When Addiction Medication Stops Working: What’s Next?

Key Takeaways

• Addiction medications are crucial in managing withdrawal symptoms, reducing cravings, and aiding recovery, but they are not one-size-fits-all.
• FDA-approved medications for SUDs include methadone and buprenorphine for OUD and naltrexone for AUD.
• The effectiveness of addiction medications can diminish due to non-compliance, tolerance, and bodily changes.
• When medications lose effectiveness, consult with your primary healthcare provider or treatment facility as soon as possible.
• Doctors are trained to identify signs of ineffective medications and can help with finding alternative therapies.
• Attempting to self-medicate comes with many risks, including adverse drug reactions, drug-drug interactions, extended or inadequate duration of use, disease masking, increased morbidity, and death.

Addiction medications are a cornerstone of substance use disorder (SUD) treatment. They act on the brain to alleviate cravings, withdrawal symptoms, and the euphoric effects of drugs. These medications typically target the brain’s reward system, which is responsible for the pleasurable sensations associated with drug use. Scientists have used their understanding of the brain’s role in addiction to create medications that can control the activity of certain brain chemicals. These chemicals, such as dopamine, opioids, and serotonin, play a crucial part in the addiction cycle.

While many medications have been proven effective in SUD treatment, they are by no means a cure. And people in recovery can feel frustrated or anxious when their medication stops working. By understanding how addiction medications work, the signs that they have stopped working, and what you should do when your medication is no longer effective, individuals can better work with their healthcare providers in finding a solution that gets them back on the path to recovery.

Addiction Medications Used in SUD Treatment

Medications play a crucial role in the treatment of substance use disorders, offering support through detoxification, rehabilitation, and ongoing recovery. Understanding the common types of addiction medications, their applications, and potential side effects is essential for those seeking treatment. 

• Opioid use disorders (OUDs) are often managed with FDA-approved medications such as buprenorphine, methadone, and naltrexone. These medications can reduce cravings and withdrawal symptoms, making them a primary intervention alongside behavioral therapies. 
• For alcohol use disorders (AUDs), medications like disulfiram, naltrexone, and acamprosate are used to manage cravings and maintain abstinence.

Some medications are used off-label to treat addiction, meaning they are FDA-approved for other conditions but have shown efficacy in managing SUDs. The combination of medication with psychosocial treatments — known as medication-assisted treatment (MAT) — is often more effective than medication alone. MAT integrates medical care with behavioral therapies, drug education, and support services to address the complex needs of individuals with SUDs.

However, it’s critical to consult healthcare professionals for proper assessment and treatment planning. Self-medication or adjusting dosage without guidance can lead to adverse effects and hinder recovery.

Buprenorphine for Opioid Use Disorder Treatment 

Buprenorphine (Suboxone) is a medication used in the treatment of opioid use disorder (OUD). It is a partial opioid agonist, meaning it binds to the same receptors in the brain as opioids but produces a weaker effect. This helps to reduce cravings and withdrawal symptoms without producing the same level of euphoria or sedation as full opioid agonists. Buprenorphine is often used as part of MAT programs for OUD, along with counseling and behavioral therapies.

One of the key benefits of buprenorphine is its ability to help individuals with OUD manage their addiction while also allowing them to function normally in their daily lives. It can help reduce the risk of overdose, improve retention in treatment programs, and increase the likelihood of successful recovery. Buprenorphine is typically prescribed by healthcare providers who have received special training and certification to provide MAT. It is available in several formulations, including sublingual tablets, sublingual films, and long-acting injections.

Methadone for Opioid Use Disorder Treatment 

Methadone is another medication commonly used in the treatment of OUD. It is a synthetic opioid agonist that works by binding to the same receptors in the brain as other opioids, such as heroin or prescription painkillers. Methadone helps to reduce cravings and withdrawal symptoms, allowing individuals with OUD to function normally without experiencing the euphoria or sedation associated with other opioids. Methadone is typically administered in a clinic setting under the supervision of healthcare providers.

One of the main advantages of methadone in OUD treatment is its long duration of action, which can help reduce the frequency of dosing compared to other medications. This can make it more convenient for individuals in treatment to maintain stability and focus on their recovery. Methadone treatment is also associated with reduced risk of overdose and improved retention in treatment programs. 

However, like buprenorphine, methadone is also a controlled substance and can be habit-forming if not taken as prescribed. It is important for individuals receiving methadone treatment to be closely monitored by healthcare providers to ensure safe and effective use.

Naltrexone for OUD and AUD Treatment

Naltrexone (ReVia, Vivitrol) is a medication used in the treatment of both OUD and AUD. It works by blocking the effects of opioids or alcohol in the brain, reducing the pleasurable sensations associated with these substances. 

In OUD treatment, naltrexone is typically used after a period of detoxification to help prevent relapse. It can be administered in a pill form or as a monthly injection, providing flexibility in treatment options. Please note that naltrexone is not a first-line treatment for OUD.

Naltrexone is also used in AUD treatment to reduce the craving for alcohol and decrease the likelihood of relapse.

One of the key benefits of naltrexone is its ability to help individuals with OUD or AUD maintain sobriety without the risk of physical dependence or withdrawal symptoms. Unlike opioid agonists such as methadone or buprenorphine, naltrexone does not produce any opioid-like effects and is not addictive. 

However, it is important for individuals receiving naltrexone treatment to be motivated to abstain from opioids or alcohol, as its effectiveness relies on compliance with the medication regimen. Naltrexone should also be used as part of a comprehensive treatment program that includes counseling and behavioral therapies for optimal outcomes.

Acamprosate for AUD Treatment

Acamprosate (Campral) works by helping to stabilize the chemical balance in the brain that is disrupted by long-term alcohol use. Acamprosate is thought to reduce cravings for alcohol and decrease the desire to drink, making it easier for individuals with AUD to maintain sobriety. It is typically used as part of a comprehensive treatment program that includes counseling and behavioral therapies.

One of the key benefits of acamprosate in AUD treatment is its ability to help individuals maintain abstinence from alcohol. It is particularly useful for individuals who have already stopped drinking and are looking to prevent relapse. 

Acamprosate is generally well-tolerated and has few side effects, making it a safe and effective option for many people with AUD. However, like all medications, acamprosate may not be suitable for everyone, and its effectiveness may vary from person to person. It is important for individuals considering acamprosate treatment to discuss their options with a healthcare provider to determine if it is the right choice for them.

Why Is My Addiction Medication Less Effective?

Several factors can lead to addiction medications losing their effectiveness. These include:

• Non-compliance with medication regimen: Not taking addiction medications as prescribed, such as missing doses or stopping treatment prematurely, can reduce their effectiveness. Follow your healthcare provider’s instructions carefully and communicate any concerns or difficulties with taking the medication.
• Tolerance: Over time, the body may develop a tolerance to addiction medications, requiring higher doses for the same effect. This can reduce the effectiveness of the medication and increase the risk of dependence. Work closely with your healthcare provider to monitor your medication regimen and adjust doses as needed.
• Bodily changes: Absorption, metabolism, and excretion (pharmacokinetics) can all have an impact on a medication’s effectiveness — especially in older adults. Be sure to let your healthcare provider know if you suspect any changes to your body are responsible for your medication not working as it should.

Signs That Addiction Medication Is No Longer Effective

Recognizing when addiction medication is losing its efficacy is crucial for adapting treatment strategies and ensuring the safety and well-being of individuals with substance use disorders (SUDs). There are several signs that may indicate when a medication, such as those used in medication-assisted treatment (MAT), is no longer working effectively.

• Increased cravings: A resurgence or intensification of cravings for the substance can be a clear indicator that the medication’s effectiveness is waning.
• Withdrawal symptoms: The re-emergence of withdrawal symptoms, which the medication previously controlled, suggests a reduced therapeutic effect.
• Changes in behavior: A return to drug-seeking behavior or a noticeable shift in mood or behavior could signal that the medication is not maintaining its intended benefits.
• Dosage frequency: A need for higher doses or more frequent dosing than originally prescribed might indicate tolerance to the medication, necessitating a reassessment of the treatment plan.
• Lack of adherence: If an individual starts missing doses or becomes non-compliant with the treatment regimen, this can lead to decreased medication effectiveness.
• Fatigue and exhaustion: Persistent tiredness or a lack of energy, even after adequate rest, can be a sign that the medication is no longer effective.
• Changes in sleep patterns: Difficulty falling or staying asleep, or alterations in sleep quality, may indicate that the medication needs to be reassessed.
• Appetite changes: Unexpected increases or decreases in appetite could be a response to a medication’s reduced efficacy.
• Aches and pains: Unexplained body aches or persistent pain that isn’t attributed to another condition may be a physical manifestation of medication failure.
• Aggravation of withdrawal symptoms: The reemergence or worsening of withdrawal symptoms suggests that the medication is not performing as expected.

It is essential for individuals and healthcare providers to monitor for these signs closely. Any changes in the effectiveness of addiction medication should prompt a consultation with a healthcare professional to consider alternative treatments or adjustments to the current medication plan. The goal is to ensure that individuals continue to receive the most effective and appropriate care for their recovery journey.

Consulting Healthcare Professionals When Addiction Medication Falters

It is essential for individuals to consult healthcare professionals when they suspect their medication is no longer producing the desired effects. Medical experts are pivotal in evaluating the situation, adjusting medication dosages, or considering alternative therapeutic approaches.

Attempting to self-medicate or adjust medication without consultation can lead to adverse health outcomes and undermine the recovery process. Risks of self-medicating include: 

• Adverse drug reactions
• Harmful drug-drug interactions
• Extended or inadequate duration of use
• Disease masking
• Increased morbidity
• Death

Doctors are trained to recognize the signs of medication ineffectiveness and are equipped with the knowledge to explore alternative therapeutic options. They can provide personalized care by adjusting medication dosages, switching to different medications, or incorporating complementary therapies as needed.

Individually Tailored Addiction Treatment

If you’re looking for drug & alcohol addiction treatment in Columbus or surrounding areas, you should seek out a center that offers medical detox, as opioid withdrawal symptoms can be extremely uncomfortable and potentially dangerous. It is also beneficial to seek an accredited treatment center that employs licensed addiction professionals. 

At The Recovery Village Columbus, we offer comprehensive addiction treatment in Ohio. We provide a full continuum of care, beginning with medical detox. After completing detox, patients can transition to residential treatment, partial hospitalization services or intensive outpatient care. We employ licensed and certified addiction professionals, and we are accredited by the Joint Commission, so you can rely on us for quality opioid addiction treatment.

It’s time to get your life back. Call our Recovery Advocates to get started on your recovery journey. Same-day admission is often available.