Last Updated on May 29, 2024 by Dr. Alberto Solà

There is no doubt in anyone’s mind that at this point opiate and opioid abuse in the United States has reached epidemic levels.  In fact, the leading national public health institution in our country, the Center for Disease Control and Prevention (CDC) has labeled it as such, and unfortunately, it doesn’t appear to be slowing down.  Opiates are a class of painkillers that are naturally derived from opium, such as heroin and morphine, and opioids are synthetic and semi-synthetic drugs that are similar to opiates including drugs like Percocet, Oxycontin, oxycodone, and Vicodin.  According to CDC statistics, over two million Americans are addicted to opioids right now, and on average, ninety-one people in our country die every day from prescription opioid overdoses.  Time Magazine reports that the number of heroin users in the United States leapt from 373,000 in 2007 to 668,000 in 2012, and that number has continued to rise since then, and intravenous heroin users’ mortality rate is sixty-four times greater than that of the general population.

Clearly, this is a major problem in our country, and doctors working in the addiction and recovery field are working hard to help those addicted find a path to recovery and sobriety.  One popular method to help opiate and opioid addicts break the hold these drugs have on them is drug replacement therapy, also known as substitution therapy, or DRT.  But does it work?  Why is it so controversial?  What are the pros and cons of this form of drug treatment?

What Is Drug Replacement Therapy?

Drug replacement therapy is currently one of the most popular, well-known and widespread treatments to help people stop using opiates and to break free of their addiction.  It has been endorsed by the World Health Organization and the United Nations Office on Drugs and Crime, and is available in fifty-five countries around the world.  Simply stated, in most cases, drug replacement therapy involves replacing an opioid or opiate with a longer acting but less euphoric and intoxicating opioid substitute.  The goal is to facilitate stability in the user’s life by helping him or her reach a stable physical condition that will allow the individual to go through counseling and rehabilitation successfully.  Rather than suddenly and entirely taking away the drug upon which these people are dependent, it gives them smaller and safer doses under the supervision of a doctor.  As a result, hopefully, the addicted individual will have fewer cravings and fewer mood swings, thereby helping them to stay focused on the healthier path they are trying to take.

In the United States, the only real alternative to consider for addicts who wish to stop using opiates is quitting completely and suddenly – also known as abstinence based treatment.  This option usually results in a difficult and often excruciatingly painful withdrawal process.  Although that method is more rapid than drug replacement therapy for getting clean, it is a difficult experience many addicts fear and would rather avoid, and is exactly what keeps many addicts from seeking help.  Ibogaine treatment is another option; this developing therapy, which seeks to interrupt addiction and in some ways reset the mind of the user, has proven very effective in many seeking treatment, but it is unfortunately still illegal in the United States.  Individuals interested in this path, however, can reach out to us at Clear Sky Recovery to find out more, and if it seems right for them, they can visit our facility in Cancun for treatment.

All of the above options, including drug replacement therapy, must be paired with counseling and, in most cases, group therapy as well.  Drug replacement therapy is only for opiates and opioids, so if the user is addicted to other drugs as well, then further steps will be necessary to combat those addictions.  Furthermore, drug replacement therapy may be needed for weeks, months, or even years before the addicted individual can get to a level of recovery where it is no longer needed.  There are several types of drug replacement therapy; methadone and buprenorphine are the two most common and the two that are available in the United States, but there are others being administered in other countries as well.


Methadone is the most common drug used in drug replacement therapy in the United States and around the world; it also has been around the longest.  It was developed in Germany in the 1930s and was approved for use in the United States in 1947.   It is synthetic, and is still considered an opiate, and like other drugs in its class, methadone can still be addictive.  Therefore, individuals who wish to follow this course of treatment must visit a federally regulated clinic each day to receive it.  Once administered, a dose lasts 24-36 hours.  It is what is known as an opioid agonist; it binds to opioid receptors in the brain and activates them, thereby largely eliminating symptoms of withdrawal and drug cravings.  It can be used as maintenance for addicts who feel unable to go the whole way and get clean, or can be offered in decreasing dosages over time to help the addict wean himself or herself off the opiate to which they are addicted.  Furthermore, methadone can be used to help addicted, pregnant women work towards recovery during their pregnancies.


Buprenorphine is a newer drug replacement therapy that has been available in the United States since 1985, but was approved by the FDA in 2003.  Unlike methadone, doctors can prescribe Buprenorphine, which is sold under the names Subutex and Suboxone in our country, to users who can administer it themselves at home.  It is a partial opioid agonist that also acts on opioid receptors in the brain to reduce cravings and withdrawal symptoms, but does not produce the euphoric feelings of opiates, opioids, or methadone.  Like methadone, it lasts 24-72 hours, but it is not as addictive; if users attempt to get “high” from it, the drug plateaus after several doses, eliminating that possibility.

Other Drug Replacement Therapies

Although methadone and buprenorphine are the only legal drug replacement therapies in the United States, other countries, mostly in Europe, are experimenting with other options as well.  Diamorophine is a pure injectable option offered under the supervision of medical staff in Switzerland, Germany, the Netherlands, and the UK which has had some success for individuals who have not benefitted from methadone and buprenorphine.  Dihydrocodiene is an oral medication, available in both extended and immediate release form in some European countries, and is used for both maintenance and treatment.  Extended release morphine has helped some people reduce their opioid use with fewer depressive symptoms in Switzerland.  And, perhaps most controversial, some countries offer actual heroin-assisted treatment; this method has been available in Switzerland since 1994, and more recently in the UK, Spain, Denmark, Belgium, Canada, and Luxembourg, and gives medically prescribed heroin to addicts in an attempt to treat them, and also to lower crime and HIV infection rates.

Pros of Drug Replacement Therapy

There have been many studies and reports on the successes and goals of drug replacement therapy.  These therapies have become more widespread in recent years not only due to the increase of opioid abuse, but also because of the desire of governments and law enforcement to reduce crime associated with drug use and abuse.  Due to reduced cravings and withdrawal symptoms, users are less likely to commit crimes to support their habits, and studies, including this one conducted in France, have found this to be true.

Furthermore, drug replacement therapies do seem to help addicts reduce or even abstain from opioids and opiates.  A study by the Australian government’s Department of Health and Aging in 2004 found that drug replacement therapy helped 70-95% of patients to reduce their use of these drugs significantly, and 40-65% were able to maintain complete abstinence for the length of the study.  Another oft cited study in the United States published by the Cochrane Drugs and Alcohol Group in 2009 found similar results.  It seems that many medical professionals and researchers in the addiction recovery field feel very strongly about drug replacement therapy and it is here to stay.  It has certainly helped a great many people find their way in recovery and begin their path to a healthier life.

Cons of Drug Replacement Therapy

However, despite its successes, drug replacement therapy also has a number of critics who raise real criticisms to its use as treatment for addiction.   Many people view drug replacement therapy as nothing more than simply swapping an illegal drug for a legal one.   In the case of methadone in particular, it’s simply another opioid that is just as addictive as heroin or morphine; it may take the user off the street and lower his or her likelihood to commit a crime, but it is just perpetuating the addiction, now in a medical and profitable setting.  Further, since buprenorphine can be prescribed by doctors, critics fear that it is being prescribed by medical professionals who do not know enough about it, and who do not encourage nor follow up with their patients about additional supportive therapies like counseling and attending meetings.  And, drugs used in replacement therapy often need to be administered for long periods of time – in some cases even for years – which can result in side effects such as depression, anxiety, and gastrointestinal issues such as constipation, nausea, and vomiting.  Despite its clear benefits, these negatives must be considered as well.

Why Does a Professional Supervise Drug Replacement Therapies?

Because drug replacement therapies generally involve substituting one highly addictive substance with another. So, a drug replacement therapy patient risks developing a drug replacement therapy addiction. Worst of all, an individual who continues to abuse an addictive substance during drug replacement therapy risks long-term health problems, along with the possibility of a fatal overdose. According to many studies in peer-reviewed medical journals, patients on opioid substitution therapy over 10x the mortality rate of non-drug users.

For people who are considering drug replacement therapy, it is typically a good idea to err on the side of caution. By consulting with a doctor, an individual can weigh the pros and cons of using replacement drugs to help combat his or her addiction. Additionally, an individual can receive expert insights into drug replacement therapy and use these insights to make an informed treatment decision.

Factors to Consider Before You Begin Drug Replacement Therapy

The decision to begin drug replacement therapy should not be taken lightly. Instead, an individual should consider the following factors during the drug replacement therapy decision-making process:

  • Environment: Although an individual may be dealing with a serious drug addiction, environmental problems may impact his or her drug dependence. For example, an individual living in poverty or struggling with an abusive relationship may need to address these problems as part of his or her drug addiction treatment. In these situations, an individual may need drug replacement therapy and/or other treatments to overcome his or her drug addiction.
  • Drug Dependence: If a person is physically dependent on a drug, he or she may choose drug replacement therapy to address this issue. However, it is certainly possible that this individual could become physically dependent on the drug he or she uses during drug replacement therapy.
  • Previous Drug Addiction Treatments: Drug replacement therapy is rarely — if ever — used as an initial drug addiction treatment. Conversely, if an individual has tried multiple therapies that failed to address his or her drug addiction, he or may want to pursue drug replacement therapy.

There are many drug addiction treatment options that an individual may want to consider prior to undergoing drug replacement therapy, too. These treatment options include:

  • Counseling: Both one-on-one and group counseling have been shown to help individuals get the support they need to overcome their addictive behaviors.
  • Medication: Various medications are available that sometimes help individuals beat their addictions.
  • Behavioral Therapy: Inpatient and outpatient behavioral therapy programs help individuals build healthy life skills and modify their attitudes and behaviors toward drug use.

In addition to the aforementioned drug addiction treatment options, ibogaine therapy is quickly becoming a popular choice to combat addiction. An ibogaine therapy program is conducted under medical supervision and tailored to an individual. It enables an individual to receive comprehensive support to treat his or her addictive behaviors. Plus, upon completion of ibogaine therapy, an individual leaves a treatment center with an aftercare plan to help minimize the risk of a relapse.

Ibogaine therapy enables an individual to identify the root cause of his or her addiction. Then, an individual can use this information to find ways to correct his or her addictive behaviors. Thanks to ibogaine therapy, an individual can also gain the insights to discover how to permanently overcome his or her addiction. Perhaps best of all, ibogaine therapy can empower an individual with the skills and confidence he or she needs to enjoy a drug-free life.

The Bottom Line on Drug Replacement Therapy

It’s clear that not all types of addiction recovery treatments work for all individuals.  However, all types are worth consideration for anyone struggling with addiction.  Drug replacement therapy has both positives and negatives for all who try it, but studies and personal experiences from those afflicted demonstrate that it is a therapy that is gaining recognition around the world.  Individuals seeking treatment should consider all paths to recovery when reaching out for help, and with the help of research and the advice of medical professionals, recovery is possible for most, even if many different therapies and attempts are necessary to get started successfully on a path to a healthier, happier, drug free life.