Understanding Opioid Replacement Therapy - Addiction Rehab Blog
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Opioid Replacement Therapy

Understanding Opioid Replacement Therapy

As you may know, the United States is in the midst of a serious opioid crisis. In the past century, we have gone through periods of discovering and using many different opioids for their perceived ability to help people come off the more dangerous drugs. As Elevation Behavioral Health shares on their page about Suboxone withdrawal, there can be many uncomfortable symptoms when withdrawing from opioids like heroin, suboxone, and methadone.

A few commonly abused opioids in the United States include:

  • Heroin
  • Oxycodone
  • Hydrocodone
  • Oxymorphone
  • Hydromorphone
  • Morphine
  • Codeine
  • Fentanyl

How Opioids Effect the Brain

Opioids can be taken a number of different ways. Some are taken orally while others are more commonly smoked. When opioids enter the bloodstream, they act on opioid receptors in the brain and facilitate the release of dopamine and serotonin. As an individual continues to take opioids, they build tolerance and dependence. This means it takes more of the drug to achieve the same desired effect. As more drugs are taken, the body becomes more dependent on the opioid.

What eventually happens in the addicted individual is the brain and body become completely accustomed the presence of opioids in the body. The brain is used to functioning with the opioid receptors filled, and the flood of dopamine becomes normal to us. Thus, when a person stops using opioids, the brain and body can react in painful and uncomfortable ways.

Opioid Withdrawal Process

Opioid abuse can result in an extremely unpleasant withdrawal process. It is perhaps one of the worst drug withdrawals a person can go through. When the opioids begin to leave the brain and body after just a few hours, symptoms can begin to arise. The withdrawal process usually peaks in severity around a week after the last use of opioids, and may last for a few weeks.

Because the body has become dependent upon the substance, removing them can cause of variety of unpleasant symptoms. Symptoms of opioid withdrawal include:

  • Nausea and/or vomiting
  • Muscle pain and aches
  • Depression and pervasive sadness
  • Agitation and irritability
  • Fits of anger
  • Digestion problems
  • Fever and chills
  • Cravings to abuse opioids

Because the symptoms of opioid withdrawal cause such discomfort, many don’t make it through the process without returning to drug abuse. This is why it’s important to seek professional detox services. At a treatment facility, you will be offered expert medical care to help keep you safe and as comfortable as possible as the drugs leave your system.

Opioid AddictionCommon Opioid Replacements

There have been several different opioid replacement therapies over the last 100 years in the US. These drugs have been found to be helpful in some cases, and have had some dangers associated with them. For some, taking medication in recovery is not a problem, while others find they struggle with it. Here are a few drugs we have used over the years as replacements for opioid addiction.


Yes, the now-famous heroin was once introduced to the world by Bayer pharmaceuticals as a safer and non-addictive form of morphine. Not used as a true opioid replacement, heroin was offered as a cough suppressant and way to get off morphine. Since then, it has become widely abused across the world. As it has become easier to synthesize and acquire, heroin is a drug of choice for many opioid addicts.


Methadone was first developed in 1937, and introduced into the United States in 1947. Used primarily as a method of opioid replacement therapy, methadone was popular for decades. However, methadone has fallen out of favor in recent years due to innovations in the industry and new drugs like Subutex and Suboxone. Although methadone is effective at getting people off heroin, the withdrawal symptoms can be worse than heroin withdrawal itself. Many users of methadone never come off the drug as the withdrawal process is painful and uncomfortable.


Buprenorphine was released in the UK in 1978 to treat pain. It was synthesized from thebaine with the goal of creating an opioid without the negative side effects. The FDA approved buprenorphine for the treatment of opioid addiction in 2002, and it slowly became more popular than methadone. Sold most commonly as Subutex or Suboxone (a mix of buprenorphine and naloxone), it has much less pyschoactive effects than methadone or heroin. Buprenorphine is often taken as a sublingual tablet and administered to those experiencing opioid withdrawal.

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The Case for Medication-Assisted Treatment

The studies on MAT (Medication-Assisted Treatment) are imperfect. A 2014 meta-analysis of 140 independent studies found that sixty to ninety percent of buprenorphine users refrained from using heroin for the first year, there was a significant reduction in self-reported drug abuse, and urine tests showed much less drugs in the system when compared with methadone users. However, the author notes that the studies were relatively small and done in the short-term. The analysis does suggest that opioid replacement therapy can be effective in keeping people from returning to their drug of choice.

Dangers and Risks of Opioid Replacement Therapy

Another meta-analysis found that users taking buprenorphine are signficantly less likely to complete their full treatment regimen than those taking methadone, with the researchers suggesting this is due to the fact that Suboxone and Subutex do not produce the same “high” that methadone produces. Furthermore, both buprenorphine and methadone users showed significant cognitive impairment compared with those that stayed abstinent, specifically in working memory and verbal memory. Again, these studies were relatively small.

Finally, there’s evidence to suggest that coming off buprenorphine can be difficult. The same studies found that about nine percent of individuals stayed sober from opioids after they tapered off with a 24 week program. Although it may seem horrible that ninety-one percent of individuals relapsed, this is actually a much better success rate than alternatives like going cold turkey. However, a user is much less likely to relapse if they stay on the opioid replacement.

The downside here is that individuals have much better rates of recovery if they stay on the opioid replacement, and the opioid replacement can cause side effects like drowsiness, memory impairment, and mild “highs.” If somebody tapers off the medication, their chances at staying sober are relatively low. However, they still have a greater chance at recovery than those who utilize abstinence-only models.

The truth is that we need to continue to study opioid replacement therapies. As with the introduction of heroin and methadone, we aren’t entirely sure how safe these medications are. The studies are mixed, the opinions are mixed, and we just don’t know entirely. We thought heroin was “safe,” and methadone was supposed to be safe. Is buprenorphine the same? It doesn’t seem so, and it seems to be much more effective. Perhaps we need more research and the development of safer alternatives and practices.

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