A variety of treatments are available to help individuals addicted to heroin to cope with the harsh withdrawal symptoms, including medications and behavioral therapies. A medically assisted detoxification is usually the first step, but the best results are typically obtained from a combination of medication to address withdrawal symptoms and supportive services like counseling, according to the National Institute on Drug Abuse. Medications to address heroin withdrawal and help prevent relapse include methadone, buprenorphine and naltrexone.
Methadone
Methadone has been used for more than 30 years, according to NIDA. It is a synthetic opiate that is administered orally and binds to the same receptors that heroin does. However, it has a much slower onset of action and its effects are sustained. This reduces the desire for the “rush” of pleasure heroin provides while preventing withdrawal symptoms, notes NIDA. “Drugs and human behavior” explains that when methadone doses are reduced to a 20 mg to 40 mg range, the craving for heroin frequently returns. For many recovering from a heroin addiction, methadone maintenance is indefinite. NIDA notes that the most effective methadone maintenance programs include counseling and other medical, psychological and social services.
Buprenorphine
Buprenorphine is a more recently developed treatment for heroin addiction. Buprenorphine is a semi-synthetic drug that has high binding affinity for the receptors that heroin normally binds with. Buprenorphine is administered orally, under the tongue or by transdermal patch and causes less physical dependence and less chance of overdose when compare to methadone, notes NIDA. Buprenorphine may also be more convenient because individuals can be given a 30-day take home dose relatively soon after starting treatment, unlike those on methadone who need to visit a dispensing facility daily. Unfortunately, according to NIDA, despite these benefits, not all patients respond to buprenorphine and in that case, some require treatment with methadone instead.
Naltrexone
Naltrexone is approved for treating heroin addiction as well as alcohol addiction. Naltrexone can effectively block the effect of heroin, because naltrexone competes for opiate receptors, notes “Drugs and Human Behavior.” Unfortunately, it is also noted that high doses of naltrexone can harm the liver's enzyme function. Additionally, according to “Drugs and Human Behavior,” the protective ‘heroin-block’ provided by naltrexone can be overridden with high doses of narcotics, which some addicts may attempt, with serious and possibly fatal consequences. Naltrexone is not as widely used as methadone or buprenorphine because of poor patient compliance, according NIDA. Additionally, in order to prevent withdrawal symptoms, a medical detoxification must take place first and be followed by a heroin and other opioid-free period for several days before naltrexone can be taken.
References
- National Institute on Drug Abuse: Heroin
- "Drugs and Human Behavior"; Tibor Palfai and Henry Jankiewicz; 1997
- National Institute on Drug Abuse: Research Report on Heroin
- National Institute on Drug Abuse: Heroin Fact Sheet
