Replacement therapy (also known as opioid replacement therapy (ORT) or opioid substitution therapy), is the medical procedure of replacing opioids, with a longer acting but less euphoric opioid. Methadone or buprenorphine are typically used for replacement therapy under medical supervision.
The driving principle behind replacement therapy is the program’s capacity to facilitate a resumption of stability in the user’s life, while they experience reduced symptoms of withdrawal symptoms and less intense drug cravings; however, a strong euphoric effect is not experienced as a result of the treatment drug.
Certain opioid medications such as methadone and more recently buprenorphine (In America, “Subutex” and “Suboxone”) are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies intended to reduce cravings for opiates, thereby reducing illegal drug use, and the risks associated with it, such as disease, arrest, incarceration, and death, in line with the philosophy of harm reduction.
Methadone (also known as Symoron, Dolophine, Amidone, Methadose, Physeptone, Heptadon and many other names) is a synthetic opioid. It is used medically as an analgesic and a maintenance anti-addictive and reductive preparation for use by patients with opioid dependence. Because it is an acyclic analog of morphine or heroin, methadone acts on the same opioid receptors as these drugs, and thus has many of the same effects.
Methadone has cross-tolerance (tolerance to similar drugs) with other opioids including heroin and morphine, and offers very similar effects but a longer duration of effect. Oral doses of methadone can stabilize patients by mitigating opioid withdrawal syndrome or making it more tolerable. Higher doses of methadone can block the euphoric effects of heroin, morphine, and similar drugs. As a result, properly dosed methadone patients can reduce or stop altogether their use of these substances.
Methadone maintenance therapy is prescribed to individuals who wish to abstain from illicit drug use but have failed to maintain abstinence from opiates for significant periods. The duration of methadone maintenance can be for months or even years. Methadone reduction programs are suitable for addicted persons who wish to stop using drugs altogether. The length of the reduction program will depend on the starting dose and speed of reduction, this varies from clinic to clinic and person to person.
The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with opiates. When used correctly, methadone maintenance has been found to be medically safe and non-sedating. It is also indicated for pregnant women addicted to opiates.
Methadone is also approved in the US for detoxification treatment of opioid addiction; however, its use in this regard must follow strict federal regulations. Outpatient treatment programs must be certified by the Federal Substance Abuse and Mental Health Services Administration (SAMHSA) and registered by the Drug Enforcement Administration (DEA) in order to prescribe methadone for opioid detoxification.
Buprenorphine is a semi-synthetic, mixed agonist–antagonist opioid receptor modulator that is used to treat opioid addiction in higher dosages, to control moderate acute pain in non-opioid-tolerant individuals in lower dosages and to control moderate chronic pain in even smaller doses.
It is available in a variety of formulations: Subutex, Suboxone, Zubsolv (buprenorphine HCl and/or naloxone HCl; typically used for opioid addiction), Temgesic (sublingual tablets for moderate to severe pain), Buprenex (solutions for injection often used for acute pain in primary-care settings), Norspan and Butrans (transdermal preparations used for chronic pain).
Buprenorphine has the advantage of being a partial agonist; hence negating the potential for life-threatening respiratory depression in cases of abuse. Studies show the effectiveness of buprenorphine and methadone are almost identical, along with the statistical likeliness of any adverse effects except for more sedation among methadone users. At low doses from 2 to 6 mg, however, suboxone has a lower retention rate than low doses from 40 mg or less of methadone
Either drugs, methodone and buprenorphine, may be used as maintenance medications (taken for an indefinite period of time), or used as detoxification aids.
Replacement treatment may be an effective treatment for improving the health and living condition of people experiencing problematic illicit opiate use or prescription drug dependence.