What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some health care providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your health care provider. However, opioid abuse and addiction are still potential risks.

What are opioid abuse and addiction?

Opioid abuse means you are not taking the medicines according to your provider's instructions, you are using them to get high, or you are taking someone else's opioids. Addiction is a chronic brain disease. It causes you to compulsively seek out drugs even though they cause you harm.

What are the treatments for opioid abuse and addiction?

Treatments for opioid abuse and addiction include

• Medicines
• Counseling and behavioral therapies
• Medication-assisted therapy (MAT), which includes medicines, counseling, and behavioral therapies. This offers a "whole patient" approach to treatment, which can increase your chance of a successful recovery.
• Residential and hospital-based treatment

Which medicines treat opioid abuse and addiction?

The medicines used to treat opioid abuse and addiction are methadone, buprenorphine, and naltrexone.

Methadone and buprenorphine can decrease withdrawal symptoms and cravings. They work by acting on the same targets in the brain as other opioids, but they do not make you feel high. Some people worry that if they take methadone or buprenorphine, it means that they are substituting one addiction for another. But it is not; these medicines are a treatment. They restore balance to the parts of the brain affected by addiction. This allows your brain to heal while you work toward recovery.

There is also a combination drug that includes buprenorphine and naloxone. Naloxone is a drug to treat an opioid overdose. If you take it along with buprenorphine, you will be less likely to misuse the buprenorphine.

You may safely take these medicines for months, years, or even a lifetime. If you want to stop taking them, do not do it on your own. You should contact your health care provider first, and work out a plan for stopping.

Naltrexone works differently than methadone and buprenorphine. It does not help you with withdrawal symptoms or cravings. Instead, it takes away the high that you would normally get when you take opioids. Because of this, you would take naltrexone to prevent a relapse, not to try to get off opioids. You have to be off opioids for at least 7-10 days before you can take naltrexone. Otherwise you could have bad withdrawal symptoms.

How does counseling treat opioid abuse and addiction?

Counseling for opioid abuse and addiction can help you

• Change your attitudes and behaviors related to drug use
• Build healthy life skills
• Stick with other forms of treatment, such as medicines

There are different types of counseling to treat opioid abuse and addiction, including

• Individual counseling, which may include setting goals, talking about setbacks, and celebrating progress. You may also talk about legal concerns and family problems. Counseling often includes specific behavioral therapies, such as
  • Cognitive-behavioral therapy (CBT) helps you recognize and stop negative patterns of thinking and behavior. It teaches you coping skills, including how to manage stress and change the thoughts that cause you to want to abuse opioids.
  • Motivational enhancement therapy helps you build up motivation to stick with your treatment plan
  • Contingency management focuses on giving you incentives for positive behaviors such as staying off the opioids
• Group counseling, which can help you feel that you are not alone with your issues. You get a chance to hear about the difficulties and successes of others who have the same challenges. This can help you to learn new strategies for dealing with the situations you may come across.
• Family counseling/ includes partners or spouses and other family members who are close to you. It can help to repair and improve your family relationships.

Counselors can also refer you to other resources that you might need, such as

• Peer support groups, including 12-step programs like Narcotics Anonymous
• Spiritual and faith-based groups
• HIV testing and hepatitis screening
• Case or care management
• Employment or educational supports
• Organizations that help you find housing or transportation

What are residential and hospital-based treatments for opioid abuse and addiction?

Residential programs combine housing and treatment services. You are living with your peers, and you can support each other to stay in recovery. Inpatient hospital-based programs combine health care and addiction treatment services for people with medical problems. Hospitals may also offer intensive outpatient treatment. All these types of treatments are very structured, and usually include several different kinds of counseling and behavioral therapies. They also often include medicines.

Many people experience pain every day. All patients with pain should receive safe and effective pain care. The objective of any pain care strategy is to safely reduce pain and increase your ability to do everyday activities.

No matter what form of treatment is used, discuss with your doctor what kind of pain relief and improvement you can expect overall and continue to follow up with your doctor on your progress.

On this page, you’ll learn about the types of pain – acute, subacute, and chronic – and options for treatment.

What are Prescription Opioids?

Opioids are natural or synthetic chemicals that bind to receptors in your brain or body to reduce the intensity of pain signals reaching the brain. Doctors sometimes prescribe opioid medications to manage pain. Common prescription opioid drugs include:

• Hydrocodone (such as Vicodin®, Norco®)
• Oxycodone (such as OxyContin®, Percocet®)
• Morphine (such as MS Contin®, Kadian®)

Acute and Subacute Pain Management

Acute pain is pain that has lasted for less than a month and has a known cause, like an injury, trauma, surgery, or infection. You may have experienced acute pain from outpatient medical procedures, like a wisdom tooth extraction, or injuries, like a broken bone. Subacute pain is pain that lasts longer than 1 month but not more than 3 months.

The goal of any pain management strategy is to safely reduce pain and increase your ability to do everyday activities.

No matter what form of treatment is used, discuss with your doctor what kind of pain relief and improvement you can expect overall and continue to follow up with your doctor on your progress.

Acute pain normally gets better as your body heals. Opioid medications are one of many ways to reduce severe acute pain, but many other options can provide relief with fewer side effects, including:

• Over-the-counter medications like acetaminophen (such as Tylenol®), ibuprofen (such as Advil®, Motrin®), and naproxen (such as Aleve®)
• Application of heat or ice
• Physical therapy, acupuncture, acupressure, massage, or spinal manipulation
• Music therapy
• Transcutaneous electrical nerve stimulation (TENS)
• Exercise

It is important to note that continuing opioid therapy during the subacute time frame might represent the start of long-term opioid therapy. Talk to your doctor about your treatment goals and the benefits and risks of different types of treatment for subacute pain.

Chronic Pain Management

Chronic pain is pain lasting three months or more.  It can be caused by a disease or condition, injury, medical treatment, inflammation, or even an unknown reason. Sometimes acute or subacute pain that is not effectively managed becomes chronic pain. Many people experience chronic pain, which can lead to impaired physical functioning, poor mental health, reduced quality of life, and contributes to substantial disability and death each year.

There are many possible options to treat your chronic pain. It is important to understand all your options and the risks and benefits of each. You and your doctor should work together to establish treatment goals for pain and function in your daily life.

Chronic pain can be managed with or without prescription opioids, but many of the nonopioid options have been shown to work better with fewer side effects. Examples include:

1. Over-the-counter medications like acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), and naproxen (Aleve®)
2. Physical therapy and exercise
3. Cognitive behavioral therapy (CBT)
4. Certain antidepressant and antiseizure medications

Take control of how you manage your pain and ask your doctor about different options. Keep in mind that sometimes you may feel worse before you feel better when starting a new treatment program. Work with your doctor to find safe and effective care to help you reach your goals.

Patient Safety Is an Important Part of Pain Care

Before starting opioids to treat pain, you can:

• Learn about prescription opioids and know the risks.
• Consider ways to manage pain that do not include opioids. Examples include:
  • Physical therapy
  • Exercise
  • Nonopioid medications, such as acetaminophen or ibuprofen
  • Cognitive behavioral therapy (CBT)
• Make the most informed decision with your doctors.

Talk To Your Doctor About What Kind of Pain Care Is Right for You

If after talking to your doctor about your pain treatment, you are prescribed opioids, be sure to ask about the risks and benefits. To help ensure your treatment is safe and effective, your doctor may:

• Prescribe the lowest effective dose of immediate-release opioids
• Check your state’s prescription drug monitoring program to check if you’ve been prescribed other controlled substances
• Test your urine for the presence of drugs during your therapy, which is increasingly becoming a routine part of care.
• Offer naloxone, which can reverse an overdose
• Follow up within the first few days after you start a new opioid or a new dose
• Follow up at least every 3 months if you are on a stable dose to ensure benefits of opioids continue to outweigh risks

If You Are Prescribed Opioids for Pain Management

• Follow up with your doctor within the first few days of starting your prescription to ensure opioids are helping.
  • You should also discuss what kind of pain relief and improvement you can expect overall. Opioids can reduce pain in the short-term but will not likely relieve all your pain.
  • Also discuss any side-effects you are experiencing.
• Develop your personal pain management plan with your doctor which may include:
  • Your personal treatment goals, which describe what you may achieve as you make progress
  • Information about treatment options
  • Referral to specialists as needed

Side Effects of Opioid Therapy

Prescription opioids carry serious risks of addiction and overdose. Opioids can slow a person’s breathing, often a sign associated with someone experiencing an opioid overdose that can cause death. The use of prescription opioids can have several side effects as well, even when taken as directed:

• Tolerance—meaning you might need to take more of a medication for the same pain relief
• Physical dependence—meaning you have symptoms of withdrawal when a medication is stopped, or you take less
• Increased sensitivity to pain
• Constipation
• Nausea and vomiting
• Dry mouth
• Sleepiness
• Dizziness
• Confusion
• Low levels of testosterone that can result in lower sex drive, energy, and strength
• Itching and sweating

The use of medication along with counseling and behavioral therapies to treat substance use disorder and prevent opioid overdose is referred to as medication-assisted treatment (or MAT).

MAT brings a “whole-patient” approach to treatment, and research has shown that it can be effective. This approach has been shown to:

• Improve patient survival
• Increase retention in treatment
• Decrease illicit opiate use and other criminal activity among people with substance use disorders
• Increase patients’ ability to gain and maintain employment
• Improve birth outcomes among women who have substance use disorders and are pregnant

Medication FDA approved for use during MAT include:

Methadone – this prescription (offered in pill, liquid and wafer forms and usually taken once a day). According to SAMHSA it changes “how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs..”

Buprenorphine – as an opioid partial agonist, this drug produces that same euphoric effects as opioids but is weaker than heroin and methadone. “Buprenorphine’s opioid effects increase with each dose until at moderate doses they level off, even with further dose increases. This “ceiling effect” lowers the risk of misuse, dependency, and side effects.”

Naltrexone– this drug works differently than methadone and buprenorphine because it blocks the euphoric effects of opioids and reduces cravings. If a person relapses, naltrexone stops him or her from getting high.

Opioid Agonists and Partial Agonists (Maintenance Medications)

Studies show that people with opioid use disorder who follow detoxification with complete abstinence are very likely to relapse, or return to using the drug. While relapse is a normal step on the path to recovery, it can also be life threatening, raising the risk for a fatal overdose. Thus, an important way to support recovery from heroin or prescription opioid use disorder is to maintain abstinence from those drugs. Someone in recovery can also use medications that reduce the negative effects of withdrawal and cravings without producing the euphoria that the original drug of abuse caused. For example, the FDA recently approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms. Methadone and buprenorphine are other medications approved for this purpose.

Methadone is a synthetic opioid agonist that eliminates withdrawal symptoms and relieves drug cravings by acting on opioid receptors in the brain—the same receptors that other opioids such as heroin, morphine, and opioid pain medications activate. Although it occupies and activates these opioid receptors, it does so more slowly than other opioids and, in an opioid-dependent person, treatment doses do not produce euphoria. It has been used successfully for more than 40 years to treat opioid use disorder and must be dispensed through specialized opioid treatment programs.

Buprenorphine is a partial opioid agonist, meaning that it binds to those same opioid receptors but activates them less strongly than full agonists do. Like methadone, it can reduce cravings and withdrawal symptoms in a person with an opioid use disorder without producing euphoria, and patients tend to tolerate it well. Research has found buprenorphine to be similarly effective as methadone for treating opioid use disorders, as long as it is given at a sufficient dose and for sufficient duration. The U.S. Food and Drug Administration (FDA) approved buprenorphine in 2002, making it the first medication eligible to be prescribed by certified physicians through the Drug Addiction Treatment Act. This approval eliminates the need to visit specialized treatment clinics, thereby expanding access to treatment for many who need it. Additionally, the Comprehensive Addiction and Recovery Act (CARA), which was signed into law in July 2016, temporarily expands eligibility to prescribe buprenorphine-based drugs for medication-assisted treatment (MAT) to qualifying nurse practitioners and physician assistants through October 1, 2021. Buprenorphine has been available for opioid use disorders since 2002 as a tablet and since 2010 as a sublingual film. The FDA approved a 6-month subdermal buprenorphine implant in May 2016 and a once-monthly buprenorphine injection in November 2017. These formulations are available to patients stabilized on buprenorphine and will eliminate the treatment barrier of daily dosing for these patients.

Opioid Antagonists

Naltrexone is an opioid antagonist, which means that it works by blocking the activation of opioid receptors. Instead of controlling withdrawal and cravings, it treats opioid use disorder by preventing any opioid drug from producing rewarding effects such as euphoria. Its use for ongoing opioid use disorder treatment has been somewhat limited because of poor adherence and tolerability by patients. However, in 2010, an injectable, long-acting form of naltrexone (Vivitrol^®), originally approved for treating alcohol use disorder, was FDA-approved for treating opioid use disorder. Because its effects last for weeks, Vivitrol^® is a good option for patients who do not have ready access to health care or who struggle with taking their medications regularly.

Because each medication works differently, a treatment provider should decide on the optimal medication in consultation with the individual patient and should consider the patient’s unique history and circumstances.

Abundant evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and opioid use disorder-related symptoms, and they reduce the risk of infectious disease transmission as well as criminal behavior associated with drug use. These medications also increase the likelihood that a person will remain in treatment, which itself is associated with lower risk of overdose mortality, reduced risk of HIV and HCV transmission, reduced criminal justice involvement, and greater likelihood of employment.

Methadone

Methadone is the medication with the longest history of use for opioid use disorder treatment, having been used since 1947. A large number of studies (some of which are summarized in the graph below) support methadone's effectiveness at reducing opioid use. A comprehensive Cochrane review in 2009 compared methadone-based treatment (methadone plus psychosocial treatment) to placebo with psychosocial treatment and found that methadone treatment was effective in reducing opioid use, opioid use-associated transmission of infectious disease, and crime. Patients on methadone had 33 percent fewer opioid-positive drug tests and were 4.44 times more likely to stay in treatment compared to controls.Methadone treatment significantly improves outcomes, even when provided in the absence of regular counseling services; long-term (beyond 6 months) outcomes are better in groups receiving methadone, regardless of the frequency of counseling received.

Buprenorphine

Buprenorphine, which was first approved in 2002, is currently available in two forms: alone (Probuphine^®, Sublocade™, Bunavail^®) and in combination with the opioid receptor antagonist naloxone (Suboxone^®, Zubsolv^®). Both formulations of buprenorphine are effective for the treatment of opioid use disorders, though some studies have shown high relapse rates among patients tapered off of buprenorphine compared to patients maintained on the drug for a longer period of time.

A Swedish study compared patients maintained on 16 mg of buprenorphine daily to a control group that received buprenorphine for detoxification (6 days) followed by placebo. All patients received psychosocial supports. In this study, the treatment failure rate for placebo was 100 percent vs. 25 percent for buprenorphine. More than two opioid-positive urine tests within 3 months resulted in cessation of treatment, so treatment retention was closely related to relapse. Of patients not retained in treatment, there was a 20 percent mortality rate.

Meta-analysis determined that patients on doses of buprenorphine of 16 mg per day or more were 1.82 times more likely to stay in treatment than placebo-treated patients, and buprenorphine decreased the number of opioid-positive drug tests by 14.2 percent (the standardized mean difference was -1.17).

To be effective, buprenorphine must be given at a sufficiently high dose (generally, 16 mg per day or more). Some treatment providers wary of using opioids have prescribed lower doses for short treatment durations, leading to failure of buprenorphine treatment and the mistaken conclusion that the medication is ineffective.

Methadone and Buprenorphine Compared

Methadone and buprenorphine are equally effective at reducing opioid use. A comprehensive Cochrane review comparing buprenorphine, methadone, and placebo found no differences in opioid-positive drug tests or self-reported heroin use when treating with methadone or buprenorphine at medium-to-high doses.

Notably, flexible dose regimens of buprenorphine and doses of buprenorphine of 6 mg or below are less effective than methadone at keeping patients in treatment, highlighting the need for delivery of evidence-based dosing regimens of these medications.

Naltrexone

Naltrexone was initially approved for the treatment of opioid use disorder in a daily pill form. It does not produce tolerance or withdrawal. Poor treatment adherence has primarily limited the real-world effectiveness of this formulation. As a result, there is insufficient evidence that oral naltrexone is an effective treatment for opioid use disorder. Extended-release injectable naltrexone (XR-NTX) is administered once monthly, which removes the need for daily dosing. While this formulation is the newest form of medication for opioid use disorder, evidence to date suggests that it is effective.

The double-blind, placebo-controlled trial that was most influential in getting XR-NTX approved by the FDA in 2010 for opioid use disorder treatment showed that XR-NTX significantly increased opioid abstinence. The XR-NTX group had 90 percent confirmed abstinent weeks compared to 35 percent in the placebo group. Treatment retention was also higher in the XR-NTX group (58 percent vs. 42 percent), while subjective drug craving and relapse were both decreased (0.8 percent vs. 13.7 percent). Improvement in the XR-NTX group was sustained throughout an open label period out to 76 weeks. These data were collected in Russia, and additional studies are required to determine if effectiveness will be similar in the United States.

Buprenorphine and Naltrexone Compared

A NIDA study showed that once treatment is initiated, a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid use disorder. Because naltrexone requires full detoxification, initiating treatment among active opioid users was more difficult with this medication. However, once detoxification was complete, the naltrexone formulation had a similar effectiveness as the buprenorphine/naloxone combination.

Because maintenance medications (methadone and buprenorphine) are themselves opioids and are able to produce euphoria in people who are not dependent on opioids, many people have assumed that this form of treatment just substitutes a new substance use disorder for an old one. This belief has unfortunately hindered the adoption of these effective treatments. In the past, even some inpatient treatment programs that were otherwise evidence-based did not allow patients to use these medications, in favor of an "abstinence only" philosophy.

Although it is possible for individuals who do not have an opioid use disorder to get high on buprenorphine or methadone, these medications affect people who have developed a high tolerance to opioids differently. At the doses prescribed, and as a result of their pharmacodynamic and pharmacokinetic properties (the way they act at opioid receptor sites and their slower metabolism in the body), these medications do not produce a euphoric high but instead minimize withdrawal symptoms and cravings. This makes it possible for the patient to function normally, attend school or work, and participate in other forms of treatment or recovery support services to help them become free of their substance use disorder over time.

The ultimate aim can be to wean off the maintenance medication, but the treatment provider should make this decision jointly with the patient and tapering the medication must be done gradually. It may take months or years in some cases. Just as body tissues require prolonged periods to heal after injury and may require external supports (e.g., a cast and crutches or a wheelchair for a broken leg), brain circuits that have been altered by prolonged drug use and substance use disorder take time to recover and benefit from external supports in the form of medication. In cases of serious and long-term opioid use disorder, a patient may need these supports indefinitely.

In 2005, methadone and buprenorphine were added to the World Health Organization's list of essential medicines, defined as medicines that are "intended to be available within the context of functioning health care systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford."

Opioid Tolerance

People who take opioids for long periods of time typically develop tolerance, a state in which more of the drug is needed to produce the same effect. Receptor desensitization and downregulation are molecular processes that cause tolerance. In people with opioid use disorder, the brain is continually exposed to high levels of opioids as well as dopamine, which is released in the reward circuit following opioid receptor activation. Brain cells respond to this by reducing their response to receptor activation and by removing opioid and dopamine receptors from the cell membrane, resulting in fewer receptors that can be activated by the drug.These mechanisms result in a lessened response to the drug, so higher doses are required to elicit the same effect. This opioid tolerance is the reason that people with opioid use disorder do not experience euphoric effects from therapeutic doses of buprenorphine or methadone, while people without opioid use disorder do. It is also the reason why people are at increased risk of overdose when relapsing to opioid use after a period of abstinence: They lose their tolerance to the drug without realizing it, so they no longer know what dose of the drug they can safely tolerate.

Mechanisms of Opioid Dependence

The sustained activation of opioid receptors that results from opioid use disorder and causes tolerance also causes withdrawal symptoms when the opioid drugs leave the body. Drug withdrawal symptoms are opposite to the symptoms caused by drug taking. In the case of opioids, they include anxiety, jitters, and diarrhea.Avoidance of these negative symptoms is one reason that people keep taking opioids, and in the early stages of treatment, medications such as methadone and buprenorphine reduce withdrawal symptoms.

Paralleling the large recent increases in opioid use, use disorder, and overdose, the incidence of babies born dependent on opioids (neonatal abstinence syndrome, or NAS) as a result of the mother’s opioid use during pregnancy has also greatly increased.Incidence of NAS rose nearly fivefold between 2000 and 2012; this increase was associated with increases in the prescription of opioids to pregnant women for pain, which doubled between 1995 and 2009.

Untreated opioid use disorder during pregnancy can have devastating effects on the fetus. The fluctuating levels of opioids in the blood of mothers misusing opioids expose the fetus to repeated periods of withdrawal, which can also harm the function of the placenta and increase the risk of:

• fetal growth restriction
• placental abruption
• preterm labor
• fetal convulsions
• intrauterine passage of meconium
• fetal death

In addition to these direct physical effects, other risks to the fetus include:

• untreated maternal infections such as HIV
• malnutrition and poor prenatal care
• dangers conferred by drug-seeking lifestyle, including violence and incarceration

Methadone and Buprenorphine as the Standard of Care for Opioid Use Disorder in Pregnancy

To lessen the negative effects of opioid dependence on the fetus, treatment with methadone has been used for pregnant women with opioid use disorder since the 1970s and has been recognized as the standard of care since 1998. Recent evidence, however, suggests that buprenorphine may be an even better treatment option.

Both methadone and buprenorphine treatment during pregnancy:

• stabilize fetal levels of opioids, reducing repeated prenatal withdrawal
• improve neonatal outcomes
• increase maternal HIV treatment to reduce the likelihood of transmitting the virus to the fetus
• link mothers to better prenatal care

A meta-analysis showed that, compared to single-dose methadone treatment, buprenorphine resulted in:

• 10 percent lower incidence of NAS
• shorter neonatal treatment time (an average of 8.4 days shorter)
• lower amount of morphine used for NAS treatment (an average of 3.6 mg lower)
• higher gestational age, weight, and head circumference at birth

Data from the NIDA-funded Maternal Opioid Treatment: Human Experimental Research study show similar benefits of buprenorphine. Still, methadone is associated with higher treatment retention than buprenorphine. Divided dosing with methadone has been explored as a way to reduce fetal exposure to withdrawal periods, and recent data show low levels of NAS in babies born to mothers treated with divided doses of methadone. Larger comparison studies are needed to determine if split methadone dosing for opioid use disorders in pregnancy is associated with better outcomes.

NAS still occurs in babies whose mothers have received buprenorphine or methadone, but it is less severe than it would be in the absence of treatment.Research does not support reducing maternal methadone dose to avoid NAS, as this may promote increased illicit drug use, resulting in increased risk to the fetus.

Injection drug use is still a primary driver of the HIV/AIDS epidemic across the world. A recent example is the small community of Austin, Indiana, where 170 new HIV infections occurred in the 8 months between November 2014 and June 2015 among people misusing the prescription opioid pain reliever oxymorphone (Opana^®) via injection. People who inject drugs frequently share their needles and other injection equipment, enabling viruses such as HIV and hepatitis C (HCV) to spread between people.

Medications for opioid use disorder treatment can reduce transmission of HIV and HCV by reducing risk behaviors in people who inject drugs and can improve HIV- and HCV-related outcomes by treating those not engaged in injection opioid use who might otherwise transition to injection, linking those with HIV/HCV infection to appropriate treatment, and improving adherence to HIV/HCV treatment. These improvements depend on accessibility of medications for opioid use disorder to people who need it and coordinating medication delivery with HCV/HIV screening and treatment.

Treatment with methadone or buprenorphine is associated with reduced injection drug use risk behaviors. Meta-analyses have shown a reduction in risk behaviors including a 32 to 69 percent reduction in illicit opioid use, a 20 to 60 percent reduction in injection drug use, and a 25 to 86 percent reduction in sharing of injection equipment. Treatment with extended-release naltrexone also reduced HIV risk behaviors compared to placebo.

Methadone and buprenorphine treatment are also associated with lower HCV infection rates in young adults who inject drugs, while other treatments and detoxification alone are not. Methadone treatment is associated with low rates of contracting HCV overall, with mathematical modeling suggesting that it can prevent 22.6 new HCV infections per 100 treated people who engaged in injection drug use, per year. Methadone treatment also reduces both HIV risk behaviors and HIV infection, with better outcomes for people who inject drugs who are in treatment (3.5 percent contracting HIV vs. 22 percent), and better outcomes for longer treatment duration and for continuous (versus interrupted) treatment.

A study comparing the effects of methadone and buprenorphine treatment on HIV risk from injection behaviors and HIV risk from sexual behaviors showed equal and significant reductions in risky injection behaviors. Risky sexual behaviors were reduced in both male and female methadone patients but were higher in male patients on buprenorphine.

Mitigating Factors

There are several known interactions between medications used to treat HIV or HCV and both methadone and buprenorphine. These could require an adjustment of dosage or revision of the treatment plan, and highlight the need for integrated care. For example, some patients are reluctant to begin highly active antiretroviral therapy (HAART) because of worries that it will interfere with their methadone treatment, so treatment providers should consider revised methadone doses for these patients.

Contracting HCV while on methadone is associated with continued injection drug use. Some studies have shown methadone detoxification alone to be associated with increased rates of contracting HIV, so ongoing treatment with this medication is key to reducing transmission of viral infection.

Possibility of Dual Therapeutic Potential

One recent report demonstrates the potential of buprenorphine to counteract a neuroinflammatory process that is involved in HIV-associated neurocognitive disorders, suggesting that buprenorphine could potentially be simultaneously therapeutic for opioid use disorder and HIV. Opioid use disorder medications are also associated with increased adherence to HAART for the treatment of HIV. Some providers hesitate to treat HCV in people who inject drugs, but a naltrexone implantation clinic showed rates of sustained virologic response in their patients that were comparable to clinics treating non-injection-drug-using patients.

If you’re a parent, you may wonder how to talk about opioids with your child. By knowing the facts, you can have an open conversation with your child about the risks. You’ll also be better able to spot signs of a problem with opioids. NIH has developed a guide to help you begin the conversation.

Opioids include medications like prescription painkillers and illegal drugs like heroin. They work by blocking pain signals sent from the brain to the body. At the same time, they release large amounts of dopamine—a chemical in the brain that can make the user want to repeat the experience.

Opioids are among the most addictive drugs. Over time, they can lead to brain changes that cause a strong need to take the drug again. These changes explain why some people who are addicted to opioids continue to take them despite negative consequences.

Children and teens are more likely than adults to become addicted to drugs. That’s why it’s important to talk with your child early.

Start by being a good listener. Explain the risks of misusing opioids, including the danger to a developing brain. Set clear expectations for your child about avoiding opioids and other drugs. And work to keep those channels of communication open.

Having this important conver-sation can help kids make better decisions.