<unk> s typically require long-term treatment and care with the goal of reducing risks for the individual, reducing criminal behaviour, and improving the long-term physical and psychological condition of the person. Some strategies aim to reduce drug<unk>  and lead to abstinence from<unk> s, while others attempt to stabilize on prescribed methadone or buprenorphine with continued replacement therapy indefinitely. No single treatment works for everyone, so several strategies have been developed including therapy and drugs.' As of 2013 in the US, there was a significant increase of prescription<unk>  abuse compared to illegal opiates like heroin. This development has also implications for the prevention, treatment and therapy of<unk>  dependence. Though treatment reduces mortality rates, the period during the first four weeks after treatment begins and the four weeks after treatment ceases are the times that carry the highest risk for drug-related deaths. These periods of increased vulnerability are significant because many of those in treatment leave programs during these critical periods. Medications<unk>  replacement therapy (ORT) involves replacing an<unk> , such as heroin, with a longer acting but less euphoric<unk> . Commonly<unk> d drugs for ORT are methadone or buprenorphine which are taken under medical supervision. , buprenorphine/naloxone is preferentially recommended, as the addition of the<unk>  antagonist naloxone is believed to reduce the risk of abuse via injection or insufflation without causing impairment. The driving principle behind ORT is the program's capacity to facilitate a resumption of stability in the<unk> r's life, while the patient experiences reduced symptoms of drug withdrawal and less intense drug cravings; a strong euphoric effect is not experienced as a result of the treatment drug. In some countries (not the US, or Australia), regulations enforce a limited time for people on ORT programs that conclude when a stable economic and psychosocial situation is achieved. (People with HIV/AIDS or hepatitis C are usually excluded from this requirement.) In practice, 40–65% of patients maintain abstinence from additional<unk> s while receiving<unk>  replacement therapy and 70–95% can reduce their<unk>  significantly. Along with this is a concurrent elimination or reduction in medical (improper diluents, non-sterile injecting equipment), psychosocial (mental health, relationships), and legal (arrest and imprisonment) issues that can arise from the<unk>  of illegal<unk> s. Clonidine or lofexidine can help treat the symptoms of withdrawal. Participation in methadone and buprenorphine treatment reduces the risk of mortality due to overdose. The starting of methadone and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies. ORT has proven to be the most effective treatment for improving the health and living condition of people experiencing illegal opiate<unk>  or dependence, including mortality reduction and overall societal costs, such as the economic loss from drug-related crime and healthcare expenditure. ORT is endorsed by the World Health Organization, United Nations Office on Drugs and Crime and UNAIDS as being effective at reducing injection, lowering risk for HIV/AIDS, and promoting adherence to antiretroviral therapy. Buprenorphine and methadone work by reducing<unk>  cravings, easing withdrawal symptoms, and blocking the euphoric effects of<unk> s via cross-tolerance, and in the case of buprenorphine, a high-affinity partial agonist, also due to<unk>  receptor saturation. It is this property of buprenorphine that can induce acute withdrawal when administered before other<unk> s have left the body. Naltrexone, a μ-opioid receptor antagonist, also blocks the euphoric effects of<unk> s by occupying the<unk>  receptor, but it does not activate it, so it does not produce sedation, analgesia, or euphoria, and thus it has no potential for abuse or diversion. In the United States, since March 2020 as a result of the COVID-19 pandemic, buprenorphine may be dispensed via telemedicine. The ultimate aim of methadone maintenance is for the individual to return to a more normal life. They could be eligible for drug dependency care, career counseling, and educational assistance once they start taking methadone under medical supervision. They can self-refer to social service providers as they continue to feel better and want to get back on their feet. Methadone may even be able to assist these individuals in avoiding relapse. Methadone is a long-acting drug, which means it sticks to the same<unk>  receptors in the brain as opium and prescription painkillers. As a result, patients who are taking methadone as part of an overdose treatment procedure will not feel<unk>  cravings or the severe withdrawal effects that come with it. This will encourage people in rehab to concentrate more on medication, laying a solid foundation for healing, rather than constantly fighting cravings and relapse impulses. Methadone is a long-acting drug that can last up to 56 hours in the body. This means it fits better as a preventive drug so it doesn't require regular dosing during the day. Methadone<unk> rs in detox also find more luck in therapy because they don't have to deal with constant<unk>  cravings or the severity of acute withdrawal symptoms. Advantages of methadone include: * Reduction in infectious disease due to the cessation of opiate misuse, especially injection drug abuse * Reduction in illegal crime due to the cessation in illicit drug usage * Overall increase in quality of life * Improved social functioning * More attendance in alcohol therapy since withdrawal symptoms aren't a diversion Methadone replacement therapy will also help people achieve stabilization early on in their rehabilitation. People should devote 100% of their time to recovery, helping them to solve the underlying problems that lead to their opiate addiction. They will get a career and start to find a better balance in their lives. It also enables parents to continue raising their children in a safe home environment. When their conditions improve and they want to refrain from taking methadone, they must be properly weaned off the medication, which must be done under medical observation. Although other medication-assisted therapies for opiate addiction, such as buprenorphine, are available, methadone is often seen as the most promising alternative for people who are heavily addicted to opiates. Methadone has a number of serious side effects, including: * Slowed breathing * Sexual dysfunction * Nausea * Vomiting * Restlessness * Itchy eyes Dosages can be adjusted after 1-2 days, or another medication may be recommended for your situation if you experience side effects. Lung and breathing complications are possible long-term side effects of methadone<unk> . Methadone, as an opiate, has the potential to be addictive. Any opponents believe that replacement drugs only substitute one addiction with another, and that methadone can be manipulated and exploited in some cases. Long-term usage has the ability to cause brain changes. Methadone causes changes in thought, cognitive performance, and memory by influencing nerve cells in the brain. An initial review is performed during alcohol therapy. The person will be evaluated and interviewed during this evaluation, and then the treatment team will then devise the optimal treatment plan for that individual. Buprenorphine Buprenorphine/naloxone tablet Buprenorphine is a partial<unk>  receptor agonist. Unlike methadone and other full<unk>  receptor agonists, buprenorphine is less likely to cause respiratory depression due to its ceiling effect. Treatment with buprenorphine may be associated with reduced mortality. Buprenorphine under the tongue is often<unk> d to manage<unk>  dependence. Preparations were approved for this<unk>  in the United States in 2002. Some formulations of buprenorphine incorporate the opiate antagonist naloxone during the production of the pill form to prevent people from crushing the tablets and injecting them, instead of using the sublingual (under the tongue) route of administration. Other<unk> s Evidence of effects of heroin maintenance compared to methadone are unclear as of 2010. A Cochrane review found some evidence in<unk> <unk> rs who had not improved with other treatments. In Switzerland, Germany, the Netherlands, and the United Kingdom, long-term injecting drug<unk> rs who do not benefit from methadone and other medication options may be treated with injectable heroin that is administered under the supervision of medical staff. Other countries where it is available include Spain, Denmark, Belgium, Canada, and Luxembourg. Dihydrocodeine in both extended-release and immediate-release form are also sometimes<unk> d for maintenance treatment as an alternative to methadone or buprenorphine in some European countries. Dihydrocodeine is an<unk>  agonist. It may be<unk> d as a second line treatment. A 2020 systematic review found low quality evidence that dihydrocodeine may be no more effective than other routinely<unk> d medication interventions in reducing illicit opiate<unk> . An extended-release morphine confers a possible reduction of<unk> <unk>  and with fewer depressive symptoms but overall more adverse effects when compared to other forms of long-acting<unk> s. Retention in treatment was not found to be significantly different. It is<unk> d in Switzerland and more recently in Canada. Naltrexone Naltrexone is an<unk>  receptor antagonist<unk> d for the treatment of<unk>  addiction. Naltrexone is not as widely<unk> d as buprenorphine or methadone for OUD due to low rates of patient acceptance, non-adherence due to daily dosing, and difficulty achieving abstinence from<unk> s before beginning treatment. Additionally, dosing naltrexone after
Opioid use disorder
Alcoholism
Stimulant use disorder
Benzodiazepine use disorder
Cannabis use disorder
Benzodiazepine dependence
Amphetamine dependence
Cocaine dependence