Menu Close

The Best ORTs (Opioid Replacement Therapies)

a doctor reviews opioid replacement therapies with a patient

When recovering from opioid addiction, faster isn’t always better—which is exactly why opioid replacement therapies (ORT) can work so well. Opioids can take a severe toll on the body, especially with strong cravings that cause intense withdrawal symptoms. Many people struggling with drugs are reluctant to seek opioid addiction treatment because they fear the withdrawal process.

What Are Opioids?

Opioids are a class of drugs. You probably already know that heroin is an opioid, but not all opioids are illegal narcotics. Many of them are prescription medications medical professionals use to treat pain. Unfortunately, even prescription opioids are addictive. It’s very easy to form a physical dependency on these substances. People prescribed opioids by their doctor often become addicted to them by accident. Some examples of opioids are:

  • Heroin
  • Codeine
  • Fentanyl
  • Tramadol
  • Oxycodone (also known under the brand name OxyContin)

Like many addictive drugs, opioid use causes the brain’s pleasure center to release massive amounts of dopamine, the neurotransmitter that makes people feel good. The brain then begins to prioritize that “high” feeling as more rewarding and thus more important than anything else—even eating or sleeping. This is why people often feel helpless against their opioid addiction. It can feel like the cravings completely control their brain.

What Is Opioid Replacement Therapy?

Different replacement drugs work in different ways. Some medications used to treat alcohol addiction cause unpleasant side effects, such as nausea, when alcohol is consumed. ORTs, however, work differently. Rather than produce an unpleasant reaction, they usually block cravings for other opioids without producing the usual, strong high. Because the cravings to use opioids are so strong, withdrawal symptoms during detoxification can be very intense.

Drug replacement programs allow the patient to gradually taper off and avoid these withdrawals or make them much more manageable. Withdrawal can be dangerous for certain people. For example, treatment guidelines for opioid dependence dictate that pregnant women should never go through withdrawal, as it can harm their unborn babies. In this case, ORT would be a safer alternative.

Can Opioid Replacement Drugs Cure Addiction?

Despite their success in keeping opioid users away from more harmful drugs, ORTs are not a solution to addiction. This is because they are opioids themselves, and many of them are also addictive. For some opioid users, ORTs provide a way to detox from opioids such as heroin and fentanyl more gently. As medical professionals administer ORTs, they don’t expose users to the same health hazards that come with injecting illegal drugs. People with opioid addictions should seek to one day stop using all opioids. But until then, ORTs can help people to distance themselves from harmful drug practices and begin to work toward a healthier, sober life.

Common Opioid Replacement Drugs

Take a look at some of the best ORTs and learn about the benefits that each one offers:

Subutex (Buprenorphine)

Subutex is one of the most commonly used drugs in opioid replacement treatment. The active ingredient, buprenorphine, binds to the same receptors in the brain as other opioids, blocking them for up to three days. This means that when other opioids are consumed, they have a much weaker effect. By occupying these receptors, cravings—and withdrawal symptoms—are diminished. Subutex can be dangerous when abused, as it does produce a mild euphoric high. Abusing Subutex can easily lead to addiction. Subutex can also cause breathing problems, so it’s important not to mix it with other medications or drugs—especially benzodiazepines. Other less dangerous side effects can occur while your body is getting used to Subutex, but they should ease over time. These include:

  • Breathing problems
  • Flu-like symptoms, such as sneezing and blocked or runny sinuses
  • Fluctuations in body temperature, including chills or fever
  • Nausea
  • Insomnia

Narcan (Naloxone)

Unlike other ORTs, Narcan is used to treat opioid overdose immediately. It is administered intravenously or intramuscularly by trained individuals and only in emergencies. Like other ORTs, Narcon also blocks the brain’s opioid receptors. But unlike Subutex, it produces no high and reverses the effects of opioids. Narcan is considered to be much safer than other opioid replacement drugs. Nevertheless, it’s normal for people treated with Narcan to experience unpleasant side effects for a few hours afterward, such as:

  • Nausea and vomiting
  • Shivering and sweating
  • Increased heart rate and blood pressure


Suboxone is a combination of buprenorphine and naloxone. A popular opiate replacement therapy, it is administered as a tablet or as a dissolvable film to be placed on the tongue. Suboxone blocks the brain’s opioid receptors but doesn’t produce a noticeable high like Subutex. It also helps to dull the withdrawal symptoms of other opioids and lessens cravings for them over time. When used appropriately, Suboxone treatment has a high success rate. There are pros and cons to using Suboxone for “maintenance.” Like other opioids, it’s also addictive and may produce withdrawal symptoms when you stop taking it. Because of these symptoms, some people think that they must rely on Suboxone maintenance for life. This doesn’t have to be the case. In fact, Suboxone can have unpleasant long-term effects, including:

  • Hair loss
  • Erratic, hard-to-control emotions
  • Anxiety and depression
  • Sleeping difficulties
  • Dwindling libido

Vivitrol/Revia (Naltrexone)

Vivitrol is a drug used to prevent cravings after you’ve stopped using opioids. It’s injected intramuscularly at least two weeks after last using opioids. Vivitrol can also be used to combat alcohol cravings. The drug occupies the opioid receptors in the brain and reduces the urge to use opioids or drink alcohol. Unlike other ORTs, it is not physically addictive. Common initial side effects of Vivitrol include:

  • A red bump where the drug was injected
  • Nausea, abdominal pain, and vomiting
  • Flu-like symptoms
  • Fatigue

While it does reduce the urge to use, Vivitrol increases sensitivity to opioids. This means that if you use opioids after taking Vivitrol, you’re at higher risk of overdose.

Methadone (Dolophine)

Methadone is usually administered as a liquid and sometimes as a tablet. It’s one of the most common opioid replacement therapies. Morphine occupies the brain’s opioid receptors. It’s long-lasting and blocks cravings and withdrawals from other opioids and their effects. Methadone should not be used by anyone with breathing problems, such as asthma. Similarly, it shouldn’t be taken with some drugs, especially benzodiazepines, due to the risk of breathing complications. Methadone is addictive. Because of this, it should be taken following methadone replacement therapy guidelines, which your doctor will explain to you. Common side effects of methadone include:

  • Nausea
  • Head spins
  • Excessive perspiration

Are Opiate Withdrawal Medications Available Over the Counter?

All of the ORTs listed are only available with a prescription. You might be tempted to try and treat your opiate addiction on your own at home. However, you should always seek the help of medical professionals when detoxing from any opioid. An opioid treatment center can provide support through withdrawals with detox protocols.

Could ORTs Help You?

After learning more about the best ORTs, you might be considering drug replacement treatment for yourself. At Northpoint Seattle, we provide medical intervention for our patients enrolled in our outpatient programs. Some opioid replacement therapies can help patients get sober and learn how to build a better future. If you are ready to turn your life around, contact us online or call 888.483.6031 for more information.