OPIOIDS

Methadone, Suboxone or Sublocade Maintenance Treatments are highly effective, harm-reduction programs that can help you to get your life back if you are suffering from opioid dependence.

Methadone and Suboxone are long-acting synthetic opioid agonist medications, taken by mouth, which attach to certain opioid receptors in the brain to replace and eliminate your dependence on other types of opioids.  Once a stable dose is reached, you should no longer experience withdrawal symptoms, cravings will either disappear or be greatly reduced, and there should not be a need to take additional opioids.  People on the correct dose of either of these medications simply feel “normal”, and function like anyone else (e.g. working, driving a car) since there should be no sedation, drowsiness, or intoxication.

A dose of Methadone or Suboxone is taken once a day, either at a pharmacy or at home, depending on your medical history and stability while in the program. Methadone is taken as a drink (typically dissolved in an orange juice) and is effectively absorbed within 30 minutes.  Due to its long half-life, methadone will suppress withdrawal symptoms for 24-36 hours and allow you to feel “normal” again and function throughout the day. 

Suboxone (also known as buprenorphine) is taken as a tablet or as a thin “film” which dissolves under your tongue or along the cheek of your mouth, and acts similarly to Methadone.  It also has a very long half-life which allows you to feel and function normally, and it also has the ability to block the effect of other opioids. 

Sublocade is the newest treatment option.  It contains the same active medication as in Suboxone (i.e. buprenorphine), however it is administered once every four weeks via a subcutaneous injection (under the skin) in the abdominal region.  The less frequent dosing regimen might be of interest to certain patients.

Once started on Opioid Replacement Therapy, you will be followed by the Addiction Medicine physician weekly for brief follow-up assessments  before your next prescription is issued.

Methadone is covered by most drug benefit programs, including the ODB (Ontario Drug Benefit) program, OHIP Plus (for patients aged 24 or younger), for patients aged 65 or greater, and through most private insurers.  If paid out of pocket, methadone typically would cost around $5 per day, which is minimal when compared to the cost of street drugs.  Another benefit of Methadone is that it is legal and safe if taken as prescribed.  Because it is dispensed at a pharmacy with a prescription from a physician, the exact potency is known, and you will know exactly what you are getting.

Suboxone (buprenorphine) is a newer medication, and fortunately, it is also covered by most drug benefit programs as described above, including the Ontario Drug Benefit (ODB) program. Out of pocket, it tends to be more expensive than methadone, and the cost will vary according to the dose and pharmacy.

Sublocade (injectable buprenorphine) is the newest treatment option.  Although fairly expensive if paid out of pocket, this medication is also fully covered by most drug benefit programs and private insurers, and allows for less frequent dosing through abdominal injections every four weeks.

Opioid Use Disorder is a chronic relapsing-remitting condition. The duration of the treatment is, therefore, challenging to predict and varies from person to person. Some studies have suggested that people who were on methadone replacement therapy for two years or more did better in avoiding future relapse. However, this varies according to the individual and the decision to start tapering off Methadone, Suboxone or Sublocade will be decided by you in consultation with your doctor.

Ideally, it is recommended that ongoing clinical stability be well established until tapering of opioid replacement therapy is considered.  The decision to start a taper, however, is ultimately driven by you. Once you are able to abstain from opioid use for some time and are in control of your life (family, social life, work), some questions to ask yourself to determine your readiness for a gradual taper off the medication are:

• Am I comfortable being around triggers and not using opioids?

• Did I change the environment around me to minimize contact with triggers (people, places, things associated with use)?

• Do I have a good support system such as addiction counseling or mutual support groups?

• Am I keeping busy with school or employment?

• Am I in good mental and physical health?