MAT (Medication assisted treatment) for opioid addiction.
There are two medications available to manage and treat opioid addiction, Buprenorphine and Naltrexone.
The preferred medication is Buprenorphine. It is available as tablets and films; as Suboxone and Subutex Naltrexone is available as an oral tablet and a once a month injection which is available as VIVITROL.
How do these medications work?
Buprenorphine works by attaching to opioid receptors and acting like an opiopid. It is a long acting drug and a single or twice daily dose is enough to prevent withdrawal symptoms for 24 hours.
Naltrexone also attaches to opioid receptors, but does not act like an opiopid, rather it blocks the opioid receptor. Naltrexone is also a long acting drug and is taken as a single daily dose, or a once a month injection.
Buprenorphine prevents opioid withdrawal, and is used to treat opiopid withdrawal. However, it is an opioid, and has some of the same drawbacks as other opioids. It is a controlled substance, only prescribers with special licenses can prescribe it, it is more expensive, and it needs to be gradually tapered to prevent withdrawal.
Naltrexone does not prevent opioid withdrawal and is not used to treat opioid withdrawal. However, once withdrawal has been adequately treated, Naltrexone can be used to reduce cravings, and because it blocks other opioids, it removes the incentive to use them.
Naltrexone is a tablet, it is not an opioid, it is not a controlled substance, it is inexpensive, does not cause sedation.
VIVITROL is an injection form of Naltrexone and one injection is effective for four weeks. This is more expensive and some insurances may not cover the cost.
Naltrexone also approved to treat alcohol addiction.
Buprenorphine & Suboxone
Buprenorphine is an opioid agonist, it acts like other opioids. Once taken it reaches the brain and attaches to opioid receptors and prevents withdrawal symptoms and cravings. When patients are assured that they will not have any withdrawal symptoms, it relieves their anxiety, and they do not have any need to search for and obtain opioid drugs.
By preventing withdrawal symptoms, it allows patients to continue to work, or attend school. If taken as prescribed it does not cause any sedation, and patients can drive and work with machinery.
It is prescribed by a licensed provider, and dispensed by pharmacies. It is suitable for outpatient use and eliminates the need for expensive inpatient rehab. It is a better alternative to daily visits to Methadone clinics.
Studies have shown that patients on Suboxone therapy are more likely to start working towards recovery and changing their drug using behaviors.
Our clinic offers group counseling and individual therapy to aid with recovery.
Once the drug cravings are in control and the patient has stopped the drug seeking behavior, then patient and provider can start to work to taper the dose, and come off the medication according to each individual’s need.
This is a very gentle method where the patient, with the guide of the provider, remains in control of the process.
How Is Buprenorphine Dosed?
Typically patients receive 8mg to 16mg/day at the beginning of therapy (one to two tablets or films) and then taper to a dose of 8mg/day or less as maintenance. Well motivated and disciplined patients can complete the program within a few months, but most patients take a year or longer. No matter how long it takes, patients still save money, their careers, their marriage and ultimately, their life.
Many insurance/prescription plans cover this medication, including AHCCCS.
You can read my Suboxone treatment protocol here.
Buprenorphine is cheaper than the street drugs you use, it is available as a fast acting tablet and film, that you can take in the privacy of your home without having to go to rehab without disrupting your work or school
What is the difference between Suboxone and Subutex?
You can read about the various formulations of Buprenorphine here.
Naltrexone for opioid addiction
Naltrexone is available as as generic tablet (50mg), and once a month depot injection (380mg) called Vivitrol.
Naltrexone is currently not the preferred drug for treating opioid addiction because Naltrexone does not prevent or manage opioid withdrawal.
Patients can only start Naltrexone AFTER they have been through opioid withdrawal, and has been abstinent for 7 to 10 days.
Typically, Naltraxone is used after the successful completion of the Suboxone Program.
Naltrexone is not an opioid rather, it is an opioid blocker. Once taken it attaches to opioid receptors in the brain and prevents other opioids from attaching to those receptors, thus preventing their action. Over time patients experience a reduction in cravings and diminished desire to use drugs.
Naltrexone, is generally not prescribed to patients with liver failure or acute hepatitis. It is used with caution in patients who have elevated liver enzymes, and may be stopped if serum enzymes indicative of liver injury continue to rise.
Naltrexone is not an opioid, is not addictive, does not cause any cognitive impairment or sedation, and is safe for patients who have to drive or operate machinery. It is not screened for in urine drug screens.
Average duration of use is three to six months. By that time patients are expected to have changed drug seeking behaviors.
Addiction is not cured by a pill. Naltrexone is not a good choice for patients who are not motivated and do not have the self discipline to abstain from drugs. Such patients can beat the treatment process by not taking Naltrexone or taking too much opioids to overcome the block. For these patients, there is a significant risk of overdose death, because after using Naltrexone for some time, their brain becomes very sensitive to opioids.
Medication cost: Cost of Naltrexone tablets is $1 to $2 per tablet. It is prescribed as one tablet per day, 30 tablets per month … the medication cost comes to about $30 to $60 per month. Most insurance plans cover the cost of the medication, including AHCCCS.
Naltrexone is now the preferred drug for use in the treatment of alcohol addiction. It is now also approved for weight reduction in the treatment of morbid obesity in combination with Bupropion.
Download the Naltrexone booklet here.
Vivitrol is the injectible form of Naltrexone. It is given as a once a month injection. It is expensive ($1100 to $1600 per injection) and currently it can only be obtained through a specialized program.
After successful treatment with Suboxone, we will discuss with you the needs for VIVITROL if appropriate. You can find more information through the manufacturer’s website https://www.vivitrol.com
Download the Vivitrol booklet here.
Caution: Once patients have been abstinent from opioids and used Naltrexone for some time, they become very sensitive to opioids. If the patient decides to use opioids again, their usual opioid dose can cause overdose or even death.
A word about Methadone.
Methadone is not used to treat opioid addiction. Methadone is offered through government contracted Methadone treatment programs or Methadone maintenance programs.
Our clinic does not offered this service.
In USA medical providers in private practice are prohibited from prescribing Methadone for opioid dependence or addiction.