Key points
- Medication treatment of opioid use disorder (OUD) has been associated with reduced risk for overdose and overall mortality.
- Clinicians should offer or arrange for patients to receive evidence-based treatment with medications for OUD.
- FDA-approved medications for treating OUD include buprenorphine (often combined with naloxone), methadone, and naltrexone.
- Detoxification on its own, without medications for opioid use disorder, is not recommended for OUD because of increased risks for resuming drug use, overdose, and overdose death.
Evidence-based treatment for OUD
Medication treatment of OUD (MOUD) has been associated with reduced risk for overdose and overall mortality. FDA-approved medications indicated for the treatment of OUD include buprenorphine, methadone, and naltrexone.
Clinicians should offer or arrange treatment with MOUD, particularly if moderate or severe. Clinicians unable to provide treatment themselves should arrange for patients with OUD to receive care from a substance use disorder treatment specialist.
Treatment providers include office-based clinicians who can prescribe buprenorphine or naltrexone and opioid treatment programs certified by Substance Abuse and Mental Health Services Administration (SAMHSA) which provide methadone or buprenorphine.
Medications to treat OUD
FDA-approved medications indicated for the treatment of OUD include buprenorphine (often combined with naloxone), methadone, and naltrexone.
Buprenorphine
- Mu-opioid receptor partial agonist
- Suppresses and reduces cravings for opioids and blunts or blocks the effects of opioids
- Can be prescribed by any clinician with a current, standard DEA registration with Schedule III authority, in any clinical setting
Methadone
- Mu-opioid receptor full agonist
- Reduces opioid cravings and withdrawal and blunts or blocks the effects of opioids
- Can only be provided for OUD through a SAMSHA-certified opioid treatment program
Naltrexone
- Opioid receptor antagonist
- Blocks the euphoric and sedative effects of opioids and prevents feelings of euphoria
- Should be started after a minimum of 7 to 10 days free of opioids to avoid precipitation of severe opioid withdrawal.
- Can be prescribed by any clinician with an active license to prescribe medications.
Additional OUD treatment
In its 2020 National Practice Guideline, the American Society of Addiction Medicine (ASAM) included treatment recommendations for OUD. It recommends that patients' psychosocial needs be assessed and that patients be offered or referred to psychosocial treatment in collaboration with qualified behavioral healthcare providers based on individual patient needs. However, a patient's decision to decline psychosocial treatment or the absence of available psychosocial treatment should not preclude or delay medications for OUD.
Clinicians should offer naloxone and education on proper use for overdose reversal to patients with OUD and to their household members/significant others.
OUD can co-exist with other substance use disorders, and patients who are actively using substances during OUD treatment might require greater support.
To guide treatment, clinicians should ask about use of alcohol and other substances. (Recommendation 8 in the 2022 Clinical Practice Guideline) Alternatively, clinicians can arrange for a substance use disorder treatment specialist to assess for the presence of opioid and other substance use disorders.
For more information about linking people with OUD to medication treatment.