Opioid Rehab and Addiction Treatment Programs

Last updated on April 10th, 2020

What is Opioid Addiction?

The opioid class of drugs includes the illicit street drug heroin as well as many commonly-prescribed prescription painkillers such as oxycodone, hydrocodone, morphine, and codeine.1 In 2017, an estimated 201 million people were struggling with an opioid use disorder (OUD) with 1.7 million people dealing with  addiction to prescription painkillers and nearly 700,000 addicted to heroin.1


Commonly Misused Prescription Opioids

Though intended for therapeutic use, some prescription opioids are diverted for nonmedical use. These include:1, 3-7

  • Hydrocodone (Norco, Vicodin): In its various formulations, hydrocodone is indicated for the relief of moderate pain such as that to occur in association with surgical procedures or injury.
  • Oxycodone (OxyContin, Percocet): Slightly more potent than hydrocodone, oxycodone is available in both controlled- and immediate-release forms and is prescribed for the management of moderate to severe pain.
  • Morphine (Kadian, MS Contin): Used to treat both acute and chronic, moderate to severe pain.
  • Codeine: Used to treat mild to moderate pain and as an antitussive agent.
  • Fentanyl: Pharmaceutical fentanyl is used, in various formulations, to treat relatively severe pain scenarios, such as postoperative pain, chronic pain, and breakthrough cancer pain (sudden moments of pain that occur in spite of regular treatment with other pain medications).

Signs and Symptoms of an Opioid Use Disorder

A diagnosis of an opioid use disorder, or opioid addiction is made based on the presence of many telltale signs, symptoms, and behavioral features. Some of these include:8

  • Using more than intended, or using for longer than planned.
  • The person having a strong desire to use less or struggling to control his use of opioids.
  • Spending an increased amount of time getting, using, or recovering from the effects of opioids.
  • Experiencing strong cravings to use opioids.
  • Cutting back or stopping important activities at work, socially, or recreationally due to opioid use.
  • Continuing to use opioids despite being aware of persistent mental or physical health issues related to such use.
  • Development of opioid tolerance, where more opioids are needed to achieve the desired effect.
  • Experiencing signs of opioid withdrawal when opioid use is suddenly stopped or the amount usually taken has been reduced.

Additional signs and symptoms of potentially problematic opioid use include:8

  • Shallow or slow breathing rate.
  • Drowsiness.
  • Impaired coordination.
  • Slurred speech.
  • Poor decision making.
  • Neglect of responsibilities.
  • Irritability.
  • Depression.
  • Sleep disturbances.

Are you worried that you or a loved one may have an opioid use disorder? Take a quick opioid addiction self-assessment.


When is Opioid Rehab Needed?

Continued misuse of prescription opioids may lead to the development of an opioid use disorder (OUD). Left untreated, people with OUD may continue to misuse opioids despite mounting health issues and other disruptions to their lives, including an inability to meet work, school, and home responsibilities. 2

People who begin to compulsively use opioid drugs can benefit from rehabilitation and treatment. Rehabilitation often begins with a period of medical detox and withdrawal management. This is because people with significant physical opioid dependence may experience severely unpleasant withdrawal symptoms when attempting to quit, including:2

  • Nausea and vomiting.
  • Diarrhea.
  • Sleeping problems.
  • Sweating.
  • Chills
  • Muscle and bone pain.
  • Intense cravings.

Detox and medical withdrawal management allows individuals to clear drugs from their systems while being kept as comfortable as possible in a situation that may otherwise be very uncomfortable.

Many individuals with relatively severe opioid addictions seek recovery help via inpatient treatment. Medical detox is incorporated at the start of many inpatient programs, to prepare a person for longer rehabilitation efforts after successful withdrawal management. In these instances, ongoing treatment will take place in a safe, supportive inpatient or residential environment that strives to minimize access to opioids or other drugs during treatment as well as reduce the number of stressors that those in recovery may face.


Inpatient vs. Outpatient Opioid Rehab Programs

Doctor reviewing patient

In addition to inpatient or residential treatment, some opioid recovery programs take place in an outpatient setting. At an inpatient facility, the person stays at the treatment facility and receives around-the-clock care from trained professional staff.

Partial hospitalization programs (also known as PHPs or “day programs”), intensive outpatient programs (IOPs), and other outpatient substance abuse programs provide treatment for a portion of time during the day or evening. The time commitment will be variable from program to program, but patients return home at the end of each day.9-11

In many cases, inpatient programs cost more than their outpatient counterparts due to their limited availability (there are a finite number of beds in any treatment facility), the high degree of involvement that the facility’s staff has with the person, the various amenities available to residents, and the fact that treatment and/or supervision is provided on a 24-hour basis.


What Happens During Opioid Rehab?

Though individual programs will no doubt incorporate a somewhat unique combination of therapeutic offerings, one might expect both inpatient and outpatient opioid addiction treatment programs to consist of several steps, including the following:10,11

  • Admission: The individual requiring treatment may be first evaluated by an addiction treatment professional. Important medical and mental health needs as well as other individual issues will be identified and taken into account as a treatment plan is drawn up at the point of admission into the program. This can be a lengthy process because the staff must first gather background information on the person and their substance use history, which will inform the basic treatment plan and the appropriate level of care. This is also the point at which the facility staff will explain the program structure and rules, provide information on privacy practices, and give the person an opportunity to decide if they want any family members or loved ones to be informed of their treatment progress.
  • Detoxification and medication-assisted treatment: Acute opioid withdrawal can be a markedly unpleasant and daunting hurdle to overcome. Medically supervised detox can make the detox process safer and more comfortable. Opioid withdrawal can be managed with several detox medications; beyond the detox period, medications may continue to be used for longer-term maintenance and recovery (read more about these medications below). These medications can help to ease the painful withdrawal symptoms, manage cravings, and ultimately decrease the likelihood of relapse.
  • Addiction therapy: The person participates in both individual and group counseling sessions. Any medications prescribed to assist with the treatment process will continue to be taken during this time. Many of the therapeutic interventions will draw heavily from evidence-based techniques such as cognitive-behavioral therapy.
  • Specialized care: The person receives treatment that is tailored to their unique situation and needs. For example, treatment could be designed with the knowledge that the patient needs ongoing care for a medical issue or is someone who might benefit from career counseling prior to program completion.
  • Aftercare: For many, ongoing recovery doesn’t end with completion of the rehab program. A plan of aftercare will be made prior to leaving treatment, which may incorporate elements of additional group counseling, individual therapy, and 12-step meeting attendance, such as Narcotics Anonymous. Through persistent aftercare efforts, a patient may feel more supported in their recovery as they move forward in their lives post-rehab.

Opioid Addiction Medication

While going through withdrawal, there are symptoms that may occur that can cause discomfort. Left unmanaged, these can result in unnecessary distress, may interfere with recovery efforts, and may even make early relapse more likely. Fortunately, clinicians are able to prescribe certain medications to help with some of these withdrawal symptoms.

In addition to keeping people more comfortable during detox, medications may also be used to maintain a person as they make progress toward their goal of long-term recovery. Opioid addiction treatment medications include the following:1,12-14

  • Methadone: A medication used as part of medication-assisted treatment (MAT) for addiction to heroin and other opioids, methadone is a long-acting full opioid agonist that works by decreasing withdrawal and opioid cravings. It can only be provided through a Substance Abuse and Mental Health Services Administration (SAMHSA)-certified opioid treatment program.
  • Buprenorphine: Another medication used in MAT to treat opioid use disorder, buprenorphine is a partial opioid agonist that also keeps withdrawal symptoms and cravings at a minimum and, through the addition of the opioid receptor antagonist naloxone (in the combination product Suboxone), may have a lower potential for misuse of the treatment drug itself.
  • Naltrexone: Used in MAT to treat both opioid and alcohol use disorders, naltrexone is a medicine that may block some of the rewarding effects of opioids. Unlike buprenorphine and methadone (which activate opioid receptors), naltrexone blocks opioid receptors which, by doing so, decreases the incidence of continued opioid misuse.

Medicine for opioid dependence may help make detox a more comfortable experience and may also help keep patients from using opioids again in the future.


How Long Does Opioid Rehab Last?

Many inpatient opioid rehab programs last for 28 to 30 days, with 60- or 90-day programs (or longer) available when needed. After evaluating a patient’s degree of opioid dependence and addiction severity, Rehab facility staff may recommend a treatment duration that fits a person’s needs and budget.

Although 28-to-30-day inpatient programs are common, longer periods of treatment may be more effective, so it may be beneficial to continue with some form of outpatient recovery program after leaving inpatient treatment.15


What to Look for in an Opioid Treatment Program?

Not all rehab programs offer the same level of treatment. When searching for a program right for you, it’s important to know what to look for. Below are some qualities common to many effective treatment programs:
• The use of evidence-based treatment approaches.
• Appropriate certifications and licensing.
• Relevant credentials and education for staff members.
• Individualized treatment plans.
• The integration of addiction treatment and mental health services.
• Studies that measure the effectiveness of the program.
• Low patient-to-staff ratio.
• Aftercare planning and ongoing support.


Opioid Rehab Cost and Payment Options

Opioid rehab facilities set their own pricing policies. For those who have it, health insurance may cover some or all of the cost of rehab. Be sure to closely analyze your policy and speak with your insurance provider before entering a treatment facility. Financing options, sliding scale payment schedules, and payment plans may also be available, depending on a facility’s policy.

Though the specific costs associated with different treatment programs will vary, generally speaking, 7-day detox may cost anywhere from $4,000 to $7,000. Inpatient treatment can range from $14,000 to $58,000, depending on the length of treatment, the type of program, the amenities, and the services offered. Intensive outpatient programs (IOPs) may range from $3,500 to $5,000 per week.13


Finding an Opioid Treatment Program

Finding the right inpatient opioid rehab center involves a number of factors, including where the facility is located, whether insurance will cover it, the cost of treatment, the qualifications of the staff, if the program is accredited, and the treatment philosophy of the facility. Be sure to ask questions about any/all of these aspects of an opioid treatment program.

The Substance Abuse and Mental Health Services Administration can provide information on specific facility accreditations to better help you determine the right treatment facility for you. Inquire about their treatment outcomes and what types of treatments are provided.  This can help you choose the best fit program for you to get you started on the road to recovery.


Sources

  1. Substance Use and Mental Health Indicators. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
  2. National Institute on Drug Abuse. (2019). DrugFacts: Prescription Opioids.
  3. U.S. National Library of Medicine. (2020). MedlinePlus: Hydrocodone.
  4. U.S. National Library of Medicine. (2020). MedlinePlus: Oxycodone.
  5. U.S. National Library of Medicine. (2020). MedlinePlus: Morphine.
  6. U.S. National Library of Medicine. (2020). MedlinePlus: Codeine.
  7. U.S. National Library of Medicine. (2020). MedlinePlus: Fentanyl.
  8. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
  9. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
  10. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.
  11. American Addiction Centers. (2017).
  12. Substance Abuse and Mental Health Services Administration. (2020). Methadone.
  13. Substance Abuse and Mental Health Services Administration. (2019). Buprenorphine.
  14. Substance Abuse and Mental Health Services Administration. (2019). Naltrexone.
  15. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
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