s missing insulin. But unlike insulin, methadone does more than just replace something that is missing. Adequate individualized doses of methadone, taken under medical supervision, stop addictive behavior. Methadone helps people overcome the debilitating influence of illegal opioids, so they can lead healthier, more normal lives.

Methadone does away with unsuccessful tries to cut down on drug abuse, never-ending searches for more drug, unmet obligations, and continual use of illegal drugs—despite personal harm.

Some people think of methadone as just a crutch for people who are too weak to stop taking drugs. But as Vincent Dole, MD—a developer of methadone maintenance treatment—once said, “There's absolutely nothing wrong with using crutches if it helps a person get back on his feet and move forward in addiction recovery. We need more crutches like that.” [Personal communication to Addiction Treatment Forum, 1996.]

Sources:

Goldsmith DS, Hunt DE, Lipton DS, Strug DL. Methadone folklore: beliefs about side effects and their impact on treatment. Human Organization. 1984;43(4):330-339.

McCann MJ, Rawson RA, Obert JL, Hasson AJ. The treatment of Opiate Addiction with Methadone. Technical Assistance Publication (TAP) 7. Rockville, MD: Center for Substance Abuse Treatment; 1994. Publication (SMA) 94-2061.

Zweben JE, Sorensen JL. Misunderstandings about methadone. J Psychoactive Drugs. 1988;20(3):275-281.

Revised July 2009

< Back to Contents >



Can Methadone Treat Addiction To Other Drugs Besides Heroin?

When methadone is taken daily, as part of a long-term comprehensive recovery program, it has a high success rate in treating addiction to opioid drugs. This class of drugs includes those made from the opium poppy, like heroin, morphine, or opium itself – these are often called “opiates.” Other opioids are made synthetically, like the prescription drugs oxycodone (Percocet), hydromorphone (Dilaudid), hydrocodone (Vicodin), codeine, and others.

All opioids work on similar structures in the brain called receptors. Methadone is a long-acting opioid. Taken just once daily, in proper doses, it occupies these receptors blocking the effects of other opioids, such as heroin. By occupying the receptors, methadone prevents “highs” and “lows,” withdrawal symptoms, and drug craving.

Methadone is not used to treat addiction to non-opioid drugs, such as cocaine, alcohol, marijuana, or other substances of abuse. In fact, taking those other substances while in treatment can slow down a person’s progress in recovery. Most patients who are taking adequate methadone doses stop using or reduce their use of other psychoactive substances. Counseling and psychosocial therapy, including 12-Step groups, may be useful in dealing with the problems of other drug and alcohol abuse. Otherwise, their recovery during methadone treatment may be slowed.

Sources:

Zweben JE, Payte JT. Methadone maintenance in the treatment of opioid dependence; a current perspective. West J Med. 1990;152:588-599.

Zweben JE, Sorensen JL. Misunderstandings about methadone. J Psychoactive Drugs. 1988;20(3):275-281.

Revised July 2009

< Back to Contents >



stay on methadoneHow Long Does A Patient Need To Stay In Medication-Assisted Treatment With Methadone?

The patients who are most successful in medication-assisted treatment (MAT) with methadone stay in treatment for more than a year. Many patients need to continue treatment indefinitely, as is the case with any chronic medical condition.

Patients who stay in MAT with methadone for less than three months usually show little or no continued improvement. After several months in treatment, patients are stabilized on methadone. At that point, the use of illegal opioids drops by up to 80%. But leaving treatment after that carries substantial risks. Almost all patients who leave MAT and do not have further treatment of some sort eventually relapse, and risk having an overdose.

Sources:

For additional information and references, see: Addiction Treatment Forum [Special Report], A Community-Centered Solution for Opioid Addiction: Methadone Maintenance Treatment (MMT), available at: http://atforum.com/SiteRoot/pages/addiction_resources/com_ctrd_mmt.pdf

Also: Brown LS, et al. The interrelationships between length of stay, methadone dosage, and age at an urban opioid treatment program. Paper presented at: CPDD (College on Problems of Drug Dependence) 65 th Annual Meeting; June 2004; San Juan, Puerto Rico.

Revised July 2009

< Back to Contents >



stop methadoneHow Can I Get Off Of Methadone?

Methadone patients who are considering stopping treatment need to talk with their health care professionals. They need to discuss why they want to stop treatment, what options they have, and what their follow-up treatment options will be. Patients must not quit MAT or lower their methadone dose on their own.

Medically Supervised Withdrawal. The generally accepted way to stop methadone maintenance treatment is called medically supervised withdrawal (MSW). The patient becomes opioid-free gradually, under a doctor’s care. The daily dose of methadone is decreased by small amounts, over many weeks or months, depending on how the patient responds. This minimizes the uncomfortable symptoms of withdrawal and craving. Stopping methadone abruptly—often called “cold turkey”—causes intense withdrawal symptoms and drug craving.

The patient needs to continue with some type of therapy after withdrawal. Few patients stay drug-free for long if they withdraw from methadone or other opioids without continuing in some form of addiction treatment program.

Rapid Withdrawal. Rapid withdrawal takes only hours. Patients are given a general anesthetic so they can tolerate the otherwise severe withdrawal symptoms. Then medications are used to remove methadone or other opioids from the body. This method is expensive, and its safety and long-term effects are under study. Many or most people return to opioid abuse (relapse) after rapid withdrawal.

Revised July 2009

< Back to Contents >



Isn't Methadone Harder To "Kick" Than Heroin ?

Many patients in medication-assisted treatment (MAT) worry about going off methadone. They’ve heard that it’s harder to “kick” than heroin.

Years ago, a study found that methadone withdrawal is less severe than withdrawal from short-acting opioids, like heroin. Because methadone is long-acting, withdrawal lasts much longer than withdrawal from short-acting opioids. So a person who has withdrawn “cold turkey” at different times from heroin and from methadone might say that “kicking” methadone was worse – because it lasted longer. This may be how the myth started.

Methadone withdrawal should never be “cold turkey.” Gradual withdrawal under medical supervision can be virtually free of discomfort. Unfortunately, patients who try to withdraw from methadone by themselves, on their own time and dose schedule, almost always suffer needlessly, and fail.

Some patients forget that they entered MAT because they could not stay away from opioids. When they decide to leave MAT, they find they cannot just stop taking methadone. Then they blame the methadone, instead of the heroin or other opioid that upset their brain chemistry in the first place. For many people who were addicted to opioids, methadone is a lifelong medication. It is necessary for controlling brain function—much like a diabetic patient who needs insulin every day to live a normal life.

Sources:

Rosenblum A, Magura S, Joseph H. Ambivalence toward methadone treatment among intravenous drug users. J Psychoactive Drugs. 1991;23(1):21-27.

Velten E. Myths about methadone. NAMA Education Series, Number 3. March 1992.

Revised July 2009

< Back to Contents >




What Is Buprenorphine?

Buprenorphine is a medication that might be used to treat opioid addiction in some people. It blocks the effect of other opioid drugs, like morphine or heroin. It is less potent than methadone, but can block methadone’s effects, so switching a patient to buprenorphine must be done gradually.

Buprenorphine is taken by dissolving a tablet under the tongue. As part of a comprehensive addiction recovery program, it can help reduce withdrawal symptoms and craving for opioids. Buprenorphine may have somewhat milder withdrawal symptoms when it is stopped and relatively less potential for overdose, than methadone. However, buprenorphine may not be potent enough to treat some opioid-dependent people who require higher doses of an opioid to control craving. As with methadone, buprenorphine has little effect in reducing abuse of other substances, such as cocaine or alcohol.

In 2002, the Food and Drug Administration (FDA) approved buprenorphine for dispensing by prescription. Any physician with adequate education on the drug and special licensing can prescribe it. This includes qualified community-based private practice physicians; patients need not attend a special clinic daily to receive the medication. Buprenorphine can also be prescribed or dispensed in an opioid-treatment program (OTP). To date, buprenorphine as an alternative to methadone to treat opioid addiction has not been widely adopted by OTPs. Future changes in federal regulations are expected that would make it easier for OTPs to dispense buprenorphine.

Buprenorphine is not generally viewed as a replacement for other approved treatments for opioid addiction such as methadone or naltrexone. Instead, it is an added treatment that may be beneficial for certain patients. Also, many patients benefit from the close monitoring, psychosocial therapy, and other rehabilitative services provided by OTPs. The long-term outcome for patients treated with buprenorphine in doctors’ offices remains to be seen.

For further information, see:
Center for Substance Abuse Treatment (CSAT). Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43. DHHS Publication No. (SMA) 06-4214. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005, reprinted 2006.

FDA Talk Paper: Subutex and Suboxone approved to treat opiate dependence.

Revised July 2009

< Back to Contents >




What Is Naltrexone? Is It Helpful For Treating Opioid Addiction?

Naltrexone, a long-acting drug developed in 1963, is taken by mouth to block the effects of opioid drugs, such as morphine, heroin, oxycodone, methadone, and others. After taking naltrexone, abuse of an opioid drug is automatically discouraged because the opioid does not produce a “high.”

Naltrexone is sometimes used in long-term addiction recovery. It helps to eliminate opioid-drug cravings and drug-seeking behavior, and to prevent further use of illicit opioids. First, however, the person must be gradually weaned-off all opioid drugs (withdrawn or “detoxed”); otherwise, taking naltrexone could cause severe withdrawal symptoms.

As a newer and still somewhat experimental approach, naltrexone or similar drugs are used to rapidly detoxify an opioid-dependent person. For this, the patient is first put to sleep (general anesthesia), because the withdrawal would be too intense to endure. Detoxification takes hours rather than days or weeks. After that, the patient takes naltrexone tablets daily for several months or longer. This approach – generally known as “rapid opioid detoxification” – can be expensive and its long-term benefits, except for relatively few patients, have been questioned by many authorities.

For treating alcoholism, naltrexone helps encourage abstinence from alcohol, or at least it helps reduce the number of drinks taken at any one time. It helps prevent full relapse to abusive drinking. The FDA approved the drug for this purpose in 1994. Naltrexone is not considered a cure for opioid addiction or alcoholism and it must be used as part of a more comprehensive recovery program.

For further information and references, see:
Leavitt SB. Naltrexone in the Prevention of Opioid Relapse. Addiction Treatment Forum [Special Report]. August 2002. Available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/NTX-Opioid.pdf

Leavitt SB. Evidence for the Efficacy of Naltrexone in the Treatment of Alcohol Dependence (Alcoholism). March 2002. Available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/NaltrexoneWhitePaper.pdf

Revised July 2009

< Back to Contents >