Is it possible to cure addiction with an opiate?
First of all, we should clear up the issue of defining opiate. While traditionally, “opiate” meant a drug derived from opium and “opioid” meant a synthetic opiate-type drug, things have changed. The words, “opioid” and “opiate” can now be used interchangeably. This takes away the confusion of trying to figure out which is which. So, what drugs are opiates?
Some examples of opiates/opioids.
- oxycodone – This is a pain reliever that is commonly found in brand-name drugs, such as percocet, roxicodone and oxycontin, a time release version.
- hydromorphone – Another pain medicine, this is the main ingredient in Dilaudid and Exalgo, an extended release form of hydromorphone.
- oxymorphone – As you can see, the names of prescription opiates are similar to the point that confusion over which is which is understandable. Oxymorphone is the ingredient in Opana, which comes in an immediate and extended release form.
- morphine – This drug is the standard by which all other opioids are compared. It is commonly used in hospitals as an IV or IM medication. It is available in tablet and capsule form as well. MS Contin, MS IR, Kadian and Avinza.
- hydrocodone – This prescription opioid is found in Vicodin, Norco, Vicoprofen, lorcet and lortab as well as hycodan and tussionex cough syrup. Zohydro is an extended release form. For many years, this was the most abused of all prescription opioids, mainly because it was more readily available. In recent years, it has been more tightly controlled to reduce abuse and diversion.
- codeine – This potent opiate is found in Tylenol #3 and Tylenol #4. It is limited in usefulness because it causes significant constipation at relatively low dosages. However, it is still used for moderate to severe pain. It is also found in cough syrups, such as Robitussin AC.
- meperidine – The ingredient in Demerol, this drug was once used frequently in hospitals for pain. It is used far less frequently due to seizure risks.
- tramadol – This opiate is considered to be somewhat mild. While it has abuse potential, it is limited because most opioid abusers are aware that it can cause seizures as the dosage goes above 400mg in 24 hours. The brand name is Ultram. This drug was once not controlled, but now it is.
- Tapentadol – Also known as Nucynta, this drug acts as an opioid and also on other receptors that make it almost like an opiate and antidepressant combination.
- heroin – Derived from the opium poppy, this opiate is not legal in the United States. The human body metabolizes heroin to morphine. heroin is four times more potent than morphine.
- Fentanyl – This legal opiate/opioid is used commonly in surgery as a part of general anesthesia. It is also used for chronic pain in the form of the Duragesic patch and Actiq, the fentanyl lollipop. In recent years, fentanyl has been found as a contaminant in heroin and other street drugs. It has been used as a replacement for heroin by many drug dealers, often unbeknownst to to the user. Fentanyl is to blame for many opiate and opioid overdoses. This is primarly due to fentanyl analogs that are known to originate in China and Mexico and are shipped to dealers through the US mail. Fentanyl is 80-100 times more potent than morphine.
- Carfentanil – Carfentanil, or carfentanyl, is a super-potent opiate, similar to fentanyl, yet it is up to 1,000 times the potency of morphine. It is often referred to as an elephant tranquilizer. When these very powerful opiates are in the environment, it is possible for them to be absorbed through the skin accidentally. It is even possible for the drug to pass through the microscopic pores of a latex glove. Hence, first responders must be very careful. Another very powerful opioid on par with carfentanil is sufentanyl. This opioid may be used in a hospital setting.
You may consider all of these drugs to be either opiates or opioids.
The above listed drugs are either naturally derived opiates or synthetic opioids. While opioid drugs historically referred to synthetic opioids, currently, it is acceptable to use the term “opioid” to refer to all of these drugs. The same goes for “opiate”. As we are currently in the midst of an opioid crisis where opioid use and accidental overdose are rampant, there is no point to making a big deal about distinctions.
Is kratom an opiate?
This brings up another related topic that may be a sore point for some people. There is a plant-based drug known as kratom or kradom. This drug is officially not considered to be an opioid. Yet, it works directly on opioid receptors in the human body. It can lead to overdose, and withdrawal sickness. It can even stimulate cravings in a person with a history of opioid addiction. I believe that if a drug acts like an opiate, it should be classified as one. Hence, I consider kratom to be an opiate.
So, what opiates can cure addiction?
First, it should be said that treating opiate addiction is not the same as curing it. Addiction treatment addresses a chronic condition. Hence, at this time, opiate addiction, or opioid use disorder, is thought to be ultimately incurable as discussed in this Recovery Village article. It can, however be treated successfully with medication-assisted treatment which includes drug therapy and psychotherapy.
Methadone and Suboxone.
Methadone is a potent opiate that is used in specialized clinics to treat serious cases of opiate addiction. While typically we think of this as a treatment for heroin addiction, people addicted to oxycodone, hydrocodone and others may do well with methadone maintenance. An alternative that works better for many patients is Suboxone. Suboxone is also known as buprenorphine/naloxone where buprenorphine is the main active ingredient.
Bupe is uniquely suited for treating opioid addiction.
Buprenorphine is a very unique opiate that both blocks receptors and partially activates them. it is also available in other brands, such as Subutex, ZubSolv, Sublocade, Probuphine, Brixadi and others. It is most often prescribed as a sublingual preparation, either a film or tablet, which is placed under the tongue to dissolve. There are also long acting injectable and even implantable forms of the drug. There are also versions of buprenorphine that are approved to treat chronic pain, such as butrans and bunavail.
Is using Suboxone just trading one addiction for another?
This is a common misconception. In fact, this kind of thinking has likely caused many overdoses and deaths. Suboxone, and similar medications, works very well as a long-term treatment for opioid addiction. It is solid, evidence-based treatment. It differs significantly from other prescribed opioids.
Here are some advantages of buprenorphine compared to other opioids:
- less abuse potential
- better ability to function, mentally and physically
- little or no withdrawal symptoms after quitting other opioids.
- few, if any, cravings for opioids during treatment
When a person takes Suboxone treatment prescribed by a doctor and follows the treatment regimen and they are clean from street drugs, they are considered to be clean. If we are to save lives in this opioid epidemic, we must be clear about this. Suboxone and other buprenorphine meds can provide successful treatment for opioid use disorder and are considered to be safe for long-term use in preventing dangerous relapses.