The Benefits and Dangers of Drug Replacement Therapy
For opiate addicts, the painful physical withdrawal is a huge obstacle to getting and staying clean. During the detox process, many opiate addicts receive opioid replacement drugs, such as Subutex or Suboxone. These drugs reduce and eliminate cravings by binding to the same receptors as heroin and other opiate drugs. Some addicts choose to remain on these drugs for long periods of time, utilizing a treatment method called “drug replacement therapy.” Taking opiate replacement drugs for a long period of time can benefit addicts in certain ways, but there are also serious dangers associated with this form of treatment.
Types of Drug Replacement Therapy
Maintenance therapy relies upon two main opiate replacement drugs: methadone and suboxone. These drugs work by binding to opioid receptors in the brain. When these molecules attach to those receptors, they eliminate cravings for opiates and also prevent opiates from attaching to these receptors, meaning that the user will not get high even if they use opiates on top of the replacement drugs.
Suboxone contains the active ingredient buprenorphine, which is a partial opiate agonist. This means that it partially attaches to the opiate receptors, and has a ceiling, or point at which an increase in the dose does not increase the effect. In contrast, methadone is a full opioid agonist, meaning that it does not have a ceiling. Also, the increasing levels methadone will heighten the side effects until all opiate receptors reach their threshold. Suboxone is available in tablets or in a film and dissolves sublingually, or under the tongue. Methadone is available as a liquid or a pill that is ingested orally.
Who Qualifies for Drug Replacement Therapy?
Many people in detox for substance addiction receive replacement drugs on a short-term basis to aid in their withdrawal process. However, some people take these drugs long-term under supervision by a doctor. For some patients who wish to control their opiate addiction, they choose to be in a suboxone or methadone program, which administers a daily, weekly, or monthly dose of their medication. In order to utilized in these programs, patients generally have to see a specialized doctor who can prescribe these medications, or enroll in a clinic program. Addicts may have to take urinalysis screens to stay in such a program or attend therapy or groups as a condition of their continued prescription.
Are There Benefits?
Proponents of long-term drug replacement therapy argue that it has multiple benefits. Primarily, support for these programs comes from the idea that by replacing illicit street drugs with monitored prescription drugs, these programs keep addicts off the street and allow them to hold a job, attend school, or have a normal routine. The other benefits, proponents argue, include decreased chances of overdose (because the dose is controlled and monitored), a decreased risk of spreading HIV/AIDS and hepatitis C (because addicts won’t be using syringes), and elimination of withdrawal symptoms.
The Dangers of Drug Replacement Therapy
Despite these benefits, long-term, maintenance drug replacement therapy (as opposed to medication-assisted detox) through Suboxone (buprenorphine) or methadone can be dangerous for addicts. Because both medications are opioids, they are habit-forming over a long period of time. Attempting to wean off of either medication after a long period may produce withdrawal symptoms that can lead to relapse. Methadone and Suboxone can produce highs if misused. They are both available on the black market and are often traded or sold for heroin and other opiates. Both drugs can also cause overdoses and very harmful drug interactions. The withdrawal symptoms for both medications last longer than a heroin or prescription pill withdrawal. This can make detox more challenging. The long-term effects of Suboxone include:
- Drowsiness, fatigue, low energy
- Gastrointestinal issues
- Decreased pain tolerance
- Higher risk of depression
Methadone can also cause harmful side effects, including:
- Irregular heart rhythms
- Respiratory or central nervous system depression, which can be fatal if extreme
- Constipation and gastrointestinal issues
- Weight gain or loss; changes in appetite
- Dental problems and tooth decay
- Fatigue and decrease in energy
- Sleep irregularities or disturbances
Ultimately, drug replacement therapy does not address the underlying social, emotional, and psychiatric factors that lead to addiction. While they may help addicts to avoid painful withdrawal in the short-term, these drugs have their own painful and uncomfortable withdrawal symptoms. The main danger of drug replacement therapy is that these drugs do little to nothing to truly address addiction; instead, they treat withdrawal symptoms. If an addict never builds a foundation of recovery and then attempts to detox from these drugs, they are very likely to relapse when faced with the uncomfortable withdrawal symptoms of methadone or Suboxone. Both drugs may assist in short-term detoxes. However, the longer an addiction persists, the greater the risk posed for addicts who wish to build and maintain long-term substance recovery.