Medications for Opioid Use Disorder

Treating opioid use disorder (OUD) requires a broad treatment approach. Medicines for opioid use disorder (MOUD) are a key part of that approach. MOUD helps reduce opioid cravings and withdrawal symptoms, improving the chances of recovery.¹

How does MOUD work?

Medicines used to treat OUD help stabilize brain chemistry, allowing people to focus on their recovery. Some reduce withdrawal symptoms and cravings, making it easier to resist opioids. Others help prevent relapse by blocking opioids from working.^1-3

These medicines are most effective when combined with behavioral therapies and support services. Together, OUD treatments address both the physical and psychological aspects of OUD.^1-3

Types of medicines for opioid use disorder

Three medicines have been approved by the US Food and Drug Administration (FDA) to treat OUD. They are:^1-3

• Buprenorphine
• Methadone
• Naltrexone

Buprenorphine, methadone, and naltrexone offer different benefits and can be tailored to each person’s needs.^1-3

Buprenorphine

Buprenorphine is a partial opioid agonist. This means it activates opioid receptors in the brain, like opioid drugs do. But it does so to a much lesser extent than opioids like prescription painkillers or heroin. It reduces cravings and withdrawal symptoms without producing a strong high.^1-4

Buprenorphine has been treating OUD for decades and was the first drug to be approved to treat OUD. Buprenorphine comes in the form of a pill or injection medicine. It is prescribed and given to you by your doctor. After some time, your doctor may allow you to take the drug at home. Sometimes it is combined with naloxone to prevent misuse.^1-4

Methadone

Methadone is a long-acting opioid agonist. It works by blocking the effects of opioids. This helps reduce cravings and prevent withdrawal symptoms.^1-5

Methadone comes in the form of a liquid and is taken daily. It must be given at a special clinic certified by the Substance Abuse and Mental Health Services Administration (SAMHSA).^1-5

Naltrexone

Naltrexone is an opioid antagonist. It blocks the effects of opioids in the brain, decreasing the effects of a high if opioids are used. Unlike methadone and buprenorphine, naltrexone does not reduce cravings or withdrawal symptoms.^1-6

Naltrexone is available as a daily pill or a monthly injection. To avoid severe opioid withdrawal symptoms, a person must be opioid-free for about 6 to 10 days before starting naltrexone.^1-6

Naloxone: A lifesaving tool

Naloxone is another important medicine used for those with OUD. But it is not a treatment for OUD itself. Instead, naloxone is used to reverse opioid overdoses.⁷

How does naloxone work?

Naloxone works by rapidly removing opioids from receptors in the brain. This restores normal breathing in someone who has overdosed.⁷

Naloxone is available as an injectable solution or a nasal spray. The nasal spray, often sold under the brand Narcan®, is easy to use. To use naloxone on someone who has overdosed, spray the medicine into 1 nostril while the person lies on their back. Multiple uses may be necessary. If after 3 to 5 minutes, the person is not responding, give another dose.⁷

Naloxone works within minutes and has no potential for misuse. It only works if opioids are present in the system. It has no effect on people who have not used opioids.⁷

Where is naloxone available?

In many areas, naloxone is available over the counter and without a prescription. Community clinics and local health departments often provide it for free or at a low cost. Find out how to get naloxone where you live.⁷

While naloxone does not treat the underlying disorder, it can save lives during an overdose. Then, people have a chance to seek treatment for OUD. Making naloxone widely available is a critical step in reducing opioid overdose deaths and connecting people to treatment options like MOUD.⁷

What are the benefits of MOUD?

Research shows that people who use MOUD are more likely to stay in treatment and reduce their opioid use compared to those who rely on behavioral therapy alone. MOUD also:^1,2,7

• Reduces overdose risk
• Supports long-term stability and overall well-being
• Improves survival rates
• Lowers the risk of infectious diseases like HIV and hepatitis C

What are the possible side effects?

While MOUD is generally safe and effective, the drugs do have some risks. Here are some possible side effects of MOUD:^4-6

• Buprenorphine – Constipation, headache, nausea, and vomiting
• Methadone – Restlessness, constipation, sweating, and itchiness
• Naltrexone – Nausea, headache, fatigue, and dizziness

These are not all the possible side effects of MOUD. Talk to a healthcare provider about what to expect when taking MOUD. You also should call your doctor if you have any changes that concern you when taking MOUD.

Addressing the stigma around MOUD

Despite its proven effectiveness, MOUD is often misunderstood. Some people believe using these medicines is "replacing one addiction with another." This is not true.¹

Methadone and buprenorphine are prescribed at controlled doses. Both medicines are given under medical supervision.¹

It is also important to note that OUD is a chronic medical condition. Like other chronic conditions, it needs ongoing treatment. Stigma can prevent people from seeking help. But it is crucial to understand that MOUD is a valid and evidence-based treatment.¹

MOUD versus behavioral interventions alone

Behavioral therapies, such as counseling and support groups, are an important part of OUD treatment. But research consistently shows that using medicines to treat OUD greatly improves outcomes, reduces relapses, and prevents overdoses.^1,8

Experts advise combining MOUD with cognitive behavioral therapy (CBT) and community support. This approach is called medication-assisted treatment (MAT). With CBT, a person can address the underlying causes of their addiction. MAT gives people the support they need to achieve and maintain recovery.^1,8

If you believe you or someone you know has OUD, don’t wait to get help.