Opioid Use Disorder Information

The information below was shared by the HEALing Communities Study in Springfield that ended December 2023. The HEALing Communities Study is a national study by the National Institutes of Health with the goal of reducing opioid overdose deaths by 40% in participating communities. The Massachusetts sites were led by a team at Boston Medical Center (BMC). Learn more.

Stigma

Stand up to stigma.

Stigma is the disapproval of, or discrimination against, a person based on a negative stereotype. Stigma often affects how people with opioid use disorder are treated, making it difficult for them to find jobs, places to live, and medical care. Even if unintentional, the hurtful words and actions of others can keep people who are struggling with addiction from getting help and staying in treatment for as long as they need it.

What to know about opioid addiction in order to reduce stigma

Opioid use disorder is not a choice. It’s a disease that can be treated. Many Americans incorrectly view opioid use disorder as a moral weakness or character flaw. In fact, it is a brain disease that can be treated.

Learn more about the physiology of addiction in this outstanding video presentation from Dr. Ruth Potee, Western MA physician and nationally known addiction expert.

Overcoming addiction takes more than willpower. Medicine can be a very effective part of the solution. Stigma leads some people to believe that taking medicine for opioid use disorder is “replacing one drug for another” and "not real recovery". In fact, people who take FDA-approved medicines are more likely to stay in recovery and enjoy healthy, productive lives.
Why does stigma matter?

Stigma keeps people from getting the best possible care. The myth that addiction is a lack of willpower stops people from seeing their doctors and getting treatment that can help them rebuild their lives, relationships, and health.

Stigma harms well-being and quality of life. As a result of harmful attitudes and stereotypes, people with addictions often face devastating consequences like discrimination in employment, loss of housing, and poor treatment from healthcare professionals.

Stigma leads to overdose deaths. Fear of being judged or discriminated against can keep people from getting the help they need and increase their chances of dying from an overdose.
What can I do to reduce stigma?
You can make a difference by creating a stigma-free environment in your family, community, workplace, and/or healthcare setting.

In your family:
- Learn how to talk to a loved one about their opioid use.
- Understand options for treatment with medications for opioid use disorder and support your loved one's interest in going to and staying in treatment, which can be years long.
- Use person-first language (e.g., say “person with opioid use disorder” instead of “addict”) to put people before their diagnosis and choose words that lessen blame and shame.
- Seek support.
In your community:
- Learn how faith-based and community organizations can support people with opioid use disorder in finding and staying in treatment with the aim of rebuilding their lives and getting back to work.
- Create an action plan to change negative beliefs in your community about opioid use disorder and its treatment with medications through education, grassroots organizing, and advocacy.
In your workplace:
- Discover how workplaces can create a recovery-friendly environment for employees.
- Improve access to treatment with medications for opioid use disorder at your workplace.
Check out the Break the Stigma (Sin Estigma) campaign for more.

Treatment and Recovery

There are multiple pathways to addiction recovery. Each person has a personal path to recovery from opioid use disorder, and treatment with medication is a medical standard of care. It can help people begin their recovery, regain their lives and place in the community, and improve relationships with family and friends.

What should I know about treatment and recovery?

Treatment is effective and recovery is possible. FDA-approved medications, combined with counseling and social support, have been shown to be effective at reducing opioid use and helping people recover. This combined approach reduces the likelihood a person will return to use and increases the odds of successful, long-term recovery in people with opioid use disorder.

Returning to opioid use does not mean treatment has failed. As with the treatment of any substance use disorder, people may return to using opioids, but it does not mean treatment has failed. Treatment of any chronic condition involves changing deeply rooted behaviors. If a person returns to using opioids, they should talk with their health care provider and discuss their treatment plan.
How do medication and treatment programs help people recover?

Treatment with medication is a medical standard of care. Research shows that medication should be the first line of treatment when addressing opioid use disorder. Medication is often combined with behavioral therapy, counseling, case management, and/or recovery support services. FDA-approved medications like buprenorphine, methadone, and naltrexone are safe and effective and can help with reducing cravings to take opioids.

Stopping drug use is just one part of a recovery process. When people enter treatment, opioid use disorder has often harmed their health and how they function in their family, at work, and in the community. Treatment addresses many aspects of a person’s life. There are many services available to assist people in recovery with medical, mental health, social, employment, family, legal, and other needs.
Where can I find help for opioid use disorder?

Find local treatment and recovery services on the 413Cares resource page. This SAMHSA resource also has helpful information about accessing care and finding quality treatment.

Medication for Opioid Use Disorder

Medications for opioid use disorder save lives. Each person has a personal path to recovery from opioid use disorder, and treatment with medication is a medical standard of care. It can help people begin their recovery, regain their lives and place in the community, and improve relationships with family and friends.

Where can I find someone who can prescribe medications for opioid use disorder?

Step 1: If you have a health care provider (doctor, nurse, etc.), start there. Ask them about methadone, buprenorphine, and naltrexone, and whether you can be prescribed one of these medications. If your healthcare provider is unable or unwilling to prescribe these medications, request a referral to another provider who can prescribe them.

Step 2: If you do not have a health care provider, find a local treatment provider in your community that may be able offer medication.
Why use medications for opioid use disorder?
People who stop using opioids often relapse (return to use) if they do not use medication to help them. Stopping and then restarting opioid use increases the chance of dying from an overdose.

Medications can help people be successful in their recovery by:
- Lowering the risk of relapse
- Lowering the risk of overdose death
- Increasing the time they stay in treatment
- Improving their lives and relationships with others
What are the medications for opioid use disorder?
The three medications approved to treat opioid use disorder are:

Methadone
- Helps with withdrawal
- You drink it
- You have to go to a clinic daily for the fi rst 90 days of treatment
Buprenorphine (Common brand names: Suboxone, Subutex)
- Helps with withdrawal
- You usually start by taking it daily as a tablet or film that dissolves under the tongue or in the cheek
- New rules now make it easier for healthcare providers to get a certificate (waiver) to prescribe buprenorphine, but not all clinics will offer it
- You typically get the prescription filled at a pharmacy
- In most cases, you can take it at home
- Once you have stabilized, your provider may recommend a long-acting form of buprenorphine, such as Sublocade (injection).
Naltrexone (Common brand name: Vivitrol)
- You must stop opioid use 7 to 10 days before starting
- You might be prescribed other medications to help with withdrawal symptoms
- Usually given as a shot once a month
Important Notes
- These medications can save lives.
- If you stop taking a medication for opioid use disorder, it can increase the risk of overdose and death.
- You should discuss with a healthcare provider which one would work best for you.
- You should never stop taking medication without the guidance of a healthcare provider. Never stop taking them on your own.

Naloxone (Narcan)

What is Naloxone?
Naloxone is a medicine that can save someone’s life if they are overdosing on opioids — whether it’s a prescription opioid, heroin, or a drug containing fentanyl. FDA approved forms of naloxone that are available include the nasal sprays Narcan® and Kloxxado™, the ZIMHI™ prefilled syringe, and generic formulations that are used with a syringe or IV.

Naloxone quickly blocks and reverses the effects of an overdose. You can tell it is working because it quickly helps a person breathe normally. It is not a treatment for opioid addiction.

Signs of an opioid overdose include:
- Being unconscious
- Very slow or shallow breathing
- Limp body
- Not responding when called, touched, or shaken
Carry naloxone with you every day. You can be a first responder. You can save a life. Learn more about overdose prevention with naloxone and rescue breathing from the You Can campaign.
Where Can I Get Naloxone?
- Get free naloxone from a local organization
- Get free naloxone from a state-supported program
- Get naloxone from a local pharmacy (no prescription needed).
- Massachusetts residents can get free Nalaxone via mail through You Can. Watch a quick instructional video and receive a free kit of Narcan (2 doses) shipped to your home. No personal information is required other than an address for shipping purposes.
Why Should I Carry Naloxone?

If you or a loved one struggle with opioid use, you should have naloxone nearby. Ask your family and friends to carry it and let them know where your naloxone is, in case they need to use it. People who previously used opioids and have stopped are at higher risk for an overdose. This includes people who have completed a detox program or have recently been released from jail, a residential treatment center, or the hospital. These people now have a lower tolerance for opioids and can overdose more easily.

You should also have naloxone on hand if you know someone who uses any illicit drug, because the dangerous synthetic opioid fentanyl is regularly added to non-opioid drugs like methamphetamine and cocaine, often without people knowing. So, naloxone should be given at any sign of an overdose. It will not work to reverse an overdose if a person has not taken opioids, but naloxone should always be tried in case fentanyl has been added. It has no harmful effect if opioids are absent.
Who Can Use Naloxone?

Anyone—including you—can give naloxone to someone who is overdosing from a prescription opioid medicine, heroin, or a drug containing fentanyl. Narcan® or Kloxxado™ nasal spray is a ready-to-use, needle-free medicine that can be used without any special training. They require no assembly and are sprayed into one nostril while the person lies on their back. The spray bottle (atomizer) is small and can fit in your pocket, purse, or glove compartment. Carry two spray bottles in case a second dose is needed.

Carrying naloxone does not mean that you are encouraging people to misuse opioids or other drugs. It just means that you are ready to save a life if they overdose.

For more information on laws that protect people who prescribe, carry, and use naloxone, please visit the Prescription Drug Abuse Policy System website.
How Safe is Naloxone?
Naloxone is very safe and saves lives. It can be given to anyone showing signs of an opioid overdose, even if you are not sure if they have used opioids. Naloxone is not addictive and cannot be used to get high.

Narcan® or Kloxxado™ nasal spray is an easy-to-use nasal spray packaged with two spray bottles (atomizers) in case a second dose is needed. A Quick Start guide in the box gives instructions and should be read in advance. People receiving naloxone kits that include a syringe and naloxone ampules or vials should receive a brief training on how to use it.

Naloxone:
- has been proven to be extremely safe, with no negative effects on the body if the person has not used opioids;
- can also be used on pregnant women in overdose situations; and
- does not cause any life-threatening side effects.
People with physical dependence on opioids may have signs of withdrawal within minutes after they are given naloxone, but this is normal and good because it means that the naloxone is helping the person to breathe again. Normal withdrawal symptoms can include headaches, changes in blood pressure, anxiety, rapid heart rate, sweating, nausea, vomiting, and tremors. These symptoms are not life threatening but can be uncomfortable.
How Do I Administer Naloxone?
To learn how to administer naloxone, check out the following resources:
- Get training from a local provider or Get Naloxone Now.
- Watch a naloxone training video.
- Get step-by-step instructions for using naloxone nasal spray.
How long before I know naloxone is working?
There are currently two naloxone nasal spray products that generally work the same: Narcan® or Kloxxado™ nasal spray. They begin working within minutes after they are given and should help the person wake up and breathe again. After administering a single spray in one nostril, put the person in the recovery position, on their side with arms forward, and upper leg bent at the knee in front of the body, somewhat like a sleep position. Further instructions can be found in the box with the product, or online by searching for "recovery position."

If the person does not respond to the first dose of naloxone within two to three minutes, a second dose should be given, after putting the person on their back again.
- Important: If using a nasal spray, a second dose requires a second spray bottle (atomizers).
Naloxone works for 30 to 90 minutes, but because many opioids remain in the body longer than that, it is possible for a person to show signs of an overdose after naloxone wears off. Therefore, one of the most important steps is to call 911 so the person can receive medical attention to monitor their breathing and treat these possible effects. Wait for emergency personnel to arrive and be sure to tell them about the products and doses you gave the patient. Be sure to throw away all used spray bottles and naloxone products.

Safe Drug Disposal

Find a kiosk, dropbox, or one-day event near you to dispose of prescription drugs that are expired or no longer needed.

It is not safe to share unused medications with others, and it is important remove all leftover prescription pain medication from your home. Medication take-back drop boxes and events are the best way to safely dispose of prescription and over-the-counter medicines that have passed their expiration date or are no longer needed.

All medicines dropped off at the drug disposal sites will be destroyed and discarded. Before disposing of medications, remove all personal information on the label of pill bottles or medicine packaging. To safely dispose of medicine at home, mix with coffee grounds or other unpalatable substances before disposing in the trash or check the

FDA list for opioids that can be flushed down the toilet. You can also ask your local pharmacist for advice on how best to dispose of a specific medicine.