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Why are Opioids in Medication used to Treat Opioid Use Disorder?

by Ash Arjan

Since the first swell of heroin misuse in the late 1960’s and 70’s through the more recent epidemic that has spanned more than two decades, addiction science has come a long way in discovering more about the nature of substance use disorder. Despite the mountains of scientific data available, many still don’t see addiction as a chronic disease and are misinformed about medication-assisted treatment (MAT), which is the most effective way to help those who have been affected by the opioid crisis. The fact that medications used in MAT contain opioids themselves tends to cause people to misconstrue how they are used effectively as a treatment. It’s important to note that there are various types of opioids, especially those used in addiction medicine.

Opioid Agonists

Methadone, the oldest known and most commonly used treatment for opioid use disorder, is a synthetic opioid agonist. It helps relieve the highly uncomfortable symptoms of withdrawal by fully engaging opioid receptors in the brain that are also stimulated by addictive substances like heroin, morphine and other opioid pain killers. While the medication does fully activate the receptors, it lasts much longer then most illicit or prescription opioids in the individuals system. At a therapeutic does, it relieves withdrawal symptoms without causing euphoria and a single dose can last more than 24 hours. This allows an individual to take methadone once per day rather than seek other opioids more frequently because the effects do not last long enough and they begin to experience withdrawal.

Partial Agonists    

Buprenorphine is a partial opioid agonist, which means that it binds to opioid receptors, but activates them at a much lower strength than full agonists.  Buprenorphine and buprenorphine compounds have a “ceiling effect”, which limits their ability to make someone “high”. At a certain point, taking additional medication or increasing the dose does not increase its effects. This ceiling effect also reduces side effects and the risk of overdose. It still helps reduce cravings and withdrawal symptoms making it effective for treating opioid use disorder at a therapeutic dose. Buprenorphine was one of the first medications approved by the FDA in the early 2000s at the height of the opioid epidemic.

Opioid Antagonists

Naltrexone is considered an opioid antagonist, which means that it doesn’t engage any opioid receptors, but does block them, preventing any opioids taken from engaging the receptor and creating a high. A patient must have all opioids, illicit or those used for treatment, out of their system to prevent immediate withdrawal symptoms. In addition, naltrexone will not alleviate withdrawal symptoms or cravings and should be used in conjunction with counseling or other recovery support.

The right form of MAT will be different for every patient. People need to understand that the use of opioids in these treatments is intentional and backed by science to give patients a better chance at achieving long-lasting re counseling and support, offer a comprehensive plan for a successful future without addiction.

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