Medications for Opioid Use Disorder

Scientific studies overwhelmingly support the use of medications to treat opioid use disorder (OUD). While you may have heard of this referred to as medication-assisted treatment (MAT), we avoid using this term. We prefer the term MOUD - medication for opioid use disorder. For opioid use disorder, medication is this treatment. However, treatment also often involves behavioral therapy and social supports. There are three medications approved by the FDA for the treatment of OUD. These medications are: buprenorphine, methadone, and naltrexone. Many people receive benefits from treatment with these medications for varying lengths of time, including lifelong treatment. It’s important to note that you may be familiar with other names for these medications because they are available as generics or under different brand names.

General Considerations

Each of the medications for OUD work in slightly different ways and are available in different medical settings. All three medications have been found to be more effective in reducing illicit opioid use than no medication in randomized control trials. Medications also reduce overdose and overdose death, decrease all cause mortality, and decrease criminal justice involvement. They are a first line defense in reversing the opioid epidemic. Like with most medical treatments, some medications may work better for some people based on their needs. That’s why we’ve included an overview of all three medications.

Buprenorphine

Buprenorphine, also known by brand names such Suboxone, Subzo and Sublocade, has been used to treat opioid use disorder since the early 2000’s. Buprenorphine reduces cravings and can block the effects of other opioids. Buprenorphine has a “ceiling effect” which means the effects plateau after a certain dose. This gives buprenorphine a very low risk of overdose among people who have previously used opioids. This also prevents the “high” that can be caused by other opioids Buprenorphine is associated with reduced risk of overdose death. Buprenorphine is available to take by mouth or through injectable formulations (think of a monthly shot).

Methadone

Methadone has been used to treat opioid use disorder since the 1960’s. It is highly effective and used by hundreds of thousands of Americans each year. Similar to buprenorphine, methadone can be used to manage withdrawal symptoms and reduces cravings for opioids. However, methadone does not have a ceiling effect and can cause respiratory depression or overdose if taken at high doses. Methadone can also cause sedation. Methadone is the least expensive medication to treat opioid use disorder but unfortunately there are additional regulatory barriers that can make it more difficult to access. Importantly, these barriers were put into place due to stigma around addiction and methadone in particular - they are not rooted in science. While some of the stigma is being reversed the outdated regulations remain in place. They require that people go to an Opioid Treatment Programs - facilities that are certified by 3 separate entities - on a daily basis to receive their medication. While after some time in treatment patients may be eligible for take home doses of their medications dose this can be an inconvenience and can perpetuate stigma around addiction. While Confidant is a proponent of the use of methadone to treat opioid use disorder we do not have a physical location that is certified as an Opioid Treatment Program for patients to receive their medication and therefore cannot offer it directly.

Naltrexone

Naltrexone is available in both an oral form and as an injectable and is used to treat both opioid use disorder and alcohol use disorder. The injectable form of naltrexone is known by the brand name Vivitrol. Naltrexone blocks but does not activate the opioid receptor. This prevents other opioids from activating the receptor and having an effect. Naltrexone can help reduce cravings and does not have withdrawal potential when a person stops using it.  Naltrexone can only be administered 7-14 days after taking opioids. The range depends on the type of opioid that was taken. When you stop taking opioids while being treated with naltrexone your tolerance for these substances may decrease. This puts you at an increased risk of overdose if you return to using opioids. Naltrexone is not recommended for use in pregnancy.

How long do people stay on medications for opioid use disorder?

This is a very common question but there is no one set answer. The goal of medication is recovery and medications for opioid use disorder are perfectly compatible with recovery. The duration of time on medications is specific to the individual and their needs. The person’s circumstances may change overtime and the medication regiment should adapt with the person. Some people may use medications for a shorter period of time and for others it may be years or even a lifetime. While some people express concern about being dependent on a medication for opioid use disorder, it is an important distinguish between dependence and addiction. Dependence is a physical dependence on a substance - which means without it the person may experience withdrawal. Addiction refers to the behavior change and harmful consequences associated with the substance use. So someone can be dependent on a substance but not addicted to it. As an example, a person with diabetes is dependent on insulin, but we would never say they are addicted to it. Medications for opioid use disorder can be thought of in the same way.

Recap

Opioid use disorder impacts many people and can be treated. Selecting the right treatment is based on many factors and should be discussed with your care team. There is no pre-determined treatment regiment or duration of time using medications that is recommended - it is person specific and should be based on your individual needs and circumstances and may change over time.