Deciding to get help
There’s lots of help available for people who are dependent on opioids. Some of this help involves taking medications. Other types involve talking and learning how to change your behaviour. Some involve moving into a rehabilitation clinic. There is no single treatment that is perfect for everybody. Different treatment types suit different people.
A lot of people struggle with opioid dependence and addiction. Seeking treatment is a normal and effective way for them to manage, reduce or stop their drug use.
Opioid dependence and addiction can be an ongoing (chronic) condition and can require long-term treatment and management.
Different countries have different treatment options and different ways of accessing them. Talk to an alcohol and drug service, community health organisation or your doctor about the options that are available to you and the costs, if any, that are involved.
If you’re using opioids and have found it hard to stop, you should talk to a drug service or doctor about getting help.
They’ll be able to give you important information and help you decide on the best steps to take for your situation.
You may not be able to stop immediately. If you’ve been taking opioids for a long time, you’ll probably need help stopping. Where you live will determine the services that are available to you. These may include:
Tapering: This refers to gradually reducing the amount of medication you regularly use.
Counselling and/or behavioural therapy: Some people will not need medical help. They’ll benefit from counselling and behaviour change therapies to help them to stop using opioids.
Medication-assisted treatment: This is a medication given to people who want to stop using opioids. The medication works by reducing the urge to use (cravings) and preventing withdrawal. This is also known as pharmacotherapy, opioid replacement therapy, or opioid substitution treatment.
Detox: Detoxification services help people stop using drugs, usually in preparation for entering treatment. Detox services may provide support to you at home, be an outpatient service that you attend daily for a short period of time or be a residential withdrawal program where you stay at a withdrawal unit for one or two weeks.
Alcohol and drug treatment: This refers to a range of services that help people reduce or stop their drug use. Some involve detoxification, group therapy, or moving into a residential clinic for a while. Talk to your doctor about the services that are available in your area and the costs that are involved.
Peer-based services: Peer support programs are professional organisations that are run by, or involve, people who have been dependent or addicted themselves. Peer-based drug user groups are a source of first-hand knowledge about drug dependence and addiction, shared in a supportive setting. In addition to support, peer programs can link you to other programs such as doctors who specialise in drug dependence and addiction, drug treatment programs, counselling and community health services.
The most well-known example of a peer-support program is Alcoholics or Narcotics Anonymous (AA/NA). These programs are abstinence-based (meaning that they want you to stop using completely), but not all will be. Instead, many peer support programs focus on helping people meet their own goals around dependence and addiction, rather than meeting abstinence goals.
Pharmacotherapy is the treatment of a medical condition with medication.
Opioid dependence and addiction can be treated with medication. This is often referred to as pharmacotherapy or medication-assisted treatment (MAT).
When someone with an opioid dependence or addiction begins MAT, they are prescribed slow-acting opioids that reduce cravings, prevent withdrawal and reduce the risk of overdose. This will usually be medications called methadone and buprenorphine but it may include others, such as slow-release oral morphine or heroin-assisted treatment.
MAT is a very effective treatment for people who are dependent on, or addicted to, opioids.
MAT allows people to:
- Stop or significantly reduce their use of other opioids
- Stop or reduce harmful drug taking practices
- Save money – methadone and buprenorphine tend to cost much less than other opioids
Though it’s not effective for everyone, many people find that MAT helps them to break the cycle of opioid dependence and addiction. With their cravings and withdrawal managed, people on MAT can give more time and attention to other parts of their lives.
Everyone’s goals are different. Once stabilised, a person may want to taper off (or gradually reduce) MAT or they may be comfortable with staying on a maintenance program.
You are more likely to be successful at reducing your opioid use on MAT than with any other type of treatment. Medication-assisted treatment is the most effective treatment for opioid dependence and addiction, but combining psychosocial treatments with MAT can lead to even better outcomes.
Methadone is a slow-acting opioid. It can be used to treat pain but is more commonly used to treat opioid dependence and addiction.
People who are dependent on opioids can take methadone to prevent symptoms of withdrawal and reduce cravings. Methadone lasts longer than other opioids like oxycodone or heroin. People taking methadone will usually take one dose every day.
Buprenorphine is also a slow-acting opioid. Like methadone, it can be used to treat pain but is more commonly used to treat opioid dependence and addiction.
3. Heroin-assisted treatment
Heroin is normally illegal but sometimes it’s used to treat people who are severely dependent on, or addicted to, opioids. For heroin-assisted treatment (or HAT), a doctor prescribes pharmaceutical-grade heroin to people who have been unsuccessful with other types of treatment.
To receive HAT, a person will visit a clinic and receive an injection of heroin. It must be administered on-site; it can’t be taken away.
HAT is currently only available in some countries like Switzerland, Germany and Denmark.
Hydromorphone is an opioid used to treat moderate to severe pain. It can also be used to treat opioid dependence and addiction in a way similar to heroin-assisted treatment.
The benefit of hydromorphone is that it’s already a licensed medicine, while heroin is not.
Naltrexone is a prescription medication used to treat opioid dependence and addiction. It’s also used to treat alcohol dependence. It’s different from other forms of MAT – it works by blocking the effects of opioids, so that a person won’t have a ‘high’ if they take opioids.
Unlike other forms of MAT, taking naltrexone does not prevent cravings or withdrawal symptoms, so it’s usually only administered after a person has stopped using other opioids to prevent them from returning to using the other opioids.
Side effects of naltrexone can include sleep problems, tiredness, anxiety, headaches, joint and muscle pain, stomach pains, nausea and vomiting.
The availability of these medicines for opioid dependence and addiction varies widely around the world. In most cases, you will need to see a doctor to get a prescription for medication-assisted treatment for opioid dependence and addiction.
Methadone, when prescribed for opioid dependence, usually comes as a syrup that the person drinks.
Patients on methadone need to attend a clinic or pharmacy every day to receive their dose. Some countries allow methadone patients to be given take-home doses to reduce how often they need to attend the clinic. Check with your doctor or clinic about this.
Buprenorphine usually comes as a tablet or film that’s dissolved under the tongue.
Buprenorphine is also available in long-acting doses, either as implants that are put under the skin and last for six months, or as a prolonged-release injection that lasts for either a week or a month. These long-acting doses reduce the need to attend a clinic as often.
In countries where heroin-assisted treatment is available, it is provided to the patient who injects it themselves under medical supervision. Heroin-assisted treatment is strictly controlled – patients are not allowed to take it off-site.
Hydromorphone is available in tablets, suppositories and injections for the treatment of pain. As a treatment for opioid dependence and addiction, it’s usually provided as an injection under similar conditions to heroin-assisted treatment.
Naltrexone can be prescribed as a tablet, implant or injection, and may help some people stabilise their drug use.
Accessing MAT for opioid dependence and addiction begins with talking to your doctor or an alcohol and drug service. They’ll know the treatments that are available in your area and the costs that are involved.
Not all doctors prescribe MAT; if your doctor does not prescribe MAT, they can put you in conact with a doctor or a clinic that does.
When you start MAT, you may find that the medication makes you drowsy. This should pass as your body adjusts to the treatment. Your doctor may also adjust your dose to the level that works best for you.
Your doctor can recommend additional therapies to help you stay on MAT and get the support you need.
‘How long will I be on medication-assisted treatment?’
It depends on your drug-using history, the drugs that you were using and your personal circumstances. Generally, people will take MAT for a few months until their opioid use has stabilised. Then, they can talk to their prescribing doctor about next steps. This may be staying at your current dose, reducing your dose, or tapering off MAT completely.
Talk to your health worker or drug worker to make sure that you fully understand what’s involved and have realistic expectations.
‘Am I just trading one drug for another?’
No. When taken for opioid dependence and addiction, methadone and buprenorphine are medicines. They are very different from other opioids like heroin, oxycodone or fentanyl – they are slow-acting so last much longer than other opioids.
However, they do carry risks of withdrawal and overdose. If taking medication-assisted treatment for opioid dependence and addiction, it’s important that you do not use other opioids or sedatives like benzodiazepines, as this can increase your risk of overdose.
It’s also important that you do not stop taking methadone or buprenorphine without consulting your doctor or an alcohol and drug service.
‘How much does it cost?’
This will depend on where you live and the programs that are available. In some places, MAT is fully subsidized (available for free) and in others, patients pay a fee per dose.
Even when you have to pay for it, MAT is usually cheaper than other drugs like heroin, oxycodone and fentanyl. This is because methadone and buprenorphine are long acting so a dose is taken daily at most. Other opioids can wear off after a few hours.
MAT also significantly reduces the costs of drug use on your health and wellbeing.
“It’s just another drug/You’re still an addict on methadone”
When taken for opioid dependence and addiction, methadone and buprenorphine are medicines. Diabetics who take insulin are not considered to be addicted to it. Taking insulin allows them to stay healthy and live their life. Medication-assisted treatment for opioid dependence does the same.
While it is true that opioids are prescribed for MAT, this is precisely why it is an effective treatment for opioid dependence. MAT is long-acting, which means it doesn’t wear off after a few hours like other opioids.
People taking MAT are less likely to seek or use other opioids and are able to get back to their normal lifestyle that’s more difficult when they’re dependent on other opioids.
People who try to stop using opioids without help from medication find it much harder. People who are on MAT are less likely to return to using opioids than people who are not.
“It’s liquid handcuffs”
Attending a clinic or pharmacy daily to receive treatment can be inconvenient. Treatments like implants and long-acting injections, along with unsupervised dosing or takeaway options reduce the need to visit daily. Some countries offer other treatment options that don’t involve visiting a clinic.
People can take MAT for a short time, a longer time or even be involved in life-long periods of treatment.
Many people who are in MAT will gradually reduce their dose over time until they stop the treatment altogether.
“I won’t be able to go on holiday or move to a different area”
Whether you can travel will depend partly on the type of MAT you’re on. Though MAT often involves daily doses, in some places you may be able to get ‘takeaway’ doses with extra approval.
It’s also important to remember that for many people, MAT is a temporary treatment, and they’ll gradually reduce their dose until they stop altogether.
Even if you’re on MAT long-term, you can talk to your doctor about how best to manage your medication while you travel or move.
Long-term doses of MAT are available – ask your doctor about these.
“Methadone/Buprenorphine gets you high”
Compared to other opioids like heroin and oxycodone, methadone and buprenorphine do not produce a strong high.
You may feel drowsy when you begin treatment, but this should pass as your body adapts to the medicine.
Our bodies adapt quickly to methadone and buprenorphine, so people quickly come to feel alert, awake and normal while on them.
“It rots your teeth”
This is a widespread myth about methadone.
While methadone does not affect your teeth, like all opioids, it can dry your mouth. A dry mouth makes your teeth more prone to tooth decay. Keeping a regular dental care routine in place and drinking plenty of water will help prevent damage to your teeth.
“You gain weight”
Some people do gain weight while on MAT. This is usually because MAT improves a patient’s health and they begin eating more – they may have already been underweight from their opioid use.
Methadone can slow down your metabolism, which can lead to weight gain, and some people report craving sugary foods. But eating foods that are high in fibre (like wholegrains, fruits and vegetables), keeping your sugar intake low, and doing regular exercise will help maintain a healthy body weight.
Reducing or stopping using can be difficult. But there are a few ways that you can make this easier.
- Practising good sleep habits
- Eating well
- Engaging in enjoyable activities like painting or playing sport
- Giving yourself time and space to adjust
- Spending time with friends and family.
Friends and family members can be a great source of support; reach out to those you are close to in times of need. However, sometimes it helps to speak to someone who understands where you’re coming from and what you’re going through. Services run by peers (people who have also been dependent or addicted) can be a great way to discuss your experiences without being judged.
Speaking to a drug worker, counsellor or psychologist can also help. Remember: the more support you have, the easier it will be to reach your goals.
You can search for services including peer support groups in your local area using the internet or speak to a drug and alcohol organisation or harm reduction service in your area.