Opioid Treatment is a category that includes several different interventions or approaches relating to opioid use disorders. People sometimes mistake opioid treatment for “opioid detox” when they are technically two different processes.
Opioid detox refers to the process of helping an opioid addicted individual discontinue their use of opioids and be medically monitored as the body withdraws from them. In a supervised setting, a person is typically assisted through a short-term opioid detox (3-10 days) by the administration of various medications used to manage withdrawal symptoms like clonidine (to guard against high blood pressure), vistaril (to reduce nausea and anxiety), and even buprenorphine (to minimize the severity of the opioid withdrawal process).
There are also variations on an opioid detox referred to as a taper. A taper often occurs on an outpatient basis and involves a more gradual reduction in dosage of either methadone or buprenorphine (suboxone) over time. This taper may take as long as 90 days and allows the individual to adjust more comfortably due to the slower, milder reduction in dosage that occurs over a coarse of weeks or months.
Maintenance is the term which refers to maintaining an individual for a significant period of time on either methadone or buprenorphine (suboxone) to allow for stabilization on the opioid replacement medication. Since opioid addiction introduces dramatic brain chemistry changes in conjunction with strong physical dependency and cravings for opiates, many people find that they need a substantial period of stabilization on methadone in order to have a realistic chance at building a personal recovery. Numerous individuals have decided that they will utilize methadone for only a few weeks with the intention of tapering off of it very quickly. This strategy is prone to failure and tends to end in dramatic relapses back to heroin and other illicit opioids.
Methadone maintenance for most opioid-addicted persons involves receiving methadone for a year or more. This length of time dramatically raises the probability of successful physical stabilization and necessary thinking, behavior, and lifestyle changes which lead to long-term drug abstinence and sustained, productive living. Put very simply, when people attempt to rush through the process of stabilization & recovery, they sabotage their chance of experiencing real success. For that reason, maintenance is a therapeutic process which should be regarded as a one year commitment or longer, and tapering off of methadone or buprenorphine should not be rushed. Bear in mind that not all individual situations are exactly the same and there are unique exceptions.
There are many different factors that play into how long a person needs to remain on methadone or suboxone maintenance. This is highly individualized depending on the length and severity of one’s opioid abuse history, one’s present medical status and general state of health, the availability of social & emotional supports, and the presence of any co-occurring psychiatric disorders like depression.
There is considerable misinformation about methadone tapering and a bit of fear-mongering that often occurs around the topic. People that generally taper successfully off of methadone or suboxone are individuals that have invested time in counseling and personal recovery growth, and who have developed a good working relationship with their doctor or treatment staff. These individuals approach tapering as a gradual goal and are allowed to halt or slow down their taper as needed. This allows their body time to adapt to the somewhat lower dosage. It also allows them to proceed slowly and carefully such that any anxiety or fears can be successfully identified and managed.
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