3.+Alternative+Treatment+Methods+for+Heroin+Addicts

//**Methadone Maintenance Programs:**// A common treatment for heroin users who are trying to stop using, are methadone maintenance programs. Methadone is a synthetic drug classified under the narcotic analgesics (Hall et al., 1998). It is a long acting opiate that blocks the effects of heroin, and also eliminates withdrawal symptoms. It has proven to be successful for people who are addicted to heroin (Ross & John, 1991). When people abruptly stop using heroin, within 6-48 hours after last use, they can experience withdrawal symptoms that can last from up to 6 to 7 days. The withdrawal symptoms are not life threating, and considered to be moderate compared to withdrawal from other drugs (eg. Alcohol). The withdrawal resembles a common flu (Ross & John, 1991). Some common symptoms are diarrhea, sweating, nausea, vomiting and abdominal cramping (Ross & John, 1991). Methadone treatment has been used for over 30 years to treat opioid addiction. It is shown to be an effective and safe treatment for heroin users. If properly prescribed this drug is not sedating or intoxicating (Hall et al., 1998). The effects of this drug do not interfere with regular daily activities (such as driving). Patients can use this drug and not feel “high” from it like they do from heroin. It is taken orally, and can stop the withdrawal symptoms for 24-36 hours (Hall et al., 1998). People can still perceive and feel pain, and have emotional reactions after taking the drug. The effects last 4 to 6 times longer than the effects of heroin last. It only needs to be taken once a day in treatment. Some noted side effects of methadone include dizziness, nausea and low blood pressure (Hall et al., 1998). In most methadone treatment programs patients not only receive the medication, but they also receive counseling, case management, nursing and additional medical services (Ross & John, 1991). These additional services prove to be extremely beneficial in helping heroin users to not relapse (Ross & John, 1991). Since there is a high cross-tolerance between opiate and opioid drugs, methadone can block the effects of other opioids, like heroin. This can lead to a less dependence on other opioid drugs. It also reduces cravings for opioids, and reduces the euphoric producing effects of other opioids. Tolerance to this drug develops slowly (Ross & John, 1991). Methadone treatment has been shown to reduce the use of other opioids, mortality, injection risk behaviors, criminal activity, and other high-risk behavior associated with HIV and other sexually transmitted infections (Ross & John, 1991). It is highly regulated by the Canadian Law and in Ontario it is regulated under the College of Physicians and Surgeons of Ontario (CPSO). It is a Schedule 1 drug under the Controlled Drug and Substances Act (Ross & John, 1991).

Another alternative pharmaceutical treatment for heroin users is the drug buprenorphine. This is a more recent addition to the medications available for treating heroin and opiate users (Hall et al., 1998). It was first used as an analgesic in England in 1969. It was initially recognized as a potential treatment for opiate addiction in the 1970’s, and was approved by the FDA in 2002. In 2004, almost 4 thousand physicians were legally able to prescribe this drug, and it can be prescribed privately in a doctor’s office (Hall et al., 1998). It binds to the same receptors as morphine does, but unlike morphine is only a partial opioid agonist. This drug reduces heroin use in dependent users by stopping the withdrawal effects (Hall et al., 1998). It has been used to treat about 900, 000 heroin users in the US. It causes weaker opiate effects than methadone does, and is also less likely to contribute to overdose problems. That is because it is only a partial opioid agonist; therefore it is less likely to cause death from an overdose as a full agonist like methadone might. It binds tightly to endorphin receptors (Hall et al., 1998). It has a lower level of physical dependence, thus when patients stop using this drug they usually have less withdrawal symptoms than methadone users. It is also associated with less sedation than methadone (Hall et al., 1998). The effects peaks 1 to 4 hours after initial dose, and the half-life is 24 to 60 hours. Therefore, it has a slow onset of action and is a long-lasting drug. This drug displaces agonists from the opioid receptors and can actually cause withdrawal in patients who are physically dependent. This can occur if it is given to a patient before other opioid effects have disappeared (Hall et al., 1998). Thus, it is only given after a patient is already experiencing withdrawal symptoms. Side effects include vomiting, nausea and constipation. In summary both buprenorphine and methadone are effective treatment medications for dependent opiate users (Hall et al., 1998). Buprenorphine can be a better choice for patients who are at a risk of respiratory depression (elderly, patients who also take benzodiazepines) since there is less of a chance of overdose with this type of drug (Hall et al., 1998).
 * // Buprenorphine: //**

Both methadone and buprenorphine can be given in conjunction with naloxone (Suboxone) to minimize abuse. Naloxone acts as an opiate/opioid antagonist, thus it blocks the euphoric effect of opioid drugs. This is done by removing the drug from the synapse and blocking the receptor sites (Ross & John, 1991). When taken with methadone or buprenorphine it blocks the euphoric effect of these drugs, but still allows these drugs to take away the withdrawal symptoms. The rational is that it will be less addicting because it masks the euphoric effects of the opiates (Ross & John, 1991). Other alternatives to the treatment of heroin dependence include Clonidine and Lofexidine. Clonidine is more limited in use because of its side effects of hypotension and sedation (O’Conner & Fiellin, 2000). Lofexidine is a centrally acting alpha-2 adrenergic agonist. It is not an opioid. It was launched in 1992 for symptomatic relief for users of opiates who are going through withdrawal (O’Conner & Fiellin, 2000). It is not as effective as methadone because it does not stop the opioid withdrawal, but just eases some of the symptoms. It reduces the withdrawal effects, but has negative side effects, including slow heart rate, dry mouth and throat and feeling dizzy or tired (O’Conner & Fiellin, 2000). There are currently more drugs under review by the FDA to be approved for the treatment of opiate withdrawal. ** References ** John, B., & Ross, A. (1991). The effectiveness of methadone maintenance treatment: Patients, programs, services, and outcome. //PsychNET//, 283-294. Retrieved from [] O'Conner, P., & Fiellin, D. (2000). Pharmacologic treatment of heroin-dependent patients. //American College of Physicians//, //133//(1), 40-54. Ward, J., Mattick, R., & Hall, W. (1998). The effectiveness of methadone treatment 1: heroin use and crime. //The University of Queensland//, 17-58. Retrieved from []