When a person becomes dependent on heroin or other opioids (such as morphine or codeine), they have a problem that may need treatment and support. Medication treatments (pharmacotherapies) for heroin or other opioid dependence include methadone, buprenorphine and naltrexone.
Before a person starts a treatment program for drug dependence, it is important that they understand what is involved. A doctor experienced in drug treatment, or a drug counsellor, can explain the process. An approved prescriber can prescribe a regular dose of methadone or buprenorphine to a person who is heroin dependent.
Methadone as a treatment for heroin dependence
Methadone is cheaper than heroin and remains active in the body for longer. Its effects last about 24 hours, with the peak effects felt four to eight hours after taking the dose. This means only a single daily dose is needed. It allows the person to stabilise their addiction and start looking after themselves.
Methadone treatment can be long term (months or years), to help the person reduce the risks of using illicit drugs, or short term (two weeks or less) to help the person safely withdraw from heroin. You drink methadone in cordial or fruit juice.
Effects of methadone
Methadone is an opioid. Unlike heroin, it does not give the user a euphoric sensation (a ‘high’). However, its effects on the body are similar to heroin in many other ways, including:
- pain relief
- feelings of general wellbeing
- reduced blood pressure
- slower heart rate
- drop in body temperature.
Side effects of methadone
Methadone can cause unpleasant side effects, but adjusting the dose can help. In some cases, side effects can be caused by taking more than the recommended dose, or by using other drugs or medications at the same time, such as alcohol or tranquillisers.
A number of people have died after mixing methadone with other drugs. While taking methadone, you should avoid:
- heroin and other opiates
- sedatives, tranquillisers and sleeping pills
- all prescribed pain relievers containing dextropropoxyphene
- dilantin (epilepsy medication).
Side effects of methadone treatment can include:
- withdrawal symptoms, if your dose is too low
- lowered blood pressure, dizziness and shallow breathing, if your dose is too high
- tooth decay – as with heroin and other opioids, methadone dries up the saliva in your mouth, resulting in tooth decay. This can be minimised with good oral hygiene
- menstrual changes
- sexual dysfunction (inability to reach orgasm)
- heart palpitations
- nausea and vomiting
- skin rashes and itching.
Methadone does not suit everyone. Some people do better with residential programs or detoxification.
Methadone for pain relief
Methadone is not only used to treat heroin addiction. Specialist pain doctors sometimes prescribe methadone to treat certain chronic pain conditions.
Buprenorphine as a treatment for heroin dependence
Suboxone film is a buprenorphine and naloxone formulation that dissolves under the tongue. Buprenorphine is a partial opiate agonist, which means it stimulates the cell receptors that are normally stimulated by opioid drugs like heroin and methadone. Naloxone is an opiate antagonist. This means that it blocks the opiate receptors in the brain and the effects of the opiates.
Characteristics include that:
- Suboxone is as effective as methadone in managing the symptoms of heroin withdrawal.
- Suboxone use on its own is very unlikely to cause overdose.
- Methadone withdrawal can be unpleasant and lengthy, while the effects of Suboxone withdrawal are mild and brief.
- A short course of Suboxone can help a person to withdraw from their methadone maintenance program.
- Only one daily dose (or less) is needed, due to its long-lasting effects.
- Suboxone is a sublingual film. The film isn’t chewed or swallowed, but dissolved under the tongue for about four to eight minutes.
Naltrexone as a treatment for heroin dependence
Naltrexone is an opioid antagonist, which means it blocks the effects of opioids. Characteristics include:
- Naltrexone doesn’t appear to be as effective as methadone in controlling the symptoms of heroin withdrawal.
- Naltrexone offers faster detoxification than methadone.
- By itself, naltrexone does not cause physical dependence.
- Naltrexone does not directly stop someone wanting to use heroin.
- Naltrexone is expensive.
- Naltrexone treatment may only suit people who are highly committed to giving up heroin.
- Naltrexone works best as part of a comprehensive treatment program, which includes counselling.
Advantages of medication for heroin dependence
Some of the advantages of methadone and buprenorphine maintenance treatments include:
- They aren’t injected, which reduces the risk of blood-borne viruses such as hepatitis and HIV.
- They are manufactured using strict controls, unlike street drugs, which can vary in strength and contain harmful fillers.
- The effects of heroin last only a few hours, while the effects of pharmacotherapy treatments last from 24 hours to a couple of days or more.
- The person who is heroin dependent no longer has to worry about getting heroin many times every day, which reduces anxiety.
- With their dependence (addiction) stabilised, the person can focus on looking after themselves, including improving their health, nutrition, relationships and employment situation.
- Pharmacotherapy treatments cost less than heroin, so the person can put their money to better use.
Starting treatment for heroin dependence
Methadone and Suboxone treatments are offered through a doctor who is an approved prescriber or through a specialist drugs treatment service.
To be part of a program, you need to:
- see a doctor who holds a government permit to prescribe treatment for you
- have regular check-ups with your doctor – they will check your dose and may test your urine for methadone and other drugs
- visit your local pharmacist or dispenser for your daily dose (you pay a dispensing fee when you pick up your methadone)
- remember that it might take a few weeks before the correct dose for you is worked out
- visit a counsellor. This may be optional in some cases, but research shows that people on drug treatment programs are more likely to quit heroin successfully if they have comprehensive treatment, including counselling.
Where to get help
- Your doctor
- DirectLine Tel. 1800 888 236 - for confidential counselling, information and referral to a registered methadone prescriber
- DrugInfo Tel. 1300 85 85 84 - for alcohol and other drug information
- Youth Drug and Alcohol Advice service, Victoria Tel. 1800 458 685 (9 am to 8 pm, Monday to Friday)
- Family Drug Help Tel. 1300 660 068 – for information and support for people concerned about a relative or friend using drugs.
This page has been produced in consultation with and approved by:
Alcohol and Drug Foundation
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