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Opioids act by attaching to receptors in the brain and stimulating them to flood the reward system with chemicals that produce intense pleasurable feelings. When the drugs wear off, they detach from the receptors and strong cravings compel seeking another dose. After as little as a few weeks of use, opiates ‘hijack’ the brain to the point that it pursues the euphoric effect as it does a basic life need and the compulsion to take more drugs becomes as powerful as the need for food and water. These changes in the brain persist even when drugs are stopped, accounting for continued cravings even after withdrawal. Unless the damage to the brain can be reversed, the individual will be vulnerable to cravings and relapse for many years.
What is medicated-assisted treatment?
Medication-assisted treatment for opioid addiction can alleviate the symptoms of withdrawal, and reduce or eliminate the cravings that would trigger a relapse. Suboxone and methadone are synthetic (man-made) opioids that bind to and activate the same opioid receptors in the brain as the abused drugs but they have different characteristics. They produce a milder “opioid effect” – pleasurable feelings but not the intense highs and subsequent crashing lows that drive users to their next dose. They help the patient avoid the debilitating symptoms of withdrawal that also often short-circuit a commitment to recovery.
Vivitrol(an injectable form of naltrexone, administered monthly) is not an opioid but an “opioid antagonist,” which means it binds to the same receptors in the brain but does not activate them. It prevents the pleasurable opioid effect and immediately reduces cravings. Vivitrol blocks other opioids from acting on those receptors so if a patient on Vivitrolwere to take another opioid, he or she would not get high, would not get sick, and would not crave the drug.
Is there a down side to medication-assisted treatment?
“Suboxone and methadone do provide a short-term benefit,” says Dr. Surasky, “but being themselves opioids they foster dependence and present the long-term challenge of eventual weaning, which may be difficult. And although they prevent cravings, they do not reverse the damage that has been done to the brain and do not allow the brain to reset its emotional temperature. They effectively perpetuate the addictive cycle so patients don’t learn coping mechanisms that will enable them to live substance free.”
What is the best way to ensure complete recovery?
Dr. Surasky continues: “Vivitrol has these advantages over Suboxone; It is not an opioid, is not addictive, and does not cause physical dependence.” By preventing even a mild opioid effect, it enables patients to get reacquainted with their own emotions and focus on behavioral changes without the interference of any mind-altering substance. According to Dr. Surasky, there are newly developed medication protocols that allow patients to be treated with Vivitrol in just a few days rather than the traditional 7-14 days without opiates. This is good news to those suffering with addiction. Suboxone can be useful during that period to reduce withdrawal symptoms. But the best opportunity for a permanent recovery from addiction is an individualized course of treatment with Vivitrolin combination with a strong support program to address the psychological, behavioral, and environmental aspects of the disease.”
Suboxone®is aregistered trademark of Indivior UK Limited
Vivitrol® is a registered trademark of Alkermes, Inc.
Russell Surasky, FAAN, ABAM, with Surasky Neurological Center for Addiction, is board certified in both neurology and addiction medicine. www.drsurasky.com
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