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A narcotic is referred to as an opioid agonist when it acts directly on the brain’s opioid receptors.
This class of drugs begins with morphine, a painkiller derived from opium, and includes oxycodone, hydrocodone, heroin, and methadone. Some drugs related to morphine are partial opioid agonists, meaning they still act on the same brain receptors but much less intensely than full opioid agonists. One of the most important partial opioid agonists today is buprenorphine.
There are several types of opioid agonists, both full and partial, available for both medicinal and illicit uses. Here are a few examples of opioid agonists and how they are used:
When a person has struggled with addiction to opioids for a long period of time, maintenance therapy, also known as medication-assisted therapy, is one of the primary tools used to help the person overcome their addiction. These medications are used to slowly taper the person off physical dependence on opioid drugs, so they do not experience intense withdrawal symptoms and can focus on therapy to overcome their addiction. While use of these medications can be valuable in recovery, they do not constitute treatment on their own; they must be used in conjunction with therapy.
Drugs used in maintenance therapy include the following:
Although withdrawing or detoxing from opioid drugs is rarely physically dangerous, withdrawal symptoms can be extremely uncomfortable. Body aches, mood swings, and cravings can all lead a person to relapse, in order to stop feeling bad. Relapse is more dangerous than withdrawal because the person loses some of their physical tolerance during withdrawal but then goes back to the same dose, or a higher dose, of the narcotic. This can lead to overdose and death.
Maintenance therapy has several goals, including:
In order to reduce the potential for relapse, maintenance drugs are given to those who have struggled with an addiction to narcotics for a long time, at high doses, or both. In part, replacement or maintenance therapy allows the person to break their routine involving drug consumption; if they do not crave the drug because of the replacement therapy, then they learn not to take it. Abusing heroin or prescription painkillers typically means abusing these drugs several times per day in order to maintain a high or to feel normal. When those drugs are replaced in the body with a different opioid agonist, the individual learns, over time, to stop the cycle of addiction by removing the routine of drug consumption from their life.
More importantly, these medications help to prevent relapse because they suppress or prevent the most intense withdrawal symptoms. If a person does not feel these aspects of withdrawal, then their body can slowly return to normal without much disruption to their work, school, and family obligations. It is important for the prescribing doctor to carefully monitor patients during this process, to make sure they are not becoming addicted to or abusing their maintenance drugs. The physician will generally outline a tapering schedule to slowly wean the person’s body off any dependence on opioid drugs, including the maintenance therapy. The average length of a tapering schedule is 2-8 weeks, depending on how high a dose of the replacement drug is needed to stabilize the individual. In some instances, people stay on their maintenance medications for months or years.
The World Health Organization, along with other national organizations, has found that physician monitoring of patients’ maintenance therapy is the only way for the treatment to succeed. The patient must attend regular visits with the doctor, in the case of buprenorphine prescriptions, or go to a methadone clinic regularly if methadone is prescribed. This allows for patient monitoring. Without this intensive focus on the patient, the patient is much more likely to return to abusing heroin, painkillers, or other narcotics, or to begin abusing the maintenance therapy itself.
Because buprenorphine and methadone are becoming more prevalent on the illicit market, people who have no tolerance to opioids can abuse these drugs and experience a euphoric high, although the high is less intense than that of stronger opioid agonists like fentanyl or heroin. In some cases, a person may also attempt to bypass the slow release through the digestive system by breaking down buprenorphine pills to snort or inject the drug and experience the effects faster. Suboxone, a brand name combination of buprenorphine and the antagonist naloxone, was designed to prevent this kind of abuse, but some individuals have found ways to bypass the naloxone component and experience a high from buprenorphine.
Maintenance therapies are still opioid agonists, either partial or full, and can still cause some effects in the individuals taking them.