Treatment Strategies for Heroin/Opioid Addiction

Introduction

This paper examines research on treatment strategies for heroin/opioid addiction, with a focus on three specific approaches: antagonist therapy, aversive therapy, and anti-drug vaccine research.

Antagonist therapy is a type of treatment for heroin addiction that works by blocking the effects of the drug. It is typically used in conjunction with other forms of treatment, such as counseling and behavioral therapy. There are two main types of antagonists: natural and synthetic. Natural antagonists, such as naltrexone, bind to the same receptors in the brain as heroin, but they do not produce the same effects. Synthetic antagonists, on the other hand, are designed to bind more strongly to the receptors and prevent heroin from binding at all. Both types of antagonists have been shown to be effective in reducing heroin use and preventing relapse. However, they are not without side effects, and they must be used in combination with other treatments to be most effective.

Aversive therapy is a treatment for substance abuse that uses negative reinforcement to discourage drug use. Aversive therapy can take many forms, but all methods share the goal of making drug use unpleasant or uncomfortable in order to decrease the likelihood of relapse. A common form of aversive therapy for heroin/opioid addiction is the administration of naloxone, a medication that blocks the effects of opioids. Naloxone is typically given in combination with a potent opiate such as buprenorphine, and the two drugs are alternated on a daily basis. When used as part of a comprehensive treatment plan, aversive therapy can be an effective tool for helping people overcome addiction.

Though vaccines are most commonly associated with protecting against communicable diseases, there is a growing body of research examining their potential to treat a wide variety of conditions, including addiction. A vaccine against addiction would work by creating antibodies that bind to and neutralize the drug molecules, preventing them from reaching the brain and producing the reinforcing effects that maintain addictive behaviors. Several attempts have been made to develop a vaccine for opioid use disorder, and though none have yet been approved for human use, several show promise. One study found that a vaccine was effective in reducing drug-seeking behavior in rats, and another found that a vaccine was able to block the reinforcing effects of heroin in monkeys. These findings suggest that a vaccine could be an effective treatment for opioid use disorder, though further research is needed to confirm these results.

Summaries

Bell and Strang (2020) summarize relevant literature on drug treatment for opioid addiction. In their review they do not provide systematic analysis but simply cover the general area regarding the field. Their main points are that Opioid Use Disorder (OUD) is a chronic condition and that strong evidence exists indicating that medications like methadone (a full opioid agonist), buprenorphine (a partial agonist) and naltrexone (an opioid antagonist) are effective for treating OUD. In their report, they describe how methadone and buprenorphine work by suppressing opioid withdrawal symptoms, and by attenuating the effects of other opioids. They also discuss how naltrexone inhibits the effects of opioid agonists. One point they emphasize is that the bulk of the evidence, or the most significant evidence shows that oral methadone has the greatest effectiveness. Studies on its use show that longer treatment using oral methadone typically results in the re-establishment of social connections for the addict and other positive outcomes. However, one final point they make is that treatments for OUD are often limited due to inadequate treatment recommendations from health care providers, propensity for relapse and the potentially heightened risk of overdose upon ending treatment.

Bisaga et al. (2018) examined literature from the 1960s onwards to evaluate research on antagonist therapy, particularly focusing on the evolution of treatment strategies for managing opioid withdrawal and the use of naltrexone. They note that new practices involve extended-release naltrexone with agonist tapers and adjuvant medications. However, they also highlight the clinical challenges that remain, such as the need to manage withdrawal and ongoing addiction while the patient receives treatment. They also point out that various clinical factors should be considered when providing treatment for each individual patient, with naltrexone, particularly with the level of opioid abuse and what the patient is comfortable with. Finally, the authors emphasize that most patients do not receive effective treatment for managing relapse.

Murphy (2020) conducted a retrospective analysis of 2018 data obtained through the National Survey on Drug Use and Health and the CDC WONDER Database so as to understand the value of OUDaversionfor addicts ages12 through 71, from their own perspective. The findings show that the economic consequences ofaddiction may be the best form of negative reinforcement therapy and that this should be further explored by researchers in the field. Murphy (2020) relies on economic data from the data sources for analysis and did not obtain any new data for the study.

Pantazis et al. (2021) focus on how pain triggers drive opioid use and they explore sex differences in abusers of opioid. Their main takeaway is that withdrawal symptoms arise when an individual stops taking opioids after extended use and any negative experience (anxiety, etc.) can trigger these withdrawal symptoms. In response, individuals tend to seek out and consume opioids in order to relieve their discomfort and have no aversive therapy in place for countering this reinforcement. Their argument is that withdrawal itself is so aversive that addicts will run back to the drug to avoid this aversion. While it may initially help to temporarily relieve the uncomfortable symptoms of withdrawal, it can ultimately lead to further drug use and addiction. Therefore, the researchers conclude that it is important to be aware of the potential role that environmental stimuli can play in promoting motivated behavior for opioids.

The National Institutes of Health (NIH, 2022) reports on the state of anti-drug vaccines, explaining that the vaccine theoretically produces antibodies that bind to opioids, preventing them from crossing the...

…about these treatments and their effectiveness. Bisaga et al. (2018) for instance highlight the need for health care providers to offer patients more information on antagonist therapy, as do Bell and Strang (2020). Murphy (2020) highlights the need to focus on aversionbut Pantazis et al. (2021) show that aversion therapy is a difficult balance to maintain due to the strong aversion to withdrawal symptoms that addicts are likely to have in the first place. Anti-drug vaccines are a novel concept but further research is still needed, though some breakthroughs particularly with certain proteins mediating blockades have been found (Hwang et al., 2019; NIH, 2022).

Limitations

The limitations of the research are that no single treatment strategy has been shown to be completely effective at preventing relapse (Bell & Strang, 2020; Bisaga et al., 2018; Murphy et al., 2020). There is a need to conduct more research on all these strategies (Hwang et al., 2019; NIH, 2022). And some more research should also be conducted on how therapy can be used to counter environmental factors that patients deal with (Pantazis et al., 2021).

Future research may be able to overcome these limitations, but it depends upon the ability to conduct human trials, and to experiment with vaccines, antagonists and aversion therapy, particularly with regard to controlling for relapse. While animal studies can provide valuable insights, they cannot always be directly translated to humans. This is because humans are much more complex creatures, with different brain structures and physiology. As a result, what works in animals may not work in humans. In addition, future research will also depend upon the ability to experiment with different vaccines, antagonists and aversion therapies. While current treatments can be effective, they often come with the risk of relapse. By testing new treatments on humans, researchers may be able to find ways to overcome these limitations and develop more effective treatments for addiction. Currently, the NIH (2022) is focusing on anti-drug vaccines and looks to address research limitations to testing for efficacy in human trials. Other research should focus on cognitive behavioral therapy and spiritual therapy as supportive elements to pharmacological therapy.

Conclusion

Naltrexone is a medication that has been shown to be an effective treatment for opioid addiction. Unlike aversion therapy and anti-drug vaccines, which seek to make the user feel sick when they take opioids or to produce antibodies that bind to the drugs when introduced to the body, preventing them from entering the brain, naltrexone works by blocking the effects of opioids. This makes it less likely that the user will experience the pleasurable effects of taking opioids, and therefore less likely that they will continue to use them. Naltrexone has been shown to be more effective than other approaches in reducing both the frequency and intensity of opioid use, as well as the risk of relapse. Furthermore, naltrexone is well-tolerated and does not produce any serious side effects. For these reasons, naltrexone should be considered the best therapeutic approach for treating opioid addiction.…