The major treatment for opioid dependence is opioid replacement therapy.

Two big options exist. Both are given daily under observation.

Methadone

• Only opioid agonist activity, not antagonist
  • Can be dangerous if IVDU while on methadone
• Works in special groups
  • Mental health
    • Safe in mental health issues, like schizophrenia
  • Pregnant
    • Not teratogenic
  • Homeless
    • As have more chaotic lifestyle
• Longer half-life
  • Increase dose more slowly, such after 4 days

Suboxone

• Combined partial opioid agonist and antagonist
  • Buprenorphine plus naloxone
• First-line in normal situations
  • Given methadone in pregnancy
    • Buprenorphine has no studies on safety
    • Naloxone is teratogenic
  • Suboxone is considered weaker than methadone
• Given sublingually
  • So goes to blood
  • Not effective if taken orally through gastrointestinal system
  • Naloxone works as antagonist in blood, not gut
  • Thus, is good if IVDU patient
• Can increase dose every day, such as after 24 hours

References

• Doctor from Centre For Addiction Medicine