WHAT IS THE HARM REDUCTION DISCIPLINE?


The Harm Reduction Discipline is a science-based treatment approach that customizes treatment to the clinical conditions, strengths, support systems and cultural preference of each individual, and allows for both short-term and long-term goals.

Unlike Total Abstinence, it allows individuals in treatment to progress at their own pace, and achieve recovery one step at a time. Decades of medical studies have found the Harm Reduction Discipline to be most effective for individuals facing various challenging lifestyle and co-occurring conditions, in addition to their addiction.

REPLACEMENT THERAPY

Replacement therapy is an evidence-based, medically supervised procedure, in which a longer acting opioid such as methadone or buprenorphine (a.k.a Suboxone) is prescribed as a substitute for an illegal opioid (e.g. heroin) or prescribed medication (e.g. Oxycodone).

The medication used in replacement therapy has a dual purpose – it not only blocks the effects of other opioids, but also relieves cravings and withdrawal symptoms. The use of medication in replacement therapy is consistent with the Harm Reduction Discipline (see above). While the medication can cause physiological dependence, it helps prevent the life-threatening conditions caused by drug abuse.

Long-term opiate abuse has been shown to have a long lasting effect on the brain, even to the point of permanent damage. However, most individuals who begin treatment with methadone and buprenorphine within the first few years of drug abuse achieve a full recovery and reverse such adverse effects.

 

METHADONE VS. BUPRENORPHINE: WHAT'S THE DIFFERENCE?

Methadone and buprenorphine (a.k.a. Suboxone) are among the safest medications with minimal side effects. There have been very few methadone overdoses recorded in the past 30 years, and in each instance, methadone was used (against medical advice) simultaneously with benzodiazepines (such as Xanax and Valium) and alcohol.

Medication for replacement therapy falls into 3 categories:

  • Full Agonists - Drugs that activate receptors in the brain are termed agonists. Agonists bind to receptors and turn them on – they produce an effect in the organism.

  • Antagonists - Antagonists bind to the receptors and effectively block them and prevent the receptors from being activated.

  • Partial Agonists - Partial agonists can both activate and block opioid receptors, depending on the clinical situation. They have properties of both agonists and antagonists. The agonist properties reach a maximum at a certain dose called the ceiling effect. The ceiling effect limits the abuse potential side effects of partial agonists.

Methadone is a full agonist, while buprenorphine is a partial agonist at the opioid receptor. Both forms of medication have the ability to suppress opioid craving and withdrawal, block the effects of self-administered opioids, retain patients in treatment, and decrease illicit opioid use.

Methadone Buprenorphine
Full agonist Partial agonist
Long half-life (8 to 59 hours) Long half-life (24 to 60 hours)
No ceiling effect (useful in patients dependent on high doses of opioids) Ceiling effect; good safety profile

For people who are not addicted to or dependent on opioids, the effects of partial (buprenorphine) and full (methadone) agonists are indistinguishable. However, at a certain point, the effects of partial agonists reach maximum levels. For this reason, people who are dependent on high doses of opioids are better suited to treatment with a full agonist, such as methadone.