Watch this short video, where Dr Scott Macdonald talks about choosing which medication to try first:
In this video, Dr Scott Macdonald talks about two different medication options: hydromorphone and diacetylmorphine.
Suboxone (Methadone (Methadose, Metadol-D) Buprenorphine and Naloxone)
What is methadone?
- Methadone is a synthetic opioid, similar to heroin or morphine except it has an extremely long half-life.
- What this means is that it has the ability to stay in your body continue it’s positive effects (like reducing cravings) over a longer period of time over a longer period of time (over 24 hours for methadone).
- It is one of the first-line options for long-term maintenance therapy for substitution therapy.
- By substituting your opioids with methadone, you will avoid getting withdrawal symptoms like you usually do from using, while ensuring that you are receiving safe drug therapy and promoting your overall wellness
How can I get started with methadone?
- Depending on your opioid use, your methadone will increase slowly increase over the course of a couple weeks until you have reached a stable maintenance dose (no symptoms of withdrawal)
How do I take methadone?
- Typically, at the beginning of your treatment, methadone is taken daily usually at a pharmacy and witnessed by a pharmacist.
- Once you are on a stable dose of methadone, your doctor and pharmacist may permit “carries” so that you can take a couple doses of methadone home a few days a week.
How do I stop methadone?
- Methadone, like any other opioid medication, needs to be slowly decreased in order to ensure that we are limiting the amount of withdrawal symptoms you could experience.
- If you would like to stop taking methadone, you can work closely with your doctor and pharmacist to slowly taper off the dose. This means that your dose will slowly decrease until you don’t need to take it anymore.
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Suboxone (Buprenorphine and Naloxone)
What is Suboxone?
- A combination of 2 medications: buprenorphine and naloxone.
- Buprenorphine, a synthetic opioid, acts similarly to methadone, however, it is not as strong as methadone. It is a first-line option for maintenance therapy for substitution therapy.
- Naloxone (think Narcan) stops the ability of opioids to stimulate the receptor and have an effect.
- It might be confusing as to why naloxone is part of this pill.
- The reason why it is put in this pill is, to prevent Suboxone misuse and ensure safe usage of the medication.
- It is not absorbed when you take Suboxone orally and does not have an effect on the action of Suboxone.
- By substituting your opioid with Suboxone, you will avoid getting withdrawal symptoms like you usually do from using, while ensuring that you are receiving safe drug therapy and promoting your overall wellness.
How can I get started with Suboxone?
- To start Suboxone, you need to have stopped your opioid use for at least 12-72 hours and be experiencing some effects of natural withdrawal. This way, it will be safer for you to start Suboxone without having worsening withdrawal effects.
- You will typically need to go through a “Suboxone Induction” where the dose of Suboxone is slowly tapered up (increased) until you are no longer experiencing withdrawal symptoms.
How do I take Suboxone?
- Suboxone is taken every day, however, unlike methadone, you typically do not have to go into the pharmacy every day to receive your dose
- With Suboxone, you will need to place the pill under your tongue and allow it to dissolve slowly over the course of 10 minutes.
How do I stop Suboxone?
- Stopping Suboxone, like methadone, or any other opioid medication requires tapering off.
- If you would like to stop taking Suboxone, you can work closely with your doctor and pharmacist to slowly taper off the dose.
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Slow Release Oral Morphine (Kadian)
What is Slow Release Oral Morphine (SROM)?
- Slow Release Oral Morphine, more commonly seen as Kadian, is a long-acting formulation of the opioid morphine.
- Morphine has been formulated so that its effects can last throughout the day.
- Its effects can last up to 24-hours, so it only needs to be taken once a day
- By substituting your opioid with SROM, you will avoid getting withdrawal symptoms like you usually do from using, while ensuring that you are receiving safe drug therapy and promoting your overall wellness.
- This option is generally reserved for those who have already tried and been unsuccessful methadone and/or Suboxone.
How can I get started on SROM?
- Speak to your doctor and pharmacist. Switching to SROM from methadone or opioid use is relatively straightforward and your doctor and pharmacist can facilitate this switch for you.
How do I take SROM?
- SROM typically requires a daily witness ingestion by a pharmacist, similarly to methadone.
- Instead of a pill or liquid, SROM, or Kadian, comes as a capsule filled with small beads. These beads are emptied out into a small cup by your pharmacist who will witness your daily dose of Kadian. These beads need to be swallowed whole and cannot be crushed, cut, or chewed.
How do I stop SROM?
- Stopping SROM, like methadone, Suboxone, or any other opioid medication requires a slow taper off.
- If you would like to stop taking SROM, you can work closely with your doctor and pharmacist to slowly taper off the dose.
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*the term “depressants” in this case refers to medication that depress your body and does not refer to medications that treat or cause depression or anxiety
** British Columbia Centre on Substance Use (BCSU) does not recommend switching between medications, while pregnant and postpartum
Hydromorphone
What is hydromorphone?
- Hydromorphone is another opioid that is used for substitution therapy.
- By substituting your opioid with hydromorphone, you will avoid getting withdrawal symptoms like you usually do from using, while ensuring that you are receiving safe drug therapy and promoting your overall well-ness.
How can I get started on hydromorphone/how do I take it?
- In order to use hydromorphone as substitution therapy, it requires self-injection at specified clinics 2-3 times a day under the supervision of a nurse.
- Typically, your doctor will also prescribe methadone or SROM for you to take in between doses of hydromorphone in order to prevent withdrawal symptoms.
How do I stop hydromorphone?
Stopping hydromorphone, like methadone, Suboxone, or any other opioid medication requires a slow taper off.
- If you would like to stop taking hydromorphone, you can work closely with your doctor and pharmacist to slowly taper off the dose.
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*the term “depressants” in this case refers to medication that depress your body and does not refer to medications that treat or cause depression or anxiety
Diacetylmorphine (aka Heroin)
What is diacetylmorphine (DAM)?
- DAM is heroin (an opioid) that has been formulated to ensure safe use for substitution treatment.
- By substituting your opioid with DAM, you will avoid getting withdrawal symptoms like you usually do from using, while ensuring that you are receiving safe drug therapy and promoting your overall wellness.
How can I get started with DAM/how do I take it?
- In order to use DAM as substitution therapy, it requires self-injection at specified clinic 2-3 times a day under the supervision of a nurse.
- Typically, your doctor will also prescribe methadone or SROM for you to take in between doses of DAM in order to prevent withdrawal symptoms.
How do I stop using DAM?
- Stopping DAM, like methadone, Suboxone, or any other opioid medication requires a slow taper off.
- If you would like to stop taking DAM, you can work closely with your doctor and pharmacist to slowly taper off the dose.
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*the term “depressants” in this case refers to medication that depress your body and does not refer to medications that treat or cause depression or anxiety
Levomethadone (Polamidon)
What is levomethadone?
- levomethadone is a form of methadone that is not as commonly seen in Canada but commonly prescribed in Europe for substitution therapy.
- It exists as a similar chemical structure to methadone, so it has a similar action and similar side effects.
- Like methadone, levomethadone reduces the withdrawal symptoms you feel with opioid use and provides you with a safer alternative.
- Like methadone, levomethadone is typically prescribed as an oral solution for substitution therapy.
How do I get started/How do I take it?
- While it is not as commonly available in Canada, please speak to your doctor or pharmacist.
- Like methadone, Polamidon is typically prescribed as an oral solution for substitution therapy.
How do I stop taking it?
- Stopping levomethadone, like methadone, Suboxone, or any other opioid medication requires a slow taper off.
- If you would like to stop taking levomethadone, you can work closely with your doctor and pharmacist to slowly taper off the dose.
Codeine
What is codeine?
- Codeine is an opioid that has been formulated to ensure safe use for substitution treatment. Though it is commonly used as a treatment for other medical conditions, similarly to diacetylmorphine and morphine, we are starting to these opioids being used as part of substitution therapy.
- More recently, particularly in European countries such as Germany, codeine has been explored as an option for substitution treatment, especially for cities or countries in which methadone is not available.
How does codeine work?
- Codeine is turned into morphine in the body which then acts on the body as an opioid and in this case, substitution therapy.
- Codeine, when taken consistently, will avoid you getting withdrawal symptoms while ensuring that you are receiving safe drug therapy and promoting your overall wellness.
How can I get started with codeine?
- Codeine is more commonly seen in European countries, particularly where methadone treatment may not be widely available. If you are living in such an area, consult your doctor regarding starting codeine as substitution therapy.
- Codeine can be prescribed by doctors and comes as a liquid or capsule that would be taken every day.
How do I stop codeine?
- Stopping codeine, like DAM, methadone, Suboxone, or any other opioid medication requires a slow taper off.
- If you would like to stop taking codeine, you can work closely with your doctor and pharmacist to slowly taper off the dose.
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*the term “depressants” in this case refers to medication that depress your body and does not refer to medications that treat or cause depression or anxiety