Overview: The Best ORTs (Opioid Replacement Therapies)

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When it comes to recovering from opioid addiction, faster isn’t always better— which is exactly why opioid replacement therapy (ORT) can work so well. Opioids can take a serious toll on the body, especially with strong cravings that cause intense withdrawal symptoms. In fact, many people addicted to opioids are reluctant to seek treatment because they’re afraid of the withdrawal process. This is where ORTs come in. For people with heroin dependency, opiate replacement therapy can be the ideal method of treatment. ORTs can also work for a number of other opioid addictions. Doctors frequently recommend prescriptions for a variety of opiate and other opioid replacement medications to those seeking treatment from their dependency. They work in different ways, and can be used to address a number of opioid-related issues— not just withdrawals. But before we go into those, let’s take a look at how and why they’re used.

What Are Opioids?

Opioids are a class of drug. You probably already know that heroin is an opioid, but not all opioids are illegal narcotics. Many of them are actually prescription medications used by medical professionals to treat pain. Unfortunately, even prescription opioids are addictive. It’s very easy to form a physical dependency from these substances. People who are 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)

You might be wondering, what’s the difference between opioids and opiates? Well, opiates are drugs that come from the opium poppy. Since some opioids are synthesized, they aren’t technically opiates. However, all opiates are opioids. That might seem confusing, but the important thing to know is that all opioids have a similar effect on the brain. This is because of their ability to reduce pain. It also means that they have the potential to form physical dependency in the same way. Like many addictive drugs, opioid use causes the brain’s pleasure center to release massive amounts of dopamine, the neurotransmitter that makes us feel good. Our brains then begin to prioritize that “high” feeling as more rewarding and thus more important than anything else— even eating food or sleeping. This is why people often feel helpless against their opioid addiction. It can feel like the cravings completely control their brain. No one enjoys dealing with that feeling every day. Fortunately, there are treatments that can break this hold: Opioid Replacement Therapy.

What Is Opioid Or Opiate Replacement Therapy?

Different replacement drugs work in different ways. One example of a popular replacement medication is Disulfiram (also knows as Antabuse), a medication used to treat alcohol addiction by causing unpleasant side effects such as nausea when alcohol is consumed. ORTs, however, work differently. Rather than produce an unpleasant reaction, they usually operate by blocking 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 addicted patient to gradually taper off and avoid these withdrawals— or at the very least, 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 baby. In this case, ORT would be a safer alternative. Opioid replacement therapy is a good alternative for people who would prefer to treat their withdrawal at home, but don’t want to undergo outpatient detox yet. These replacement drugs do have one major risk: they’re also opioids, and can be addictive. However, the National Institute of Drug Abuse believes that ORTs do help to curb opioid dependency, as they reduce the urge to use more harmful opioids (such as heroin) over time. They also don’t provide the same kind of high. Not to mention that treating opioid dependence with ORTs is a way to practice harm minimization, since their main aim is to reduce use of high-risk opioids such as heroin and fentanyl. The World Health Organization believes that ORTs are “the most promising method of reducing drug dependence”. These replacement drugs can be a stepping-stone to a life completely free of opioid dependence.

Can Replacement Drugs Cure Opioid Addiction?

Despite their success rate in keeping opioid users away from more harmful, illicit narcotics, ORTs are not considering 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 in a more gentle way. As ORTs are administered by medical professionals, 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.

The Best Opioid Replacement Therapies

There are many kinds of opioid replacement drugs, and each one of them has their own pros and cons. What works for one person may not be suitable for another person. Take a look at some of the best ORTs and learn about the benefits that each one offers:

1. Subutex (Buprenorphine)

What is it? Subutex is one of the most commonly used drugs in opioid replacement treatment. It’s often taken orally as a pill, which melts in the mouth. How does it work? Subutex’s 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 opiates are consumed, they have a much weaker effect. By occupying these receptors, cravings — and withdrawal symptoms — are diminished. What are the risks and side effects? Subutex can be dangerous when abused, as it does produce a mild euphoric high. Keep in mind that it is designed with a ceiling effect, which limits this feeling once the dosage reaches a certain point. Abusing Subutex can easily lead to addiction. Subutex can also cause breathing problems, so it’s very important not to mix it with any 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

2. Narcan (Naloxone)

What is it? Unlike other ORTs, Narcan is used to immediately treat opioid overdose. It is administered intravenously or intramuscularly by trained individuals and only in emergency situations. It’s frequently used to combat fentanyl overdose. How does it work? Like other ORTs, Narcon also blocks the brain’s opioid receptors. But unlike Subutex, it produces no high, and actually reverses the effects of opioids. This is why it’s used to treat overdoses. Narcan saves lives. What are the risks and side effects? 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

3. Suboxone

What is it? Suboxone is the combination of Buprenorphine and Naloxone (the active ingredients in Subutex and Narcan). A popular opiate replacement therapy, it is administered as a tablet or as a dissolvable film to be placed on the tongue. How does it work? Suboxone blocks the brain’s opioid receptors, but it doesn’t produce a noticeable high like Subutex. It also helps to dull withdrawal symptoms of other opioids and lessen cravings for them over time. What are the risks and side effects? Suboxone has the same initial flu-like side effects as Subutex. It should also never be combined with benzodiazepines due to risk of breathing difficulties. As this drug is a pain killer, you may experience effects such as lowered pain tolerance after long-term use. When used appropriately, Suboxone treatment has a high success rate. In fact, statistics show 49% of people abusing prescription painkillers reduced their usage when undergoing this kind of ORT. Research studies have also shown that Suboxone is particularly effective in helping young adults to continue treatment for their addiction and avoid using illicit substances, including other opioids. There are pros and cons to using Suboxone for “maintenance”— that is, drug replacement therapy. 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

Suboxone should not be seen as a “cure” for opioid addiction. The end goal should always be to overcome all opioid addiction, including Suboxone. Considering this, it’s important to work with your doctor to gradually ease yourself off this drug. This is also necessary in order to avoid relapsing and using a more dangerous opioid, such as heroin.

4. Vivitrol/Revia (Naltrexone)

What is it? 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. How does it work? Vivitrol 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. What are the risks and side effects? 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 do use opioids after taking Vivitrol, you’re at higher risk of overdose.

5. Methadone (Dolophine)

What is it? Methadone is usually administered as a liquid and sometimes as a tablet. It’s one of the most common replacement therapies.How does it work? Morphine occupies the brain’s opioid receptors. It’s long-lasting and blocks cravings and withdrawals for other opioids, as well as their effects. It’s long-lasting, much like Subutex. What are the risks and side effects? Methadone should not be used by anyone who has 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 in accordance with methadone replacement therapy guidelines, which your doctor will explain to you. Common side effects on methadone include:

  • Nausea
  • Head spins
  • Excessive perspiration

Just like Suboxone, Methadone should not be seen as a permanent solution to opioid addiction.

Other Medications For Drug And Opioid Addiction

Other drugs are sometimes prescribed to treat opioid dependency and withdrawal. These are often administered during detoxification according to the Clinical Opiate Withdrawal Scale (COWS). Remember: Always follow your doctor’s instructions when taking medication. Do not mix medications unless instructed to do so by your doctor.

1. Baclofen

Usually prescribed to treat spinal disorders, this anti-spasmodic can be very effective in reducing not only opioid cravings, but the depression associated with withdrawal.

2. Neurontin (Gabapentin)

Neurontin is a seizure medication that can also help to reduce opioid withdrawal symptoms, especially digestive issues and irregular body temperature.

3. Campral (Acamprosate)

Campral is frequently used to treat alcohol addiction, but it can also assist with the opioid detoxification phase. It works by occupying the brain’s opioid receptors, and so reduces both cravings for and effects of these drugs.

4. Zofran (Ondansetron HCL)

Zofran is considered to be a good treatment for withdrawal as it isn’t addictive. It can help with opioid detox as it drastically reduces nausea. But even though it isn’t addictive, it’s important to follow the correct dose when using Ondansetron HCL for opiate withdrawal.

Are Opiate Withdrawal Medications Available Over The Counter?

All of the ORTs listed so far are only available with a prescription. Another option for opiate addiction treatment is anti anti-nausea medication, such as Pepto Bismol, which can be obtained without a prescription. This can be useful in easing some withdrawal symptoms (such as nausea). You might be tempted to try and treat your opiate addiction on your own at home. However, you should always seek help of medical professionals when detoxing from any opioid. A opioid treatment center will be able to implement an outpatient program for you that aligns with proper withdrawal and detox protocols.

Are There Natural Replacements For Opioids?

People with opioid addictions may seek out “natural” replacements for opioids. However, it’s dangerous to confuse the word “natural” with “safe”. After all, opiates such as heroin come from the opium poppy, a plant. Some natural opiate replacements, such as kratom, are also addictive, affecting the brain’s pleasure center in the same way as opioids. Kava, a Polynesian plant, is sometimes used as a natural opioid replacement due to its calming effects. However, kava may cause liver damage, and many doctors do not recommend that it be consumed. If you’re seeking out an alternative to pharmaceutical opioids as a way to avoid developing a dependency, then there are a few safe options:


An herb used for treating sleep disorders, such as insomnia, valerian can have a relaxing effect on the mind and body. It is taken orally as a capsule or as a tea. Valerian can help you to unwind at the end of the day.

Blue Lotus

This flower can help to relax muscles and ease pain. As such, it can be a mild replacement for other opioid painkillers. It’s usually ingested as a tea, but can also be bought in capsule form.


Passionflower is a natural sleep aid similar to valerian. It also helps alleviate withdrawal symptoms, and eases anxiety. Again, make sure you check with your doctor before taking any substance, natural or otherwise. Herbal remedies can sometimes react badly with other substances that you may be taking.

Think Opioid Replacement Therapy Might Be For You?

After learning more about the best ORTs, you might be considering drug replacement treatment for yourself. Don’t hesitate to get in touch with a nearby treatment center to discuss options for your recovery and see which method will work best for you and your life.


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