Replacement and Maintenance Treatment

We are all aware of the destructive nature that drug addiction can cause to family and friends. With this growing problem, many health organizations have been researching ways to treat people. One solution to address the problem is a replacement and maintenance treatment. By definition, it is a medical treatment that involves replacing an illegal substance, such as heroin, with a longer-acting but less euphoric opioid; methadone or buprenorphine are the drugs usually prescribed.

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Maintenance Therapy for Heroin

The methadone maintenance program is known for its curbing of withdrawal symptoms from heroin. It is used in situations where detoxification and rehabilitation have failed to bring results. The drug-addicted person desires to stop illicit drug use. Usually, a person slowly increases the dosage over time. The maintenance dose is the amount of methadone the patient requires to prevent opioid withdrawal symptoms without producing euphoria.

The first dose of methadone should be between 10-20mg. In the first two weeks of treatment, deaths from a methadone overdose can occur with doses as low as 40-60mg per day. That is why only a medical doctor prescribes methadone. He conducts the assessment on which professionals base the decision to prescribe methadone. They also take part in the planning and review of the treatment.

The drawback is that some people reported addiction to methadone. Methadone is administered in most cases over a prolonged or indefinite period of time.


Patients with severe liver disease or intolerant of methadone or ingredients in methadone should not take this replacement drug.

Maintenance Program & Alcohol

Naltrexone (ReVia) and Acamprosate (Campral) are a few drugs on the market for alcoholism. They are thought to reduce the response to alcohol by lowering cravings, decreasing drinking stimulus, and increasing headache and nausea to discourage intake.

Naltrexone c (ReVia®)

Naltrexone c (ReVia®) was approved to treat alcohol dependence to support abstinence and decrease relapse risk.

On a maintenance therapy, the person will start at 25 mg once daily and get a dose of 50 mg once daily. The beginning dose is to minimize side effects (see below). The pill blocks endorphins when alcohol is consumed. An important note is that the individual must be opioid-free for 7 to 10 days before starting the maintenance treatment. If the patient needs to begin opioid therapy, he must stop naltrexone seven days prior.

Some side effects of this drug include nausea, vomiting, headache, fatigue, drowsiness, hepatotoxicity (Toxic liver disease damaging the liver). This medicine blocks the euphoria of narcotic drugs, including heroin. Since naltrexone will make a person more sensitive to lower doses of opioids, using opioids while on naltrexone is contraindicated.

Acamprosate (Campral®)

Acamprosate (Campral®) is approved to maintain abstinence from alcohol in patients who are abstinent at the beginning of treatment. The usual dosage is 666 mg three times daily. However, with mild to moderate renal impairment the dosage should be 333 mg three times daily.

Acamprosate is part of a comprehensive management program that includes counselling. It is thought to restores the imbalance, but the mechanism in which it is supposed to do so is not clearly established. It is contraindicated for people with severe renal impairment, who are pregnant, or with hypersensitivity.

Some side effects include diarrhea, nausea, headache, depression and suicidal ideation. Naltrexone patients should not take Acamprosate.

Maintenance Programs & Addiction Treatment Help

If you or someone you know is struggling with a methadone maintenance therapy or some other substitution drug and do not like the effects call and speak with one of our referral counsellors.

Addiction requires caring professional addiction counsellors with well-proven addiction treatments. Substitute drugs may be useful to get the person up to a point where no drugs are substituted. Otherwise, you may just be substituting a problem for another. If you find yourself stuck in a drug substitution problem, call and speak with our counsellor about it, they will help. We work with drug rehab centers across Canada, and many are affordable. Give us a call.

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