Opiate addiction treatment options

Detox deals with the body. It gets the opioids out and eases the worst days. It does not change the cravings, the stress or the daily patterns that follow.

Federal treatment guidance does not recommend short detox with nothing after it, because so many people return to opioid use. There is also a safety problem. After withdrawal your tolerance is much lower, so an amount you used to handle can now stop your breathing.

This is why the plan for what comes after detox matters more than detox itself. That plan is usually a medication, with outpatient or residential care around it.

If you are with someone who is not breathing or cannot be woken, call 911 right away and give naloxone if you have it.

Medication is the part of treatment with the strongest proof behind it. In a study funded by the National Institutes of Health, people who had survived an overdose were followed for a year. Those who received methadone had 59% fewer opioid overdose deaths. Those who received buprenorphine had 38% fewer.

The National Institute on Drug Abuse calls treatment with one of these medicines the standard of care for opioid use disorder. So a good first question for any program is whether it offers them or will work with a prescriber who does.

Counseling and peer support help many people stay in treatment and rebuild daily life. They work best alongside medication. Our page on counseling and behavioral therapy explains the main kinds.

Here are some common ways people combine them.

• Medication in outpatient care. You start buprenorphine at a doctor’s office or by telehealth, or methadone at an opioid treatment program, and keep living at home. For many people this is the whole plan, and it works.
• Detox, then medication. You go through supervised withdrawal, then start a monthly naltrexone shot, or you start buprenorphine or methadone during detox and simply stay on it.
• Residential rehab, then outpatient care. You spend several weeks in a program, then step down to regular visits near home, staying on any medication you started.

Care can step up or down as your needs change. If weekly visits are not enough, a more intensive program is an option. When life is steadier, visits space out.

What happens after the first phase counts for a lot. Aftercare covers staying on medication, check-ins, recovery housing and what to do if you slip.

You do not have to work this out alone. A clinician will ask about your health, what you have been taking and your home life, then suggest a level of care. These questions help you get ready for that talk.

• Do you have a safe, stable place to stay where opioids are not all around you?
• Can you get to appointments, or would video visits work better?
• Are you pregnant, or do you have other health or mental health conditions?
• What have you tried before, and what happened?
• What do you need to protect: a job, child care, your privacy?

When you compare programs, ask if they are licensed, if they offer FDA-approved medication, and what support they give after you finish. You can find treatment in your state through our directory. For worries about money, start with our guide to treatment costs.

You can also call the SAMHSA National Helpline at 1-800-662-4357. It is free, private and open 24 hours a day. If you are in crisis or thinking about suicide, call or text 988.