Treatment for addiction to prescription painkillers and heroin—drugs classified as opioids—can be especially challenging. The severity of withdrawal symptoms and cravings drives many patients to leave treatment prematurely. And prolonged use of opioids fundamentally changes brain function in ways that increase the risk of relapse. Experts at the Hazelden Betty Ford Foundation specialize in the prevention, assessment, and treatment of addiction and co-occurring disorders among teens and adults. Nurses Susan Munson, RN, CARN, and Jill Rome, RN, CARN, work in the medical unit at the Foundation's inpatient treatment center for teens and young adults in Plymouth, Minnesota, where part of their care-giving involves helping patients detox comfortably and safely from opioids and other drugs. Here they discuss the role of medication-assisted treatment as part of the center's evidence based Twelve Step approach. Getting a stable start "For most patients, going through opioid withdrawal feels like a terrible case of the flu," explains Munson. Nausea, body ache, fever, and fatigue are common withdrawal symptoms. Anxiety, depression, restlessness, and irritability are often part of the picture, as well. "Opioid detoxification is a physical and emotional roller coaster for patients," Munson adds. "They're anxious. They're upset. They're really scared." As such, they're not in good shape to begin a treatment program that demands their full attention—body, mind, and spirit. "With treatment for opioid dependence, our immediate goal is to help patients make it through the discomfort of opioid withdrawal and reduce their cravings," says Munson. "Once the patient is medically stable, he or she can begin to focus more fully on other aspects of treatment." Determining the best path At the Hazelden Betty Ford Foundation, the use of medication to assist treatment is determined on a case-by-case basis by clinicians who work together in multidisciplinary teams to carefully assess each patient’s situation, explains Rome. "We look at multiple factors and variables, including the patient's history of opioid use, physical and mental health, treatment and recovery history, support network, risk of relapse, and other considerations," she notes. Physicians work with each patient to determine the treatment course that best fits his or her clinical needs. Patients may receive Suboxone®, a combination of buprenorphine and naloxone, for detoxification to ease opioid withdrawal. Some patients may receive a recommendation for a monthly, extended-release injection of Vivitrol®, also known as naltrexone, to ease cravings. This medication works to block opioid craving and help prevent relapse. Through use of these medications, clinicians at the Hazelden Betty Ford Foundation are seeing more patients stay in treatment longer, which allows engagement in other evidence-based therapies and techniques. Studies show that the longer patients remain engaged in treatment, the better their long-term recovery rates. In all cases, the Hazelden Betty Ford Foundation uses medications only as an adjunct to, and never as a replacement for, Twelve Step, evidence-based addiction treatment, Rome emphasizes. "Our aim is to engage patients for a long enough period of time to allow them to complete treatment and gain the insight and skills they need to get healthy and stay healthy." The importance of follow-up care Ongoing recovery management—including education, accountability, and continuing care—is especially critical for people in recovery from opioid addiction because the risk of accidental overdose during relapse is extremely high. At the Hazelden Betty Ford Foundation, continuing care can involve up to 18 months of services and support. As part of their continuing care plan, patients commit to attending regular appointments and support groups, taking medications as prescribed, and having regular urine drug screens. It's a path that can lead to lasting recovery. "We see amazing transformations take place," says Rome. "From the time they first come through our doors at intake to the time they leave at discharge, some patients look like completely different people. That's what I tell families: There is hope. Treatment works."