Opioid Replacement Therapy

Opioid replacement therapy uses medications to help people escape the grips of opioid or heroin addiction. Methadone and buprenorphine are the two medications used most. Opioid replacement therapy helps people stay in treatment longer and can prevent relapse.
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Overcoming an opioid addiction is challenging. Relapse is common — and for many, willpower alone isn’t enough to overcome the grips of addiction.

Fortunately, there are medications that can help.

Opioid replacement therapy reduces cravings, stabilizes brain chemistry and blocks the euphoric effects of opioids. This type of therapy is also called opioid substitution treatment or opioid maintenance therapy.

How Opioid Replacement Works

Opioid replacement treatment addresses the two most vexing problems associated with opioid dependence and addiction: withdrawals and cravings.

Opioid withdrawal is often an agonizing experience that triggers severe cravings. The process is so excruciating that many people relapse.

Opioid replacement therapy works by stabilizing the brain’s opioid receptors. The drugs suppress withdrawal symptoms and eliminate cravings without producing a high.

That said, opioid replacement therapy is not a magic pill that cures addiction. It works best when combined with intensive behavioral therapy, counseling and support. This combination approach is known as medication-assisted treatment.

Medications for Opioid Addiction

The FDA has approved three medications for treating opioid addiction: buprenorphine, methadone and naltrexone. In some countries, heroin is used as an opioid replacement therapy. Heroin is not used for this purpose in the United States.


Methadone is the oldest proven treatment for opioid dependence and addiction. It binds to the same brain receptors as other opioids but doesn’t activate them as quickly. As a result, it doesn’t deliver the same euphoric rush as heroin and other opioids.

People begin detox with an initial dose of 20 to 30 milligrams of methadone. This is usually adequate to suppress withdrawal symptoms and extinguish cravings. Over time, a person will build up to a level of 80 to 120 mg a day.

Methadone costs less than $1 a day. But it’s only accessible through federally licensed opioid treatment programs. A person must visit a clinic early every morning to receive their maintenance dose. Individuals receiving methadone will also take regular drug tests and receive counseling.

Methadone has other drawbacks. It can cause dangerous heart arrhythmias. People can also overdose if they mix methadone with benzodiazepines or other sedatives.


Buprenorphine also binds to the brain’s opioid receptors more strongly than other opioids but has less intense effects. Like methadone, it relieves the flu-like symptoms of opioid withdrawal. It also reduces cravings but won’t make a person high.

Buprenorphine is the main ingredient in suboxone, a leading opioid replacement medication. Suboxone also contains naloxone. Naloxone blocks the effects of opioids in the brain to deter abuse of the drug.

Buprenorphine comes in several different formulations. Prices range from $4 to $30 a day, depending on the product. Buprenorphine is easier to get than methadone. Physicians can prescribe the drug on an outpatient basis. There are no federal requirements for drug testing or counseling, but therapy is an important component of opioid addiction treatment.

A person must already be in withdrawal before they take their first daily dose. This can make it challenge for some people to begin treatment. If it’s started too soon, buprenorphine will thrust a person into full-blown withdrawal. This is known as precipitated withdrawal.

Buprenorphine is susceptible to abuse. A person can space out their doses and use opioids in between to get high. Some people crush and inject it to increase the drug’s effects. Others sell their buprenorphine on the streets to make money. For these reasons, close monitoring is essential.


Naltrexone has been used for opioid dependence and relapse prevention since 1984. The man-made drug blocks the euphoric effects of opioids and reduces cravings. Unlike methadone and buprenorphine, naltrexone does not relieve withdrawal symptoms.

A person must fully detox before they begin naltrexone. This requires approximately three to 10 days of abstinence, depending on the person. The drug is also expensive and not always covered by insurance. Naltrexone injections can cost upwards of $1,000 a month. The pill form is about $7 a dose.

At one time, naltrexone came only in pill form. Patients often stopped taking their medication and relapsed. Today, naltrexone is available as a long-acting monthly injection called Vivitrol. The so-called “blocker shot” takes the burden off someone who might stray from therapy.

Length of Treatment

The duration of opioid replacement therapy can vary, depending on the person.

But research shows that those who remain on medication longer have better success. In most cases, patients should remain on the medications for one to two years before trying to taper.

Those on replacement therapy for fewer than six months have poor outcomes.

Benefits of Treatment

While opioid replacement therapy isn’t for everyone, the approach has significant benefits.

People on replacement therapy use drugs at much lower rates. Because they don’t have to contend with cravings and withdrawals, they’re better able to focus on recovery and rebuilding an addiction-free life.

The therapies also reduce the chance of relapse and the risk of dying.

A 2017 review in The BMJ found that people who relied on opioid replacement therapy had a much lower risk of dying from an opioid overdose.

The death rates of patients receiving methadone were less than a third of the normally expected level. The authors surmised that buprenorphine treatment is “probably also effective” but requires more study.


While medication-assisted treatment is the first-line treatment for opioid addiction, misconceptions still exist.

Some people believe that a person isn’t really sober if they are receiving replacement therapy. Others view it as a moral flaw if someone can’t conquer their addiction through shear willpower. Another misconception is that medication-assisted treatment swaps one addiction for another.

In fact, addiction is a chronic brain disease — and like other diseases it often requires treatment with medications. Just as a diabetic can’t control their illness without insulin, people suffering from an addiction often can’t manage their disease without the help of medications.

The drugs used in opioid replacement therapy don’t make a person high. Rather, they stabilize the individual and prepare them for recovery. With medication-assisted therapy, people are able to get back to work and function normally. Their lives no longer revolve around compulsive drug-seeking and dope sickness.

To find out if opioid replacement therapy is right for you, contact a drug rehab center today. They can create a treatment plan tailored to your needs that will put you on the path to recovery.

Medical Disclaimer: DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Amy Keller, RN, BSN
Content Writer, DrugRehab.com
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
Kim Borwick, MA
Editor, DrugRehab.com

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