Opioid Addiction &
Treatment Options

Addiction is a chronic, relapsing brain disease that changes how the brain works and affects behavior. Addiction is defined by an uncontrollable urge to seek and use opioids, despite the problems they cause. People with addiction cannot simply stop using drugs for a few days and be cured of their addiction. Most patients need ongoing care.1,2

Treatment programs include counseling and social support to treat the psychological aspects of addiction. They may also include medication to help treat the physical effects of addiction.1

The BRAIN and pleasure2

Mechanism of action (MOA) of endorphins

To understand how addiction happens, it is important to understand how the brain normally works. The human brain is stimulated by everything you do. When you do something you enjoy (such as eating delicious food), your brain releases chemicals called endorphins. Endorphins attach to opioid receptors in the brain, causing them to release a chemical called dopamine. Dopamine gives you a good feeling to reward you for doing something, which makes you want to repeat these behaviors.


The BRAIN and OPIOID USE2

Mechanism of action (MOA) of opioids

Opioid street drugs (such as heroin) and opioid pain medications attach to some of the same receptors as endorphins. However, opioids cause the release of more dopamine than normal enjoyable activities do, causing a “high.” When the high ends, the brain craves this feeling again.


Developing tolerance2

Opioid use over time causes tolerance development

As the brain builds up a tolerance, you need more and more opioids to feel the same way as that first time. Over time, the body often starts to depend on opioids to feel normal and avoid the symptoms of withdrawal.


UNDERSTANDING TREATMENT OPTIONS2

Medications for treating addiction work by interacting with some of the same receptors in the brain that are triggered by drugs. When used with counseling, medication can help treat the physical effects of addiction.

Counseling and medication target different regions in the brain

The psychological benefits of counseling2

The psychological effects of addiction are very powerful. That’s why addressing these effects is so important—especially when someone is starting recovery. Counseling teaches people effective recovery skills to help prevent relapse. It can also help with:

Self-acceptance
and personal
growth
Developing
positive life
skills and habits
Coping with
relapse triggers,
stressors, and
urges
Reducing the
urge to use
opioids
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Counseling and a strong support network are essential to helping people to stay in recovery.


The physical effects of addiction can be treated with medication2,3

Medications for treating opioid addiction work by interacting with some of the same receptors in the brain that are triggered by drugs. Medication can help in treating the physical effects of addiction, and should be used alongside counseling.

There are three types of medication used with counseling to treat opioid dependence:

  • Full agonist
  • Partial agonist
  • Antagonist (blocking)
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Discuss all the benefits and risks of agonists, partial agonists, and antagonists with a medical doctor.


AGONIST MEDICATION4,5

Mechanism of action (MOA) of agonists

Agonists attach to and activate opioid receptors just like opioid street drugs or prescription drugs do. When taken as directed, agonists may stabilize a patient and prevent withdrawal. Patients don’t have to detox to start on agonist medication, but they will experience withdrawal when they stop because agonists prolong dependence on opioids.


PARTIAL AGONIST MEDICATION6

Mechanism of action (MOA) of partial agonists

Partial agonists attach to opioid receptors, but do not stimulate them as much as full agonists. When taken as directed, partial agonists may stabilize a patient and prevent withdrawal. Patients don’t have to detox to start on a partial agonist medication, but they will experience withdrawal symptoms when they stop because partial agonists prolong dependence on opioids.


ANTAGONIST OR BLOCKING MEDICATION4

Mechanism of action (MOA) of antagonists or blocking medication

Antagonists also attach to opioid receptors, but do not cause the release of dopamine. They are non-addictive and do not lead to or prolong physical dependence. Antagonists create a barrier that blocks opioid molecules from attaching to opioid receptors. Patients must detox before starting on antagonist medication.

VIVITROL is not right for everyone. There are significant risks from VIVITROL treatment, including risk of opioid overdose, severe reaction at the injection site and sudden opioid withdrawal.
See Important Safety Information below. Discuss all benefits and risks with a doctor. See Prescribing Information and Medication Guide.

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References:

  1. National Institute on Drug Abuse (NIDA). Treatment approaches for drug addiction. https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/df_treatment_ approaches_final_7_2016.pdf. Updated July 2016. Accessed September 21, 2016.
  2. National Institute on Drug Abuse (NIDA). Drugs, brains, and behavior: the science of addiction. NIH publication 14-5605. https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/soa_2014.pdf. Revised July 2014. Accessed September 21, 2016.
  3. Office of National Drug Control Policy. Healthcare brief: medication-assisted treatment for opioid addiction. https://www.whitehouse.gov/sites/default/files/ondcp/recovery/medication_assisted_treatment_9-21-20121.pdf. Published September 21, 2012. Accessed October 22, 2015.
  4. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002;1(1):13-20.
  5. Stotts AL, Dodrill CL, Kosten TR. Opioid dependence treatment: options in pharmacotherapy. Expert Opin Pharmacother. 2009;10(11):1727-1740.
  6. Kleber HD. Pharmacologic treatments for opioid dependence: detoxification and maintenance treatment options. Dialogues Clin Neurosci. 2007;9(4):455-470.
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