What Are Alternatives to Methadone? Exploring the Options

While much of the focus of late has been on COVID-19 and the pandemic, the opioid epidemic continues to rage throughout our great nation. As substance abuse treatment centers strive to meet the growing needs of those with substance use disorders (SUD), the need for alternative treatment options including medications to assist with opioid addiction has come to the forefront. 

Traditionally, methadone, or more specifically methadone maintenance treatment (MMT) has been the ‘go to’ medication for helping those addicted to opioids get through the dangerous withdrawal period and stay off opioids. However, today there are a number of other viable medications to assist with recovery from opioid addiction. 

According to the 2019 National Survey on Substance Abuse Treatment Centers (N-SSATS), 80.4% of substance abuse treatment centers offered more medications for opioid addiction treatment than methadone alone. This was up by nearly 31% from 2009. 

So what exactly is methadone and why are options needed for medication-assisted treatment (MAT)? 

What Is Methadone? 

Methadone is a synthetic analgesic drug in the opioid class with effects similar to morphine but longer-lasting. This drug is commonly used for the treatment of heroin and morphine addictions and also as a pain reliever. 

Methadone was developed in the late 1930s by German scientists to help with the opioid shortage in that country. During World War II, methadone was widely used by the German army. The generic name ‘methadone’ was given to this synthetic opioid in 1947 and introduced in the United States that same year by Eli Lilly and Company as an analgesic under the name Dolophine. 

While methadone is used for pain treatment, its use as a treatment for opioid dependence began in the early 1970s in the United States and remains its main use. Methadone clinics are found throughout the U.S. with about 1,500 federally certified methadone clinics or opioid treatment programs. There are also private methadone clinics. In some areas, however, there aren’t methadone clinics around. This is one of the reasons why alternative medications to methadone for medication-assisted treatment (MAT) are needed. 

To date, dispensing of methadone must be done at a ‘methadone clinic’. Physicians and other healthcare professionals are unable to do so at this time. This makes it difficult for some who want to utilize MMT to do so. 

How Methadone Works

Methadone is usually taken orally. This opioid substitute works as a long-acting opioid acting on the same receptors in the brain as heroin and prescription opioids. This helps those with opioid dependence to navigate through the difficult withdrawal phase and also helps to manage longer-lasting cravings for the drug. 

While some individuals do become dependent on methadone usually when it is abused, research shows the following to be benefits of MMT: 

• Increased chance of long-term recovery
• Decreased criminal activity
• Decreased rates of infectious diseases
• Improved quality of life
• Increased social functioning
• Improved participation in treatment programs

However, there are also cons to MMT. These are:

• Developing an addiction to methadone
• Available only through methadone clinics
• Respiratory issues
• Decreased sexual function and interest
• Loss of appetite and nausea
• Low blood pressure and dizziness
• Sleep disturbances
• Swelling of hands, feet, arms, legs

The most commonly cited concern with MMT is the abuse of the opioid substitute. Those who are using methadone may begin to abuse it to achieve that ‘high’ they got from either heroin or a prescription opioid. 

It’s important to note that no matter what type of medication is being used to help with the treatment of opioid use dependence (OUD), that other parts of treatment are essential for recovery. These include behavioral therapies such as cognitive-behavioral therapy (CBT) or dialectical behavioral therapy (DBT). In addition, if the person with the dependence has other mental health disorders such as depression or anxiety, treatment programs that address these issues are vital for long-term recovery from opioid addiction. 

If you or a loved one are struggling with an opioid, alcohol, other substance use disorder, or mental health disorder Futures Recovery Healthcare offers hope and help. Our compassionate, highly skilled staff are devoted to helping each person in our care recover from alcohol or drugs.

While methadone has been effective as medication-assisted treatment for many with an OUD, there are other options available today. 

Exploring Alternatives to MMT

One of the other commonly used medications to treat dependence on short-acting opioids such as heroin, morphine, codeine, and synthetic opioids such as hydrocodone and oxycodone is buprenorphine. This generic drug is marketed under the names Suboxone and Subutex. 

This Federal Drug Administration (FDA) approved drug is the first drug that was approved to be prescribed and dispensed in physicians’ offices and not mandated to clinics alone. For this reason alone, buprenorphine is a better alternative to methadone for many. 

Buprenorphine is an opioid partial agonist. This means that opioid receptors in the brain are activated through use but to a lesser degree than an opioid full agonist. The feelings of euphoria and well-being are produced but it is less intense. Another important benefit not found with methadone is that this drug works to block the effects of other opioids like heroin or prescription opioids. 

Like other MATs, buprenorphine helps those with OUD: 

• Maintain a level of physical comfort during the early stages of recovery
• Stops or reduces cravings for heroin or another opioid to which the person is dependent
• Reduce relapse risks
• Blocks the effects of other opioids

Naloxone is a drug commonly used to reverse an opioid overdose. However, Zubsolv is a drug combination of naloxone and buprenorphine used to treat OUD. Zubsolv is similar to Suboxone, which is also a combination of naloxone and buprenorphine.  Zubsolv, like Suboxone, is taken in a pill form placed under the tongue and allowed to dissolve. Research into the effectiveness of Zubsolv shows that those in treatment who are taking Zubsolv tend to remain longer than their counterparts not on any MAT. 

Another medication more recently associated with treatment for OUD is Probuphine. Approved for use by the FDA in 2019, this controlled narcotic is an implant device that utilizes buprenorphine to help with opioid dependence. 

Four small rods are surgically inserted into the arm of the patient. Following insertion, Probuphine then works to consistently deliver buprenorphine to the patient in regular doses. While this is a relatively new way to administer buprenorphine, more research into its effectiveness as a MAT is needed. 

Lofexidine or Lucemyra is a recently approved drug used for opioid withdrawal treatment. Used previously for the treatment of high blood pressure and anxiety, this drug has been shown to reduce withdrawal symptoms but not to the degree that methadone does. However, it’s important to note that early studies also show that the withdrawal period was shorter than with methadone. 

Lofexidine may be helpful for those individuals who are interested in extended-release naltrexone as a longer-term treatment for OUD. 

Naltrexone, also known as Vivitrol and Revia, is used for both OUD and alcohol use disorder (AUD). This drug works by blocking the ‘high’ effect of both narcotics and alcohol and is taken only after the withdrawal phase of recovery from alcohol or opioids. 

MAT: Part of a Comprehensive Treatment Plan

Today, there are numerous alternatives to methadone for the treatment of OUD. However, no matter what type of medication is used, it’s essential to also take part in behavioral and all other therapies as recommended by a professional. These therapies often include family therapy, group therapy, and more. 

It’s also vital to have a strong support system when leaving treatment. There are treatment centers with vibrant and active alumni groups. In addition, connecting with support groups in the local community is helpful in maintaining long-lasting recovery. Groups like 12 Step programs (Alcoholics Anonymous, Narcotics Anonymous), Refuge Recovery, SMART Recovery, Celebrate Recovery, and more are available across the nation. 

For many with OUD, there is a chronic pain issue. This must also be addressed in treatment in order to increase the chance of long-term, sustainable recovery. Futures offers specialized programming for those living with chronic pain and addiction. 

As addiction rates continue to climb, the need for effective, evidence-based, and comprehensive treatment does as well. Finding a treatment center that is well-versed in treating the whole person is essential for long-term recovery. 

Futures offers multiple pathways for recovery to all of our patients. With specialty tracks for trauma, first responders, and more, Futures understands how important it is to address all aspects of addiction in treatment. 

If you or a loved one are ready to reclaim your life, contact us today and learn how to get started. Our caring, knowledgeable admissions team is available online or call at 866-804-2098.