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Medication

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    Medication-Assisted Treatments in Milwaukee

FDA-Approved Medications to Treat Opioid Use Disorders

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Methadone

What Is Methadone?

Methadone is a synthetic opioid medication used to treat chronic pain, but it is primarily utilized in treating opioid addiction. Methadone is regulated by the DEA and is only administered for addiction treatment through an approved opioid treatment program (OTP). Methadone is a full-agonist opioid, meaning that it acts similarly to other opioids by fully activating the receptors in the brain.

How Does Methadone Work?

Methadone attaches fully to the opioid receptors in the brain and, at an appropriate dose, does not create the euphoria or "high" illicit opioids create. It does eliminate the physical withdrawal symptoms felt when opioids are no longer present in the system of the individual using the drugs. This is critical in controlling the cravings that cause relapse early in recovery for so many. When withdrawals and cravings are controlled, individuals can focus on addressing the causes of addiction and repairing the damage done to their lives. Additionally, methadone has some opioid-blocking properties, limiting the effect of other opioids used while methadone is present.

Medication-assisted treatment (MAT), along with evidence-based behavioral treatment, are the most effective ways to improve the chances of long-term recovery from opioid abuse. One of the most commonly used medications in MAT for opioid addiction is methadone.

Methadone is a long and slow-acting opioid used to treat heroin addiction or addiction to other opioids. It has been used since the 1950s to treat addictions to heroin and, more recently, other opioids. It is helpful for those with opioid addiction to ward off the most difficult withdrawal symptoms, helping to prevent relapse.

Methadone is a prescription medication that must first be given by a doctor in either a tablet or liquid form. Our clinics do the initial medical assessment, administer the first dose, and provide daily dosing beyond that. Many times, people who either have an opioid use disorder themselves or have a loved one with an addiction to opioids wonder about the best way to stop using opioids and how methadone clinics work.

OTPs are established solely for the purpose of dispensing medications used in medically assisted drug therapy treatments. Often, what is referred to as a 'methadone clinic' also provides other medications such as Suboxone and naltrexone.

It's vital to stay on the prescribed amount of methadone consistently and adhere to all the protocols established, as this is how methadone clinics work at being successful in helping those with addiction issues work towards long-lasting recovery. Research has shown that when a person stays on MAT for one year or more, there are positive lifestyle changes, including a reduction in criminal behaviors and transmission of disease.

Buprenorphine

What Is Suboxone and How Does It Work?

Suboxone is a medication that is often used in medications for addiction treatment for opioid use disorder (OUD). It helps people stop using opioids by managing withdrawal symptoms and reducing cravings. If you or someone you know struggles with opioid addiction and wishes to find a solution, you may be interested in learning about how Suboxone can help with recovery.

Suboxone can be used as an induction agent to stabilize someone in withdrawal during the medical detoxification process as well as for maintenance treatment to promote recovery from opioid use disorder. It consists of a combination of two drugs: buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist). It is administered as a dissolvable film placed either under the tongue or on the cheek. The U.S. Food and Drug Administration (FDA) approved a generic buprenorphine and naloxone sublingual (applied under the tongue) in 2018.

What is Buprenorphine, and What Does it Do?

Buprenorphine is a long-acting opioid drug used to replace the shorter-acting opioids that someone may be addicted to, such as heroin, oxycodone, fentanyl, or hydromorphone. Long-acting means that the drug acts more slowly in the body for a longer period of time. The effects of buprenorphine last for 24 to 36 hours. In contrast, a person who uses short-acting opioids to avoid withdrawal must use them three to four times a day.

When taken at the correct dose, buprenorphine prevents withdrawal symptoms and reduces drug cravings without causing the person to feel high (euphoric) or sleepy. This lowers the harms associated with opioid misuse and gives people who are addicted to opioids a chance to stabilize their lives. This treatment is known as opioid agonist therapy. Buprenorphine therapy for opioid addiction works similarly to methadone, another opioid agonist therapy.

When combined with medical and supportive care, buprenorphine and methadone are equally effective treatments for opioid addiction, although one may work better than the other for some people.

Buprenorphine/naloxone is a pill that is absorbed under the tongue, whereas methadone is taken as a drink.

Buprenorphine has a lower risk of overdose than methadone.

Any physician can prescribe buprenorphine, but only those who have completed special training can prescribe methadone.

Methadone is most commonly available through specialized treatment clinics; buprenorphine treatment may be easier to access than methadone.

It can take weeks to reach a fully effective dose with methadone but only a few days with buprenorphine.

Side effects can be less pronounced with buprenorphine.

Can Buprenorphine Interact With Other Drugs?

Mixing methadone or buprenorphine with other drugs that depress the central nervous system can be very dangerous. Avoid other opioids, alcohol, and benzodiazepines (e.g., Ativan, Xanax, Restoril, Valium, clonazepam). Taking these is especially risky when you first start opioid agonist therapy. Using other drugs while taking opioid agonist treatment can also cause your dose of buprenorphine to wear off more quickly, meaning you could experience withdrawal.

Can You Overdose on Buprenorphine?

All opioids have a risk of overdose, though the risk is higher with methadone than with buprenorphine. The risk is especially high when you start treatment and when you stop taking opioids (buprenorphine or other opioids) for a while and then start again. Mixing opioids with other drugs also increases the risk of overdose. If you or someone you know uses opioids, it is a good idea to have a free naloxone kit. Naloxone is a medication that can temporarily reverse the effects of an opioid overdose and allow time for medical help to arrive.

Naltrexone

What is Naltrexone?

Intramuscular extended-release Naltrexone is a medication approved by the Food and Drug Administration (FDA) to treat both Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD) as a Medication-Assisted Treatment (MAT) option. Naltrexone can be prescribed and administered by any practitioner licensed to prescribe medications and is available in a pill form for Alcohol Use disorder or as an extended-release intramuscular injectable for Alcohol and Opioid Use disorder. A Risk Evaluation and Mitigation Strategy (REMS) is required for the long-acting injectable formulation to ensure that the benefits of the drug outweigh its risks. The pill form can be taken daily for AUD, but the extended-release injectable formulation is approved for the treatment of OUD. The pill form is taken daily, and the extended-release injectable is administered every four weeks or once a month by a practitioner.

Naltrexone is one component of a comprehensive treatment plan, which includes counseling and other behavioral health therapies to provide patients with a whole-person approach. Naltrexone is not a recommended MAT option for anyone younger than 18 years of age or for patients experiencing other health conditions.

How Naltrexone Works

Naltrexone is not an opioid, is not addictive, and does not cause withdrawal symptoms with stop of use. Naltrexone blocks the euphoric and sedative effects of opioids such as heroin, morphine, and codeine. Naltrexone binds and blocks opioid receptors and reduces and suppresses opioid cravings. There is no abuse and diversion potential with naltrexone.

Naltrexone for Opioid Use Disorder

To reduce the risk of withdrawal symptoms caused by OUD, patients should wait at least seven days after their last use of short-acting opioids and 10 to 14 days for long-acting opioids before starting naltrexone.

Patients taking naltrexone should not use any other opioids or illicit drugs, drink alcohol, or take sedatives, tranquilizers, or other drugs. Patients should notify their practitioner about all medications they are currently taking as well as any changes in medications while being treated with naltrexone.

While the oral formulation will also block opioid receptors, only the long-acting injectable formulation is FDA-approved as MAT and requires REMS.

Patients on naltrexone who discontinue use or relapse after a period of abstinence may have a reduced tolerance to opioids. Therefore, taking the same or even lower doses of opioids used in the past can cause life-threatening consequences.

Naltrexone for Alcohol Use Disorder

When starting naltrexone for AUD, patients must not be physically dependent on alcohol or other substances. To avoid strong side effects such as nausea and vomiting, practitioners typically wait until after the alcohol detox process before administering naltrexone.

Naltrexone binds to the endorphin receptors in the body and blocks the effects and feelings of alcohol. Naltrexone reduces alcohol cravings and the amount of alcohol consumed. Once a patient stops drinking, taking naltrexone helps patients maintain their sobriety. Naltrexone MAT treatment lasts for three to four months. Practitioners should continue to monitor patients who are no longer taking naltrexone.

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