Alternative Treatments for Opioid Dependence​

From: Chapter 3: The Fundamentals of Methadone Maintenance Treatment, in Methadone Maintenance: A Counsellor's Guide to Treatment (© 2003).

Occasionally, people are able to recover from opioid dependence through self-help or by "maturing out" or "growing out" of it. Given the serious nature of opioid dependence and its consequences for the dependent person and for society, this approach alone cannot be relied on.

Narcotics Anonymous and Other Mutual Help Groups

For some people who are opioid-dependent, mutual help groups, such as Narcotics Anonymous, outpatient "drug-free" counselling, and long- or short-term residential "drug-free" treatment are effective. However, for many people who are opioid-dependent, each of these approaches alone is not as effective as comprehensive MMT alone.

Alternative Maintenance Medications

In other jurisdictions, other maintenance medications, such as LAAM (levo-alpha-acetylmethadol), buprenorphine and heroin, are used in the way methadone is used in Ontario. In Canada, LAAM and buprenorphine have occasionally been prescribed under the federal government's Special Access program.

Naltrexone

Another alternative is long-term treatment with naltrexone, an opioid antagonist (a drug that blocks the effects of opioids without having any opioid effects). Naltrexone may be started after opioids have been discontinued for at least 10 days. Because opioids will have no effect on a client taking naltrexone regularly, the client will presumably stop self-administering opioids.

Although there have been excellent results in highly motivated (or highly coerced) client groups, overall compliance and retention in treatment is poor. Naltrexone also has a tendency to produce or enhance depression, and it very effectively blocks the effect of opioid analgesics, thus making it more difficult to manage clients with moderate to severe pain.