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Some people build tolerance to opioids over time. This requires them to increase their drug dosage to maintain the benefit, and that in turn also increases the unwanted side effects. [78] Long-term opioid use can cause opioid-induced hyperalgesia, which is a condition in which the patient has increased sensitivity to pain. [101]
Opioid agonist therapy (OAT) is a treatment in which prescribed opioid agonists are given to patients who live with opioid use disorder (OUD). [1] In the case of methadone maintenance treatment (MMT) , methadone is used to treat dependence on heroin or other opioids , and is administered on an ongoing basis.
[109] [110] This approach is seen as ineffective without plans for transition to long-term evidence-based addiction treatment, such as opioid agonist treatment. [64] Though treatment reduces mortality rates, the first four weeks after treatment begins and the four weeks after treatment ceases are the riskiest times for drug-related deaths. [7]
“The brain changes, and it doesn’t recover when you just stop the drug because the brain has been actually changed,” Kreek explained. “The brain may get OK with time in some persons. But it’s hard to find a person who has completely normal brain function after a long cycle of opiate addiction, not without specific medication treatment.”
This allows the body to adapt to the absence of drugs to reduce the withdrawal symptoms. The most commonly used strategy is to offer opioid drug users long-acting opioid drugs and slowly taper the dose of the drug. Methadone, buprenorphine-naloxone, and naltrexone are all commonly used medications for opioid use disorder. [19]
Long-acting injectable naltrexone (under the brand name Vivitrol) is an opioid antagonist, blocking the effects of heroin and other opioids, and decreases heroin use compared to a placebo. [28] Unlike methadone and buprenorphine, it is not a controlled medication. [28]
Naltrexone is also a partial inverse agonist, and this property is exploited in treatment of opioid addiction, as a sustained course of low-dose naltrexone can reverse the altered homeostasis which results from long-term abuse of opioid agonist drugs. This is the only treatment available which can reverse the long-term after effects of opioid ...
Methadone is almost as effective when administered orally as by injection. Oral medication is usually preferable because it offers safety, and simplicity and represents a step away from injection-based drug abuse in those recovering from addiction. U.S. federal regulations require the oral form in addiction treatment programs. [69]
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