If you are addicted to opiates, your doctor may discuss the possibility of substitution therapy with you. Below you will find answers to some of the most frequently asked questions about this treatment.
What should I consider when choosing between methadone and Suboxone?
Methadone has been successfully used to treat opioid addictions in the U.S. since the 1970s. A full opiate agonist, methadone works by mitigating withdrawal symptoms, reducing cravings, and preventing users from getting high on heroin or other opioids. Because it has a high potential for abuse and can be fatal in the event of an overdose, methadone can only be distributed at licensed methadone maintenance clinics, and patients in treatment must travel to the clinic daily to receive their medication.
Suboxone is a newer alternative to methadone that consists of buprenorphine, a partial opioid agonist, and naloxone, an opioid antidote. Like methadone, Suboxone prevents withdrawal and cravings; however, it is less likely to cause a fatal overdose because at higher doses, buprenorphine reaches a ceiling effect. Naloxone is an added safety precaution. If patients were to dissolve the tablets and inject them, they would experience opioid withdrawal symptoms because the intravenously injected naloxone would prevent their body from absorbing the buprenorphine. For these reasons, Suboxone may be prescribed by a physician at his/her doctor's office, and patients may take their medication at home.
Although methadone requires daily clinic visits, it is sometimes the best choice for patients who have severe opioid addictions. Because it does not have a ceiling effect, methadone works for patients who require very high doses to prevent withdrawal symptoms. Methadone also tends to be less expensive than Suboxone.
Is substitution therapy safe?
Yes. When used as directed, methadone and Suboxone may be safely taken for many years. They may cause mild side effects, such as constipation, sweating, or stomach ache, but these side effects often subside over time. Rarely, methadone may cause serious side effects, but the risks associated with these medications are significantly less than the risks associated with illicit opioid use.
Is substitution therapy safe during pregnancy?
Yes. Both methadone and Suboxone may be safely taken throughout pregnancy. In fact, continuing substitution therapy throughout pregnancy prevents expectant mothers from relapsing into opioid abuse and helps to protect the health of both mother and child. Newborn infants do experience withdrawal from both methadone and Suboxone, but this can be safely treated in the hospital. Some studies suggest that Suboxone may cause fewer withdrawal symptoms in newborns. No long-term risks to the child’s health have been shown as a result of exposure in utero to either methadone or Suboxone.
What other options do I have besides substitution therapy?
Detoxification (medically monitored withdrawal in either an outpatient or inpatient setting) in combination with regular psychotherapy can sometimes be effective in preventing relapse.
Naltrexone injections and implants can also be used to help recovering opioid addicts remain sober.
Does substitution therapy replace rehab or other therapy?
No. Medications alone are not effective for helping addicts stay away from drugs in the long term. You must continue to participate in drug counseling, psychotherapy, and support groups to make the daily lifestyle choices needed to stay in recovery.
Can substitution therapy be used for other opioid addictions besides heroin?
Yes. Methadone or Suboxone may be used to treat addictions to any opioid drug. In addition to heroin, substitution therapy can help treat addictions to morphine, opium, and narcotic painkillers, including oxycodone, Vicodin, and codeine.
Many other questions are likely to arise during treatment, especially if substitution therapy will be involved. If you or a loved one is struggling with an opiate addiction, contact the UCLA Dual Diagnosis Program today.
