Opiate Use disorder


How do you know if there is a problem?

If you have had two or more of the following within a single 12 month period, then you have opiate use disorder:

1. Opioids are taken in larger amounts or over a longer period of time than you planned.     

2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.     

3. A great deal of time is spent in finding the opioid, using the opioid, or recovering from it.     

4. Craving, or a strong desire to use opioids.     

5.  Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home.     

6. Continued opioid use despite having  persistent or recurrent  social or interpersonal problems caused or worsened by the effects of  opioids.     

7. Important social, occupational or recreational activities are given up or reduced because of opioid use.     

8. Recurrent opioid use in situations in which it is physically hazardous     

9. Continued use despite knowledge of having a persistent or  recurrent physical or psychological problem that is likely to have been  caused or exacerbated by opioids.      

10.  Tolerance - needing more opioids to get the same effect or less effect felt with continued use of the same amount of an opioid     

11. Withdrawal - having symptoms of withdrawal when not using the opioid or needing to use an opioid or something similar to avoid withdrawal symptoms 

What are the treatments?

Currently, the best evidence supports treatment with an opiate agonist like methadone or buprenorphine (also called suboxone, sublocade (a once a month injection) or probuphine (a set of implants that slow release medication over 6 months), along with counseling.  For people who do not do well with either of these options, slow release oral morphine treatment is available in Marmora as well.  

Injectable opiate agonist therapy is only available in specialized centers, such as Toronto or Ottawa.

Detoxification can also be done, but has a high risk of relapse, and people are at risk of overdose after detox, because they may use the same amount of opioid they did before they detoxed, but your body loses tolerance quickly to opiates (within a couple of days).

Opiate Agonist Therapy

In this type of treatment, the patient is prescribed a substitution medication such as methadone or buprenorphine (also called suboxone, sublocade or probuphine), so that they can reduce the harm of opiate use to their bodies and to their lives. This usually means that they get to stop having to buy illegal opiates, which can help them get their life back, whether that is through returning to work or school, or just by being part of their family again. 

Some people are concerned that this treatment means they are trading "one addiction for another". Although all opiates make you physically dependent on them, having a steady dose of opiate in your body instead of the rapid ups and downs of using short acting opiates helps keep a person level. Also, because you no longer need to look for opiates, or try to find the money for them, or hide what you are doing, or try to cover up recovering from their effects, you really can go back to leading a completely normal life. 

I often tell people it is similar to having diabetes. Some people with diabetes need to be on medication. This is not an issue of willpower - they need the medicine to continue to live their lives. Other diabetics may lose a lot of weight, and eat perfectly, and may get off of the diabetes medicines. But very few of those people do, and we don't expect them to, or make them feel ashamed of this. The same is true of opiate addiction. 

How do I know what treatment is right for me?

This will depend on a lot of things - including how each medication makes you feel, as well as how you pay for your medication, and what other health issues you have. 

Buprenorphine is available as a daily sublingual (under the tongue) tablet, a once a month injection (available sometime in 2020 hopefully!) and as a 6 month implant called probuphine. Dr. Holowaty is trained in placing the Probuphine implants, and feedback from patients so far has been extremely positive.

We have partnered with Addictions and Mental Health Hastings Prince Edward to provide counseling on Tuesday mornings as well. 

But what if I also have pain?

Both methadone and buprenorphine are very good pain medications. Some people worry about the naloxone component in Suboxone (the trade name for buprenorphine/naloxone in Canada). Naloxone is NOT absorbed by mouth. It was added to prevent people from injecting it. If you inject naloxone, it produces a rapid withdrawal effect. But you do not need to worry about that if you are taking the medication as prescribed, under your tongue. 

How do I get started?

Please come to the rapid access addiction medicine clinic hours Tuesdays from 830-12 and 1-5 PM for an intake visit, or call to see if you can come at a different time. 

If you are not in the area, but a different part of Ontario, please go to  the Drug and Alcohol Helpline (1-800-565-8603) to connect with programs and services in your area.