Which Substitute Drug is used in Heroin Addiction Treatment Programs?

Which substitute drug is used in heroin addiction treatment programs? The most common one is Suboxone, but methadone is also sometimes used in certain cases. Suboxone is preferred because it’s safer than methadone, and it can also be prescribed for use at home. Methadone can only legally be prescribed for opioid maintenance use by specially licensed physicians working in methadone clinics. Methadone can be prescribed for pain by any licensed physician but not for opioid withdrawal or maintenance. Suboxone can also only be prescribed by specially licensed doctors. These doctors are identified by the presence of an X number next to their standard DEA identification number on their prescription pads. Any doctor writing any kind of controlled substance must be registered with the DEA to do so. Their DEA number isn’t random. There is a certain formula that pharmacies can use to verify if a particular number is legitimate or not.

What is Suboxone?

Suboxone is a combination drug containing buprenorphine, a synthetic opioid and naloxone, an opioid overdose rescue drug. Buprenorphine is a long-acting partial agonist narcotic. This means that while it works on the same brain receptors that other opioids do, it’s only a partial action. It cannot fully activate the brain’s mu receptor. This makes it safer than full agonist narcotics like morphine. It also limits its ability to produce euphoria. Buprenorphine activates the mu receptor just enough to relieve withdrawal symptoms and curb drug cravings. It can be taken either short-term, to manage opioid withdrawal, or long-term, to prevent relapse back to heroin or other opioids. Naloxone is included to prevent intravenous abuse of the buprenorphine. If injected, the naloxone in Suboxone will not only prevent any high from the buprenorphine but will cause an instant, full-blown withdrawal reaction. Most addicts are aware of this. Very few, if any, would try to get a high by injecting Suboxone. You can be sure it would be a most unpleasant experience.

Methadone is also synthetic, but it’s a full agonist. This means it fully activates the mu receptor, but in comparison to oxycodone and other full-agonist opioids, it produces little euphoria. However, it’s still a stellar analgesic, often relieving pain when other opioids have failed to do so. It’s long-acting and will keep an opioid-dependent person out of withdrawal for at least a full 24 hours. It’s effective in fairly low doses. These factors all make methadone a good choice for opioid maintenance treatment. Because it fully activates the mu receptor, there is a higher risk for overdose compared to buprenorphine, but careful monitoring of the dose should avoid this risk. Like buprenorphine, methadone can be used either short-term or long-term. When used short-term, the drug is started in a higher dose that is gradually reduced over a period of time, usually several weeks.


There is another alternative for heroin addiction treatment. It’s called clonidine, and it’s not a narcotic. Clonidine is better suited for lower-level heroin addictions and for those who prefer not to use another opioid to help them withdraw. Clonidine is a beta-blocker drug used for high blood pressure and certain heart conditions. However, it’s been used off-label for opioid withdrawal for many decades. Its effectiveness is limited compared to methadone and buprenorphine, and it has potentially serious side-effects. Nevertheless, it’s an alternative for some heroin addicts who may want to try it. It will not relieve all opioid withdrawal symptoms, and it’s usually combined with other non-opioid medications like benzodiazepines, muscle relaxants, medications for nausea and diarrhea and non-narcotic pain relievers.

Although Suboxone has become the gold standard for opioid withdrawal and maintenance, it’s not a solution for everyone. Some people don’t respond well to it. Others may be allergic to one or both of the ingredients, although this is unlikely. Buprenorphine most often fails when a person has a very high tolerance to opioids. This may be seen in persons who have been taking large amounts of fentanyl for awhile. These people may not find adequate relief from Suboxone, but methadone almost always will work, as long as the dose is sufficient. Methadone is very powerful, even by mouth and should only be prescribed by doctors familiar with its use. In fact, many doctors refuse to prescribe methadone for any reason because it’s unpredictable and can be hard to dose properly.

Let us Help

We’re a group of professional drug counselors available anytime at 772-266-5320. We can help explain more about Suboxone, methadone and other options for opioid withdrawal. We can also guide you to the best rehab facilities near you. Please call. We look forward to speaking with you.

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