News of the opioid crisis in the United States has garnered headlines for years. Opioid misuse and overdoses have devastated families and communities across the country.
According to the Department of Health and Human Services (HHS), synthetic opioid overdoses in the United States claimed the lives of 48,006 people in the 12-month period ending in June 2020. An estimated 10 million people misused prescribed opioids in that time.
For individuals with opioid use disorder (OUD), programs are available to help provide treatment with medication and therapy. Known as opioid treatment programs, they can also teach strategies to assist you with meeting your individual goals.
Some programs focus on people under 18 years old, while others are exclusively for adults. You may benefit from an inpatient program centered on supervised detox. Or, an outpatient program may better meet your needs.
The costs of opioid treatment programs also vary considerably. Some take Medicaid and federal military insurance, while others accept only private health insurance or self-payment.
What’s most important to understand is that finding an opioid treatment program may not just improve your quality of life. It may also save you from a deadly overdose.
Opioid treatment programs vary, but in general, they include:
- a review of your medical history
- a review of your history of opioid use
- a physical examination
- drug screening
You’ll also meet with a counselor to discuss an individualized treatment plan and review the policies and expectations associated with the program.
Treatment programs usually feature the supervised use of medications to help:
- Read opioid cravings
- treat withdrawal symptoms
- block effects of other opioids
- lower the risk of overdose and death
Programs also often include some type of behavioral therapy.
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that medications for OUD are safe and effective when used appropriately and should be offered to anyone with OUD.
You‘ll probably have the option of receiving counseling along with your medication. You can choose whether you want to pursue this.
The three medications approved by the Food and Drug Administration (FDA) for OUD are:
Methadone and buprenorphine are both opioids. But when used under medical supervision, they can help treat the serious withdrawal symptoms and cravings experienced by people with OUD who use other opioids, such as oxycodone and hydrocodone.
A 2021 report by the National Institute on Drug Abuse (NIDA) suggests that methadone and buprenorphine are equally effective in treating OUD. But the best results often rely on the duration of therapy.
Naltrexone is not an opioid, unlike the other two medications. It’s also used to treat alcohol use disorder, as it can effectively mute the effects of alcohol and opioids. By interfering with the “high” that opioids and alcohol provide, naltrexone diminishes the cravings for the substances.
Interventions such as cognitive behavioral therapy (CBT) may help stop opioid use. CBT focuses on changing the way you think about a situation, dispelling unrealistic and unhelpful thoughts. This helps you feel differently and make your behavior healthier and more realistic.
Because OUD is often associated with other health conditions, some treatment programs feature other services, such as treating alcohol use disorder and other substance use disorders. Some people who inject substances also share needles, so some programs include testing for HIV, hepatitis B, and hepatitis C, and treatment if necessary. Some programs also offer harm reduction services, such as supplying safe injection materials or needle exchange.
You might also get screening and treatment for mental health conditions, including:
Out-patient vs. in-patient
Opioid treatment programs can be either outpatient or inpatient.
In an outpatient program, you’ll live at home but attend a treatment program at a hospital, clinic, or other location regularly. People often go daily at first.
An inpatient program will require you to stay at a hospital or residential treatment facility. You‘ll be there overnight for a period of weeks or months.
Your options may depend on the severity of your OUD and the programs available in your area.
A residential or inpatient program may be best for people with a history of overdoses or other mental health conditions. These are more costly than outpatient programs.
If your OUD is severe, an inpatient program may also be the best option. It can help you manage intense withdrawal symptoms in the beginning, which can lead to a more successful outcome.
Outpatient treatment programs offer more flexibility at a lower cost and may be better for some individuals.
To make the best decision, talk with the people running the programs. Some helpful things to let the staff know are:
- how long you’ve been using
- what you’re currently using
- when you last used
- if you’ve ever overdosed
- what treatments you’ve tried in the past, including both medication and nonmedication therapy
- how you responded to past treatments
You may consider involving family members or close friends in the decision as well. While this is not the best option for everyone, some find comfort in the support of loved ones.
Cost is one of the biggest obstacles for many people to enroll in and complete an opioid treatment program. But it’s not the only challenge. Some hurdles are based on the availability of programs in a given community, while others have more to do with perceived stigmas about substance use.
The costs of opioid treatment can be prohibitive for many people. A 2018 report by the Kaiser Family Foundation noted that 1 year of inpatient OUD treatment costs a person more than $16,000. Some programs far exceed that figure.
Outpatient costs vary considerably, depending on the medications and the amount of behavioral therapy involved. An NIDA report from 2021 estimated that 1 year of outpatient daily methadone treatment and integrated support services could cost more than $6,500.
Insurance coverage for treatment programs for opioids and other drugs has expanded in recent years. Many programs are covered, at least in part, by Medicare, Medicaid, or private insurers. The Affordable Care Act (ACA) lists substance use disorder treatment as one of the 10 essential health benefits that must be included in all health insurance plans sold on the health insurance exchanges or provided by Medicare.
OUD is a problem in cities, suburbs, and rural areas. But urban areas tend to have greater access to health services than rural areas.
In a 2017 report, Centers for Disease Control and Prevention (CDC) researchers noted that people in rural areas tend to be older, sicker, and, in many cases, poorer than the general public. These are all factors that can affect opioid use and misuse. There are fewer treatment programs within easy reach of many people living in the rural United States.
A few pervasive stigmas surrounding OUD can get in the way of people accessing and completing treatment.
One common belief is that medications such as methadone or buprenorphine are just drugs that will replace one addiction with another. But these medications act differently on the brain. When used as part of a licensed, supervised OTP, they are remarkably effective at treating OUD.
There is also a widespread view among the general public that OUD reflects a flaw in someone’s character. A national survey from 2017 suggested that 3 in 4 people believe that people with OUD are themselves to blame for the condition. According to
This stigma can be a barrier to both finding and receiving effective care.
But public perception may be evolving. A recent study in Virginia found that
For many people, OUD is one of several health conditions that require treatment. if you‘re living with multiple conditions, it may be more difficult to find a program that will provide all the services you need.
For example, treating OUD but not depression may leave a person vulnerable to return to using opioids. If you have a co-occurring condition, talk with treatment care professionals about what kind of comprehensive services they offer.
The opioid crisis has claimed the lives of
If you or a loved one is in need of services, don’t delay. Reach out and learn what programs are in your community and whether one would be affordable and effective for the person in need.
To find treatment programs in your area, visit the SAMHSA Opioid Treatment Program Directory. You may also look for local treatment programs listed by the HHS.