Opiate addiction is a growing public health menace, and over the years, efforts have been made to help addicts overcome their opiate addiction. The most successful intervention method is opiate replacement therapy, followed by dose reduction until the addict is fully recovered. Once, the only drug used for opiate detox was methadone. In the last decade, new molecules have been introduced and approved to help overcome opiate dependency.
Methadone, buprenorphine, naloxone, and naltrexone represent a shift in the way opiate addiction and detox are understood and treated. Each drug is intended to improve on the major demerits of the last ones. However, considering the nature of opiate addiction and opioids, long-term studies are needed to thoroughly weigh the therapeutic advantage of each drug over the rest.
Methadone is a full opioid receptor agonist. It occupies opioid receptors in the brain much like the opiates it replaces and produces similar but muted and longer-lasting psychotropic effects. It was introduced to replace the likes of heroin and morphine while maintaining the patient’s addiction in legal, controlled settings. Opiate addiction involves an unhealthy and even criminal lifestyle. With methadone, addicts can attend methadone clinics and have their daily doses given to them. With time, it is assumed that a full detox can be achieved by reducing the dose given to each addict. The chief advantage of methadone is that it considerably reduces the withdrawal symptoms experienced when addicts get off opiates.
Buprenorphine, on the other hand, is a partial opioid receptor agonist. This means that while it occupies the same opioid receptors as methadone and opiates, it produces a considerably weaker psychotropic effect. This way, it acts as an opiate replacement and mitigates withdrawal symptoms, much like methadone. However, like methadone, it possesses an addictive potential too. Therefore, there is a chance that addicts can get hooked on the drug too and need detox to get off.
Naloxone is a fast-acting reversible opioid receptor antagonist. It occupies the same opioid receptors in the brain as opiates, methadone, and buprenorphine, and it cannot be displaced by the opiates. As an antagonist, naloxone produces no psychotropic effects. It is not used only in opiate detox but combined with buprenorphine (in Suboxone). Like methadone, suboxone requires daily administration. However, unlike methadone, it employs a dual effect to help patients overcome their opiate addiction.
Naltrexone (the drug inside Vivitrol) is also a reversible opioid receptor antagonist, but unlike naloxone, it is longer-acting. Therefore, it is more useful in the management of opiate addiction and detox. Naloxone’s faster action is more suited for emergency opiate overdose treatment. Naltrexone for opiate detox is available as an intramuscular injection and as an implant. The injectable form is the approved formulation, and it is known as Vivitrol. Naltrexone blocks the opioid receptors in the brain and prevents opiates from binding to it. Like naloxone, it is non-narcotic and non-addictive.
An initial clinical evaluation is important to help determine which of these molecules will provide the best benefits and the least side effects for each opiate addict. But now more than ever, full opiate detox is achievable.
