The evolution of heroin addiction treatment

As the 20th century dawned, the widespread ramifications of opiate and heroin addiction had become undeniable. The 19th Century Opium Wars between Britain and China saw millions of Chinese becoming addicted, while an estimated 200,000 Americans, many former Civil War soldiers, developed morphine addiction. Tragically, heroin was an attempt to create a non-addictive alternative to morphine (as morphine had been intended to replace opium).

Today, the medical community and society are still grappling with the devastating consequences of heroin addiction and abuse. But are modern treatment solutions working? And what solutions were attempted in the past?

Man in rehab therapy for heroin addiction

The early 20th Century: Sanatoriums and the “cold turkey” approach

At the start of the 20th century, the widespread use of opiates like heroin and morphine in pharmaceutical drugs (heroin was often prescribed as a cough suppressant) meant many people were at risk of addiction. This led to addicted individuals in some countries entering sanatoriums similar to those designed for tuberculosis treatment. These facilities, the precursors to modern rehab centres, were isolated havens dedicated to promoting detoxification from heroin and other opiates. The popular “cold turkey” method was most commonly used, involving complete and immediate cessation. Though it often led to terrible withdrawal symptoms, it was the mainstay of early heroin addiction treatment.

In modern-day Afghanistan, the world’s biggest producer of heroin, the Taliban have adopted a similar approach to heroin addiction treatment. While sanatoriums were different in different countries, Afghanistan’s detox centres can give us some idea of how tough and potentially dangerous the process must have been.

to see how this limited approach causes major distress and potentially lethal consequences for those in recovery, watch this video.

The mid-20th Century: The emergence of methadone

With increasing recognition of the shortcomings of the “cold turkey” approach, the 20th century witnessed fervent efforts to find more humane and effective treatments. In the 1960s, methadone, a synthetic opioid, represented a groundbreaking treatment shift.

What is methadone?
Methadone is a synthetic opioid medication used to treat opioid addiction and severe pain. It acts on the same receptors as opioids, helping reduce withdrawal symptoms and cravings while providing a longer-lasting effect to help individuals stabilise their lives during recovery.

Methadone Maintenance Therapy involves administering controlled doses of methadone to heroin-addicted individuals. This satisfies the brain’s opioid receptors, reducing cravings and withdrawal symptoms without the euphoric high, allowing many to transition to productive societal roles. While this was a safer and more effective solution than pure detox, there was still progress to be made in heroin addiction treatment.

The late 20th Century: Holistic approaches & harm reduction

The latter part of the 20th century signalled a shift in understanding addiction. Experts began to understand that while detox is a crucial aspect of heroin addiction treatment, it unaddressed the underlying emotional and psychological reasons for addiction. This led to a more holistic approach to heroin addiction treatment being developed. Two of the most significant breakthroughs in heroin addiction treatment during this time were:

Behavioural therapies and counselling

The therapeutic landscape expanded with the adoption of Cognitive Behavioural Therapy (CBT) and Contingency Management. These methodologies emphasised understanding addiction triggers, altering harmful behaviour patterns and reinforcing positive choices. CBT was found to be so effective that it is still a key component of effective heroin addiction treatment in rehab centres worldwide.

CBT therapy session

Harm reduction

The late 20th century also witnessed the rise of the Harm Reduction movement. This approach recognised that not everyone was ready or able to achieve total abstinence. As a result, strategies like needle exchange programmes and safe injection sites emerged aimed at minimising the immediate dangers of drug use.

These strategies became particularly important after the emergence of HIV, as sharing needles is one of the most common ways the virus is transmitted. While there are critics who believe that these programmes facilitate heroin use rather than prevent it, they greatly improve the safety of those who are addicted to heroin until they are ready to seek treatment.

The 21st Century: Pioneering new frontiers

As the new Millennium dawned, a better understanding of heroin addiction and the need for more comprehensive treatment options saw major leaps forward in recovery solutions. These solutions have given heroin addiction treatment services more effective weapons in the battle against this deadly illness. Some notable innovations include:

Buprenorphine: An alternative to methadone

In the early 21st century, Buprenorphine was introduced as another option for medication-assisted treatment. With fewer side effects and a safer profile than methadone, it soon gained traction as a preferred treatment for many people in heroin addiction treatment.

Naloxone: A revolutionary lifesaver

While Buprenorphine had major benefits for long-term heroin addiction treatment, Naloxone emerged as a game-changer in emergency settings. When administered during an opioid overdose, it can swiftly reverse the life-threatening effects, essentially pulling individuals back from the brink of death. In San Francisco, where the opioid crisis has seen tens of thousands of people addicted to heroin and fentanyl, NGOs and other organisations hand out special kits to users that contain new needles and clean water for mixing the drugs (as many had reverted to using dirty puddle water) and Naloxone to administer to anybody overdosing in the streets.

Advanced behavioural therapies

Recent years have also seen the rise of innovative treatments that aim to recalibrate the brain’s addiction pathways and address underlying traumas fueling the addiction. Some of the most effective therapies include Dialectical Behaviour Therapy, EDMR, Motivational Interviewing and a host of holistic therapies. The most effective heroin addiction treatment programmes provide comprehensive programmes incorporating multiple rehab therapies for maximum effectiveness and the best chance of sustained recovery.

Digital interventions

The digital revolution hasn’t spared the realm of heroin addiction treatment. From teletherapy sessions to recovery apps and online communities, technology is playing a pivotal role in expanding treatment accessibility. This became particularly important during the COVID-19 pandemic when physical access to heroin addiction treatment services became difficult and the lessons learned during this time really helped to push digital solutions forward.

Genetic therapies: Rewriting the code of heroin addiction

Our genes are pivotal in how we respond to drugs and our susceptibility to addiction. By targeting these genetic markers, scientists hope to revolutionise heroin addiction treatment. Some exciting studies include identification of genetic markers. Recent research has pointed to specific genes and genetic variants that may increase susceptibility to opioid addiction. For instance, variations in the gene OPRM1, which codes for opioid receptors in the brain, have been linked to opioid sensitivity and addiction risk.

Image of a brain

Gene editing techniques

Technologies like CRISPR-Cas9, a revolutionary gene-editing tool, offer the potential to modify genes associated with addiction. While still in its nascent stages for heroin addiction treatment, preliminary research in other medical areas shows that CRISPR can effectively target and modify specific genetic sequences.

Potential therapies

One of the proposed approaches involves altering the expression of certain genes to increase the production of endogenous opioids—natural painkillers produced by our bodies. By doing so, the need for external opioids might decrease, reducing the risk of addiction.

Conclusion: Continual progress on a challenging path

The journey through heroin addiction treatment is a testament to human resilience, adaptability and our unwavering desire to find solutions. With each era, our approach has become more nuanced, our tools more sophisticated, and our understanding deeper. As we forge ahead, the commitment remains unchanged: to free individuals from the chains of heroin addiction and pave the way to recovery, renewal and a happier, healthier future.