By keeping cravings at bay, medication-assisted substance-abuse treatment allows addicts to focus on the critical behavioral changes they must make to avoid relapse. Most insurance covers the meds.
Naloxone (brand name Narcan) has been in the news recently as an overdose-reversal "rescue" medication. It is not used for treatment by itself.
There are three main treatment medications:
Method of action: An agonist, it activates the same opioid receptors as pain pills and heroin but dispensing is tightly controlled.
Regulation: For substance-abuse treatment, pill can be given only at daily visits to certifieds center until patients reach certain milestones.
Pros: Avoids withdrawal. Can be tapered.
Cons: Can be abused and lead to overdose. "Methadone maintenance" has been stigmatized over the years; some see it as a substitute drug.
Method of action: Partial agonist activates opioid recepters less fully. It also blocks other opioids.
Other formulation: The brand Suboxone combines buprenorphine with naloxone in a daily film placed under the tongue. The overdose-reversal part has no effect when taken orally but will trigger withdrawal when crushed and injected, preventing abuse.
Regulation: Physicians can prescribe it to limited numbers of patients with a special license. The Obama administration plans to relax that standard.
Pros: Private physicians can write weekly or monthly scripts. Avoids withdrawal. Can be tapered.
Cons: Current regulations limit its use.
Method of action: This opioid antagonist blocks receptors, preventing other opioids from attaching.
Other formulation: The more commonly used extended-release version, sold as Vivitrol, is a monthly injection. (The brand drug was used in a new study of former inmates with abuse histories.)
Regulation: It can be prescribed by any provider.
Pros: Long-acting version avoids daily temptation to skip a pill and use. Not a narcotic; can't be abused.
Cons: To avoid withdrawal at the start, patient must be opioid-free for seven to 14 days, depending on the drug that was abused.