Pros and Cons of Opioid Dependency MedicationPeople who take illicit opioid street drugs or improperly consume prescription pain medications can develop symptoms of dependence and addiction. Opioid treatment programs rely on the use of several medications to provide help for those affected. Each of these approved medications is known to provide important benefits. However, anyone taking or prescribing them must be aware of the potential drawbacks that come with their use.

FDA Approved Medications for Opioid Treatment

In the U.S., the Food and Drug Administration (FDA) has approved three medications for people receiving treatment for opioid addiction[i]. Two of these medications — buprenorphine and methadone — are also opioid substances. However, when used properly in a treatment setting, they have a therapeutic effect and do not produce the “high” that tends to drive addiction.

Buprenorphine is a relatively weak medication classified as a partial opioid agonist. Substances in this category only partially activate the chemical pathways that allow opioids to reach the brain. Methadone belongs to the family of full opioid agonists, which have an easier time triggering changes in the brain’s chemical environment.

Naltrexone is not an opioid. In fact, it belongs to a group of substances called opioid antagonists or anti-opioids. When they enter circulation, these substances block the activity of opioid drugs and medications, preventing them from producing their painkilling and euphoric effects.

Pros and Cons of Buprenorphine

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) notes that buprenorphine provides several benefits for the treatment of opioid addiction. These benefits include:

  • A reduction in the intensity of withdrawal symptoms during opioid detox[ii]
  • A reduction in the intensity of the craving for continued opioid use
  • A reduced risk for medication abuse during treatment
  • A reduced risk for fatal overdoses during relapse episodes

The upside of buprenorphine use is accompanied by several potential drawbacks. For example, anyone who takes the medication can experience side effects such as:

  • An irritable mental state
  • An anxious or distressed mental state
  • Nausea accompanied by vomiting
  • Insomnia
  • A spike in normal body temperature
  • Cramping and aching muscles
  • Continued cravings for opioid use

Some people in treatment may attempt to use buprenorphine as a substitute target for opioid abuse. To help prevent this possibility, the medication can be combined with an anti-opioid called naloxone. When taken in the proper amount, naloxone acts as a kind of shutoff switch for buprenorphine by limiting the opioid’s mind-altering effects. Several branded medications, including Suboxone, Zubsolv and Bunavail, contain a combination of buprenorphine and naloxone.

Pros and Cons of Methadone

Methadone is used to achieve two goals in opioid treatment[iii]. First, the medication eases the severity of withdrawal symptoms by decreasing pain sensitivity in the central nervous system (i.e., brain and spinal cord). In addition, its presence in the bloodstream blocks the euphoric effects of all commonly abused opioid painkillers and street drugs. Methadone is commonly used in long-term maintenance therapy programs, and as a temporary treatment with abstinence as a final goal.

As a full opioid agonist, methadone can easily trigger addiction if taken improperly. To avoid this possibility, federal law limits availability of the medication to treatment programs that meet SAMHSA approval. In addition, doctors keep close watch on people who receive the medication, check for signs of developing problems and make dosage adjustments whenever required.

Methadone use can also lead to the onset of certain serious side effects, including:

  • Chest pain
  • Breathing problems
  • Dizziness
  • Fainting
  • Confusion
  • Sensory hallucinations
  • Rash
  • Hives
  • A swollen throat, tongue, lips or face

Anyone who experiences any of these problems should seek medical assistance at once.

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Pros and Cons of Naltrexone

When used at the proper time in treatment, naltrexone provides two important benefits. First, it helps reduce the severity of ongoing opioid cravings[iv]. In addition, when present in the bloodstream of a person who relapses back into opioid use, the medication stops that person from getting high.

Since naltrexone immediately disrupts the effects of opioid substances, its use during the detox process can lead to the rapid development of serious withdrawal symptoms. For this reason, doctors only prescribe the medication for people who have completed detox and established an initial state of abstinence for at least one week. Side effects that can occur in naltrexone recipients include:

  • Stomach upsets
  • Diarrhea
  • Sleep disruptions
  • Headaches
  • Joint and muscle soreness
  • Vomiting
  • Unusual nervousness

Methadone vs Suboxone

Suboxone is the best-known branded medication containing buprenorphine and naloxone. In programs that pursue opioid maintenance as a goal instead of complete abstinence, doctors can use this medication as an alternative to methadone. There are two potential advantages to programs that prescribe Suboxone or other branded buprenorphine/naloxone products. First, while doctors can only administer methadone in federally approved facilities, they can administer Suboxone in a wider variety of settings, including their own offices. In addition, as a partial opioid combined with an anti-opioid, Suboxone presents a much lower risk for abuse than methadone.

Dangers of Self-Detox

Anyone who goes through opioid detoxification should do so in a medically monitored setting under a doctor’s oversight. There are two main reasons for following this important precaution. First, the medications used to ease the severity of opioid withdrawal are only available in medical detox facilities. In addition, people who attempt to detox on their own run the risk of experiencing mild to severe withdrawal complications that put their health at risk.

The Importance of Addiction Counseling

To achieve the best possible results, medication use in opioid treatment must be paired with addiction counseling and some form of behavioral psychotherapy. Counseling and behavioral therapy allow[v] people in recovery to do such things as:

  • Understand the underlying causes of their substance problems
  • Recognize the places and situations that make them more likely to take part in substance abuse
  • Develop coping skills that help them avoid relapse in those places and situations
  • Decrease their chances of relapsing while still in treatment
  • Improve their willingness to meet their individualized treatment goals

A recommendation for or against medication assisted treatment should only be made after completing a thorough psychiatric and medical assessment. Then, and only then, a successful addiction treatment plan can be implemented based on the individual needs of the client.

  1. The Pew Charitable Trusts: Medication-Assisted Treatment Improves Outcomes for Patients With Opioid Use Disorder
    http://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2016/11/medication-assisted-treatment-improves-outcomes-for-patients-with-opioid-use-disorder
  2. Substance Abuse and Mental Health Services Administration: Buprenorphine https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
  3. Substance Abuse and Mental Health Services Administration: Methadone https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone
  4. Substance Abuse and Mental Health Services Administration: Naltrexone https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone
  5. National Institute on Drug Abuse: Principles of Drug Addiction Treatment – A Research-Based Guide (Third Edition)
    https://www.drugabuse.gov/sites/default/files/podat_1.pdf