Drug Maintenance Therapy for Heroin Addiction: The Pros and Cons

Drug Maintenance Therapy for Heroin Addiction: The Pros and Cons

Drug addiction is a medical problem that requires a medical solution. Moral judgments about the behavior of addicts are commonplace, but to stop substance abuse once and for all we must move beyond such considerations and recognize addiction for what it is — a disease.

The idea of addiction as something sinful and shameful may limit our ability to respond to it practically and effectively. With heroin addiction, for example, research has shown that people who are treated with drug maintenance therapy have a better rate of recovery than those who rely only on professional counseling, in-patient/outpatient services and peer group meetings. And yet, because one drug is being replaced with another in this style of treatment, many people have rejected it — including treatment professionals — who might be expected to be more open-minded. This is the product of a reactionary attitude that lumps all drugs together as if they were all equally bad, which is unfortunate and, in this instance, illogical.

What Is Drug Maintenance Therapy for Heroin Addiction?

In drug maintenance or drug replacement therapy, a substance with similar chemical characteristics but more benign side effects is substituted for the heroin the addict normally consumes. This drug will bind to the brain receptors that crave heroin, satisfying the biological urges addicts feel but without causing the overwhelming physical and psychological reactions. As the new drug is phased in, heroin is phased out, gradually and progressively so that no cravings or withdrawal symptoms are experienced.

The two alternatives commonly used in drug replacement therapy are methadone—a milder opioid cousin of heroin—and a pharmaceutical medication called Suboxone (another drug called naltrexone is also used to combat heroin addiction, but not as a part of maintenance therapy). The latter is comprised of two drugs (buprenorphine and naloxone) that neutralize each other and suppress the euphoric feelings normally produced by activated heroin brain receptors.

It can take heroin addicts up to two months to make the transition to methadone, while the change to Suboxone can take place in as little as three days. A person who starts drug maintenance therapy should expect to continue taking replacement drugs for one to three years (on average), after which a gradual withdrawal program can be instituted that should allow the patient to transition to a completely drug-free life.

The Pros and Cons: A Closer Look

When used as prescribed, methadone and Suboxone can eliminate heroin withdrawal symptoms. Because they are administered on a medically supervised schedule, addicts are not forced to scramble to secure supplies of the drugs they rely on. And, unlike heroin, these substances will not disable their users in any way or prevent them from living a normal life. While undergoing drug maintenance therapy, recovering heroin addicts can hold down jobs, repair tattered relationships and more effectively manage their lives in general.

Dozens of studies have been carried out that have established the effectiveness of this type of treatment. This is why more and more medical professionals have become outspoken in their support of drug maintenance therapy, and somewhat harsh in their dismissal of the arguments of critics who are worried about the ramifications of substituting one drug addiction for another.

For drug maintenance therapy to work, however, it is essential that recovering addicts stick with the program and not deviate from their medically approved plan for recovery. Heroin addicts have a history of making bad decisions related to drug use, so there are legitimate reasons to be concerned about their ability to use maintenance drugs responsibly.

Methadone and Suboxone will not deliver the expected benefits if used more or less frequently than prescribed, and they cannot be combined with alcohol, illegal drugs and most pharmaceutical medications without grave risk. Addicts who hope to recover under a drug maintenance regime will have to be more self-disciplined and less impulsive in their self-care habits than they have been in the past, and if they start abusing the drugs that are supposed to save them, their prospects for healing will vanish.

Another problem is that drug maintenance therapy is unlikely to work if it is not used in conjunction with a more traditional type of treatment program. Rehabilitation following drug addiction normally includes some combination of detox, residential treatment, outpatient services, individual and family therapy, 12-step group attendance and a firm commitment to stay with it for as long as it takes to reach a healed state. Drug maintenance therapy is another useful tool in the addiction specialist’s toolbox, but to truly make a difference, drug maintenance therapy will need to be supplemented by additional treatment services, which will help the addict learn to face up to his drug dependency in all of its physical, emotional and psychological complexity.

One last problem with drug maintenance therapy is that it can sometimes become permanent. Usually, recovering addicts can be weaned off methadone or Suboxone when the time is right. But some people find it impossible to fully overcome their heroin addiction, even after being off of that drug for years. These individuals may suffer repeated relapses when attempts are made to get them off their replacement drugs, giving doctors no choice but to continue prescribing methadone or Suboxone.

Choosing a Brighter Future Without Heroin

At times, evidence-based standards in drug and alcohol rehabilitation have not been observed religiously. The most conscientious professionals in the highest-quality treatment centers are working hard to overcome this, and that is one of the reasons support for drug maintenance therapy seems to be growing.

In a sense, drug maintenance therapy does replace one drug addiction with another, at least for a time. But it also saves lives and increases the chances of ultimate recovery, and this should be the most important consideration for heroin addicts looking for a way to escape from the dungeon of drug dependency.

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