Treatment options for opioid addiction
There are two main treatment options for opioid addiction: opioid agonist maintenance treatment with either methadone or buprenorphine (available as a 4:1 combination of buprenorphine and naloxone) and psychosocial treatment:
- Opioid agonist maintenance treatment: Follows specific provincial guidelines, with frequent urine drug testing and often combined with outpatient counselling.
- Psychosocial treatment: May occur in a residential or outpatient setting. Treatment can range from three weeks to one year or more. Some programs take patients on opioid agonist maintenance therapy.
Determining the best treatment option
Patients often request a trial of abstinence first before attempting opioid agonist treatment. Abstinence is not as effective in achieving or maintaining remission from opioid dependence as is methadone or buprenorphine treatment. Consider methadone or buprenorphine maintenance if the trial of abstinence fails.
Combining opioid agonist maintenance therapy and psychosocial treatment yields better outcomes.
Rationale for using methadone and buprenorphine to treat addiction
Controlled trials and large cohort studies have demonstrated that methadone and buprenorphine are highly effective treatments for opioid addiction. They improve treatment retention and reduce illegal opioid use, HIV transmission and mortality (Kahan et al., 2011). In appropriate doses, methadone and buprenorphine:
- suppress symptoms of opioid withdrawal for the full 24-hour dosing interval
- reduce cravings for opioids
- do not cause sedation or euphoria
- block the euphoric effects of other opioids.
Structure of methadone and buprenorphine treatment
Patients receiving methadone or buprenorphine treatment initially take their medication daily under the supervision of a pharmacist. Treatment also involves regular urine drug testing, counselling and medical care.
If after several months patients are psychosocially stable and have stopped opioid and other problematic drug use, they are gradually given an increasing number of doses to take home.
Prescribing guidelines vary by province and territory. The Inventory of Guidelines on the Treatment of Harms Resulting from Prescription Drug Use links to guidelines from across Canada that can inform the best practices of health care practitioners who provide treatment using prescription drugs.