An Rx for Change: New Approaches for Treating Heroin Addiction

It is widely known that our society is experiencing a heroin epidemic. Some even understand heroin’s highly addictive qualities. But amidst the rise in heroin-related overdoses and deaths, many are not aware of how addiction to this particular drug can be treated, if not prevented.

According to the Centers for Disease Control and Prevention (CDC), heroin use has increased among men and women of most ages, ethnicities and income levels, with some of the most significant surges occurring in groups with historically low rates of use. Between 2004 and 2013, heroin use rose significantly in women (100%). It also increased in populations with notable significance to the workplace — the privately insured (63%) and people with higher incomes (60% for households with an annual income of $50,000 or more).

This new, complex epidemic poses significant challenges and warrants new approaches to treatment to combat its devastating effects.

Addiction

The destructive rise of heroin addiction seems senseless without an understanding of the underlying diagnosis: addiction. Like reliance on any other addictive substance, heroin addiction is a medical condition – a chronic, relapsing brain disease that cannot be stopped by good intentions or willpower alone. At its core, addiction is characterized by an individual pathologically pursuing relief or reward from a substance or behavior, despite harmful consequences. While the initial decision to use drugs may be voluntary, the brain is chemically changed by repeated drug use, interfering with a person’s ability to resist.

In the case of heroin, the drug is often injected, snorted or smoked and causes an almost immediate period of intense euphoria. The rush wears off quickly, resulting in a crash. Then, the user experiences an intense craving to use the drug again in order to stop the crash and restore the rush. It’s a gripping cycle – a hallmark of addiction.

Behavior-altering chemical changes in the brain, paired with intense withdrawal symptoms, make drug addiction especially devastating. Individuals going through withdrawal often experience severe pain, diarrhea, nausea and vomiting within just hours of their last dose. While heroin is a short-acting opiate, withdrawal symptoms can last up to 10 days and some symptoms can linger long after use has stopped.

Treatment

Like other chronic diseases, there is no “cure” for heroin addiction. But over time, effective treatment can help people effectively manage their addiction, restore a degree of normalcy to brain function and minimize (or eliminate) strong urges and harmful behaviors.

A variety of effective treatments are now available for heroin addiction, including pharmacological (medications) and behavioral interventions. And research shows that, for most, integrating both types of treatments is the most effective approach. This integrated approach is known as “Medication Assisted Treatment,” or MAT.

Medication

Medication eases cravings and other physical symptoms by targeting the same opioid receptors in the brain as heroin. The use of medications has shown increased retention in treatment and decreased drug use and criminal activity. Three types exist:

• • Agonists (e.g., methadone) – that activate opioid receptors and mimic the action of the opiate (i.e., heroin), without producing a high
  • Partial (e.g., buprenorphine such as Suboxone®) – that activate opioid receptors but produce a smaller response than agonists
  • Antagonists (e.g., Naltrexone, Vivitrol®) – that block the receptor and interfere with the rewarding effects of the drug

Behavioral Interventions

Behavioral treatment consists of in- or out-patient counseling and works to modify behaviors and expectations related to drug use. The goal of counseling is to increase an individual’s ability to cope with various life stressors and develop a support system that will help sustain a drug-free lifestyle.

Studies have proven MAT effective, showing decreases in opioid use, opioid-related overdose deaths, criminal activity and infectious disease transmission. Studies also show increases in social functioning and retention in treatment and a whole host of positive effects for pregnant women including improved infant outcomes, reduced symptoms of neonatal abstinence syndrome and shortened hospital stays.

Treatment stigma: Trading one drug for another?

No matter its effectiveness, addiction treatment often carries societal stigma – especially when medication is a part of the approach. Some see pharmacological treatment as a mere trade-off, subbing in one harmful drug for another. But, in reality, the opposite is true.

In contrast to heroin, medications used for treatment (e.g., methadone and buprenorphine) do not give patients a high. Instead, they have a gradual onset of action and produce stable levels of the drug in the brain. As a result, patients taking these medications experience reduced cravings and withdrawal symptoms. These medications restore balance to the brain circuits affected by addiction, allowing the brain to heal.

Maintenance treatments can save lives by stabilizing individuals and allowing for much-needed medical and psychological healing.

Role of employment in successful treatment outcomes

In tandem with pharmacological and behavioral interventions, employment often serves a pivotal role in addiction treatment. Numerous research studies have found that employment before or during substance abuse treatment predicts both longer retention in treatment and the likelihood of a successful outcome.

Employment also helps moderate the occurrence and severity of relapse to addiction, giving individuals an opportunity to develop new social skills and introduce them to new, sober friends who can help them maintain sobriety.

A good offense is the best defense

Because the abuse of prescription pain medication is a risk factor for heroin use and addiction, employers can play a major role in preventing heroin use and addiction by

• learning more about addiction as a disease,
• challenging personal prejudices around this medical issue,
• identifying helping resources that offer a variety of treatment modalities, and
• implementing comprehensive drug-free workplace policies and programs that can both prevent heroin addiction from occurring and offer guidance if it does.