Medication That Makes Recovery Possible, Reducing Cravings And Saving Lives

Using an opioid to treat opioid addiction can sound like a contradiction, but the science tells a different story and it saves lives. I’m joined by Dr. Julia D’Alo from GRC’s Advanced Recovery Network to explain, in plain language, what medications for substance use disorders are and why medications for opioid use disorder (MOUD) are considered the gold standard for care.

We walk through the three FDA-approved options for opioid use disorder treatment: methadone, buprenorphine, and naltrexone. You’ll hear how buprenorphine works as a partial agonist, why that “partial” effect can make it safer, and how it relieves opioid withdrawal symptoms and cravings so people can stop waking up consumed by the next dose. We also talk about methadone as a full agonist, why it can be highly effective with the right monitoring, and how naltrexone works as a blocker, including the tradeoff that it may not ease cravings or the “sick” feeling of withdrawal for everyone.

We also tackle the stigma head-on: the misconception that medication is “just replacing one drug with another,” the reality of physical dependence, and how people can taper safely when it’s appropriate. Most importantly, we connect MOUD to real outcomes that matter: better treatment retention, less illicit opioid use, lower fatal overdose risk, fewer infections like HIV and hepatitis, and more stability at work and at home. If you’re in southwestern Pennsylvania, GRC’s Advanced Recovery Network offers a full continuum of care across 16 locations plus statewide telehealth services.

Subscribe so you don’t miss future conversations, share this with someone who needs a clearer picture of MAT and MOUD, and leave a review with your biggest takeaway.

To learn more about GRC’s Advanced Recovery Network visit:
https://www.GatewayRehab.org
GRC’s Advanced Recovery Network 
Multiple Southwestern Pennsylvania Locations  
800-472-1177 

Transcript

Welcome And Mission Of TRC

SPEAKER_00 0:03

Welcome to Recovery Roll Call, where hope has a home. Here, the experts of TRC's Advanced Recovery Network, a not-for-profit with over 50 years of experience, offer a full continuum of care with 16 locations across southwestern Pennsylvania and statewide telehealth services. TRC's Advanced Recovery Network provides individualized evidence-based treatment and family programming. Our goal is to help increase knowledge of the disease of addiction, share the many roads to recovery, and reduce stigma in our communities. All right, let's take roll.

SPEAKER_01 0:56

And many people don't realize they exist. Welcome everyone. I'm Melanie Winter, co-host and producer here in the studio with Dr. Julia Diallo of GRC's Advanced Recovery Network. Dr. Diallo, how are things going today?

SPEAKER_02 1:10

Great. Thank you so much for having me.

SPEAKER_01 1:14

Well, Dr. Diallo, let's dive in.

What Medications For SUD Are

SPEAKER_01 1:16

What are medications for substance use disorders and how do they work?

SPEAKER_02 1:21

So there are quite a few because there are quite a few substance use disorders. So medications for substance use disorders are medications that tend to be FDA approved, but also can be used. There's some medications that can be used off-label as well. The primary substance use disorders that have medications that can be used for them are alcohol use disorder, opiude use disorder, as well as tobacco use disorder. But I would say some of the greatest uh efficacy and outcomes are seen with medications for opiate use disorder.

SPEAKER_01 2:01

And so what types of medications are commonly used to treat these disorders?

Methadone Buprenorphine Naltrexone Explained

SPEAKER_02 2:06

Sure. So opiate use disorder, there are three FDA-approved medications. Um they are methadone, buprenorphine, and naltrexone. Um and I would say that um methadone and buprenorphine have the uh greatest efficacy or um best outcomes associated with their use. And there are also some good outcomes seen with naltrexone. All three of those medications work very differently, um, but they um uh uh have, you know, uh they're effective sort of for different ways. So I would say that uh buprenorphine and methadone are most similar to one another in that they are actually opioids. So sometimes there's some confusion around that because people will say, well, why would you use an opioid to treat opioid use disorder? And um, which is a great question. Um, the reason why is because they are different types of opioids. So buprenorphine specifically is what we refer to as a partial agonist. So, and all other opioids are full agonists. And an agonist is something that acts on a receptor fully. So um a partial agonist um acts on those receptors just partially. So buprenorphine will um act on the opioid receptors, but it only does it in a um in a partial manner so that it's very safe. You can take um a lot of it and it doesn't cause respiratory depression or it doesn't cause people to stop breathing. But what it does do is it satisfies what the receptor wants. So when when a person is uh sick or they're having cravings or any types of symptoms of opioid withdrawal, when they take that medication, those symptoms go away. And um, that person is no longer waking up and thinking about obtaining opioids all the time. It helps them focus on feeling better and entering into recovery.

SPEAKER_01 4:14

And is that how these medications help reduce cravings and withdrawal symptoms?

SPEAKER_02 4:19

Exactly. Exactly. And so methadone can work very similarly. Um, methadone is a full agonist, so it has um the the side, the the the sort of safety profile of methadone is not as favorable as buprenorphine, but it can be used very safely and effectively as well. Um and um as you had mentioned uh a little earlier, buprenorphine and methadone are associated with um uh a lot of really great, great outcomes in patients that take them, like improved treatment retention, um, reduced illicit use of um of opioids, um also decrease in fatal overdose rates, um, decrease in criminal activity. Um people are less likely to use IV drugs, so they're less likely to get hepatitis and HIV, um, you're more likely to be employed, um, you're more likely to retain custody of your children. So, I mean, and the list goes on and on and on. So these medications really are a vital um uh uh sort of tool in your toolbox when you're treating opioid use disorder. In fact, they are considered the gold standard treatment for the disease. So um they're they're really, really important.

Misconceptions And Medication Dependence

SPEAKER_01 5:35

What are some misconceptions that people have about using medication as part of treatment?

SPEAKER_02 5:41

Yeah, so what we touched on a little bit before is I think sometimes people are uncomfortable with the idea of um using an opioid to treat opioid use disorder. Um so I think that's one of them. Um, but again, I think when you understand better how they work and why they work, um, you can kind of understand why, why we use them like that. And then additionally, because they are opioids, at least those two of the three, they are um, you know, you you're dependent on them. So just like if you were to stop an opioid and you get sick, if you were to stop methadone or buprenorphine, you would also um have symptoms of withdrawal. But we have ways to help people stop taking them if and when that is appropriate. So people can be on medications for opious disorder lifelong, um, or sometimes they uh, you know, they they don't need them lifelong, and we can help them um stop using them safely and without a lot of suffering.

Medication Plus Therapy For Engagement

SPEAKER_01 6:46

And how do medications work alongside counseling, therapy, and other supports?

SPEAKER_02 6:52

Yeah, so I mean, truthfully, engagement in treatment goes up dramatically when a person is on medication. So um, if a person is not on medication, what we sometimes will see is they can't focus, um, they don't feel well, they are their mind is somewhere else. So they're thinking about obtaining opioids, they're thinking about how sick they feel, um, and they're not sitting in group or in that individual session really engaged in the conversation. And so I would say that's one of the that's one of the biggest things about medications for opioid use disorder is that they really help people engage in treatment in clinical services.

Choosing The Right Medication

SPEAKER_01 7:39

And how do you determine which medication is the right fit for a particular patient?

SPEAKER_02 7:44

Sure. Yeah. So a lot of times it's based on what a patient has taken in the past, um what their experiences have been in the past. Um, sometimes it can be based on, you know, how much of a substance they're using or um or uh like sometimes, uh, you know, not to throw something else in the conversation, but there are other opioid type substances that we use these medications for, like kratom, um, which is, you know, your gas station heroin that you've heard of, or um uh, you know, so we we sometimes we'll use less of the medication or we'll use the medications a little differently in that in that type of situation. Um, but and then naltrexone is a is an actual blocker of that receptor. So we were talking about the agonist working on the receptor. Naltrexone actually blocks the receptor so that if you try to use an opioid, it won't work. The only problem with naltrexone is it doesn't satisfy the cravings and it doesn't help the sickness. And so sometimes it doesn't have the same efficacy for people. But um, yeah, I mean, all of these decisions are individualized because they have to be, treatment just has to be individualized. There's no, there's no way around that. So you have to have a lot of conversations and um talk a lot about, you know, what's worked for you in the past and what hasn't. What do you want to do? Um, what are the potential side effects of these medications and how we're going to use them short-term or long term.

SPEAKER_01 9:19

Well, Dr. Diallo, thank you for helping us understand how these medications support recovery. We appreciate your expertise, and we'll see you next time. Thanks for having me.

Wrap Up And How To Get Help

SPEAKER_00 9:34

Thanks for joining Recovery Roll Call. Remember, recovery isn't a destination, it's a journey. One day longer, one day stronger. If you're a family member or loved one of someone struggling with addiction, help is close by. Visit gatewayrehab.org. Call 800-472-1177. Or start a live chat with our team right on the website. DRC Advanced Recovery Network. Hope has a home here. We'll see you next time.