Guide to Opioid Replacement Therapy

When someone is addicted to opioids and make the attempt to quit, they can experience intense cravings. To help manage cravings and manage withdrawal symptoms opioid replacement therapy may be recommended.

This page will explain what opioid replacement therapy is, the types of therapy available, the pros and cons, and how to get help if you or a loved one are struggling with addiction to opioids.

What Is Opioid Replacement Therapy?

Opioid replacement therapy is the use of opioid medication to treat addictions to more powerful opioids like heroin or OxyContin. Opioid addiction can be very strong, going so far as to change how the brain operates, and attempting to quit can lead to intense cravings and withdrawal symptoms.

Opioid replacement therapy provides an individual with opioid medication in an effort to quell the withdrawal symptoms and help them through the withdrawal process. Since withdrawal symptoms aren’t intense, individuals can then focus on therapy, helping them to find a firm footing in recovery.

The goal of opioid replacement therapy is not to simply transfer someone’s opioid addiction from one substance to another. Opioid replacement therapy aims to quell drug cravings and prevent withdrawal symptoms with milder opioids, providing less chance for overdose and the potential for serious long-term health consequences. The goal is for a person to slowly taper off the opioid medication

Types of Opioid Replacement Therapies

The primary medications used in opioid replacement therapy are methadone, buprenorphine, and Suboxone.

Methadone

Methadone is the better-known and more established medications used in opioid replacement therapy. It’s a long-lasting synthetic opioid that is used to reduce opioid cravings and prevent individuals from experiencing withdrawal symptoms, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Methadone has been used for this purpose —  most commonly in cases of addiction to heroin or prescription opioids, for decades.

How Does Methadone Work?

When methadone is taken as prescribed, it has proven to be effective and safe, according to SAMHSA. According to NIDA, individuals who used methadone were over four times more likely to stay in treatment. It does not provide the euphoric effects that many opioids do, rather it blocks the painful symptoms of opioid withdrawal. Methadone can be found in pill, wafer, and liquid form, and it is usually administered once per day.

Methadone cannot be obtained through any physician. The drug can only be distributed by an opioid treatment program or specified clinics. According to the National Institute on Drug Abuse (NIDA) methadone treatment should last at least one year, but this is not a consensus opinion in the medical community. Some patients remain on the drug for many years. The goal is to taper a patient off methadone slowly until they no longer have any physical dependence on opioids.

Buprenorphine

Buprenorphine is the another opioid commonly used in opioid replacement therapy. This option has been available for much less time than methadone has, and it differs from methadone in a variety of ways.

How Does Buprenorphine Work?

Buprenorphine is a long-acting opioid that acts on the same brain receptors as illicit opioids. Like methadone, buprenorphine can quell cravings for opioids in those who are physically dependent. However, unlike methadone, buprenorphine is not administered strictly through specific clinics. This medication can be obtained via prescription from a specially trained physician. Thus, buprenorphine is more accessible that methadone.

It has been shown to decrease the chances of opioid misuse, according to SAMHSA. Buprenorphine does produce some of the effects related to opioids but to a much lesser degree than those associated with heroin or prescription painkillers. It has what is known as a “ceiling effect,” which means that increasing the dose will not increase the effects beyond a certain point.

Suboxone

Suboxone contains buprenorphine and naloxone. The buprenorphine prevents withdrawal symptoms, and the naloxone acts as an abuse-deterrent.

Naloxone is an opioid antagonist that is commonly used to reverse the effects of an opioid overdose. In the case of Suboxone, naloxone has little to no effect on a user if the drug is taken as prescribed. However, if an individual attempts to inject Suboxone instead of taking the pill orally, the naloxone will trigger withdrawal, leading to various unpleasant symptoms. This serves as a significant deterrent for misuse of this drug.

Pros and Cons of Opioid Replacement Therapy

There are benefits and drawbacks to opioid replacement therapy, as should be expected when dealing with substances as powerful and addictive as opioids. The pros and cos will vary depending on how an individual proceeds through the process and whether they adhere to the guidelines set out by their physician. Some of the pros include:

• Lower chance of overdose.
• Decreased physical dependence.
• Less likelihood of relapse since withdrawal symptoms are controlled.

However, some of the cons that can arise include:

• Misuse of the prescribed opioid replacement medication.
• Risk of addiction to the prescribed opioid medication.
• Overdose potential as a result of misuse.

While some people encounter problems with the medication they use during opioid replacement therapy, it is generally considered safer than continuing to use substances like heroin, fentanyl, or morphine. Decreasing the chance for overdose alone can be enough to save someone’s life.

Medication-Assisted Treatment

While opioid replacement therapy is a helpful tool for treating opioid addiction medication alone is often not enough to help people achieve longterm meaningful recovery from substance use disorders.  Opioid replacement therapy is considered more effective when used as an aspect of medication-assisted treatment (MAT).

MAT uses medication like methadone or buprenorphine in conjunction with counseling and behavioral therapy. The medication helps manage the physical symptoms of addiction, while therapy addresses the underlying issues that contribute to continued substance misuse, teaches coping skills and trigger awareness, and provides a foundation for sustained recovery.

Examples of Therapies Used in MAT

Depending on the individual’s needs and circumstances, treatment plans will involve a combination of therapeutic interventions. Some of these are more “traditional” therapies like cognitive behavioral therapy, and others may be augmentative, like music therapy. Examples of therapies used in MAT include:

• Cognitive Behavioral Therapy (CBT). CBT is one of the most effective therapeutic tools available to those struggling with opioid addiction. It addresses with the connections between an individual’s thoughts, feelings, and behaviors. When an individual can change their thoughts, they can change the behaviors associated with those thoughts. CBT teaches individuals how to anticipate problems in their recovery and gives them coping strategies and solutions to deal with those issues. CBT used in conjunction with opioid replacement therapy can be an effective combination in the pursuit of recovery.
• Group Therapy. Another productive form of therapy is group therapy.While not a therapeutic discipline in-and-of-itself, the group therapy setting can be incredibly beneficial to people on their recovery journeys. Group therapy involves a therapist and multiple individuals in recovery in each session. The group setting can help to put individuals at ease, seeing that they are not alone on their recovery journey. Group participants can share their struggles with the group and learn from the experiences of others.
• Music therapy. This form of therapy can be a useful form of complementary therapy that is also done in a group setting. This involves a trained therapist using music in a control fashion. Music therapy can help to reduce stress, something that is a very common trigger of relapse. It can also help with depression, which is often a symptom of withdrawal. Music can alleviate boredom, anxiety, muscle tension, and a variety of other issues that are common in recovery.
• Recreational Therapy. Outdoor therapy can be another productive form of therapy in substance abuse treatment. This type of therapy involves immersion in nature and overcoming challenges via activities like rock climbing, hiking, and water sports. Such activities expose those in recovery to new, healthy habits and can often boost self-esteem. Overcoming challenges in outdoor or adventure therapy can be correlated to overcoming challenges in recovery. In addition, participants often work as teams, fostering collaboration and communication skills.

Opioid Addiction Treatment

If you or someone you love is struggling with addiction to opioids getting professional treatment can help get you on the road to recovery and back to living the life you deserve. At our inpatient rehab in Las Vegas, we use evidence-based addiction focused healthcare to help people struggling with opioid use disorders.

Contact our helpful and knowledgeable admissions navigators 24/7 at to learn more about our different levels of addiction treatment and to find out more information about how to start rehab admissions. They can also answer your questions about how to pay for rehab or using your insurance to cover addiction treatment.