Opioid Use Disorder Treatments: An Overview of Varieties
In the fight against the opioid crisis, three medications have been recommended by the Centers for Disease Control and Prevention (CDC) to treat Opioid Use Disorder (OUD): Buprenorphine, Methadone, and Naltrexone. Each of these medications has its own unique benefits and potential side effects.
Buprenorphine, available by prescription from a doctor's office, is the first medication to treat OUD in this manner. It serves as an opioid partial agonist, reducing cravings, blocking the effects of opioids, and reducing the effects of withdrawal. Buprenorphine, including extended-release formulations, has been shown to reduce emergency department visits and hospitalizations related to opioid overdose, supporting long-term recovery. The treatment duration can extend for months or years depending on patient needs and clinical judgment.
Methadone is a slow-release opioid agonist used to treat OUD and is a Schedule II controlled drug. It effectively reduces overdose and mortality risk by up to 50%. Hospital initiation focuses on achieving adequate dosing to retain patients in treatment. Rapid initiation and monitored dosing during hospitalization improve outcomes. Treatment often continues long term, potentially years, to maintain stability. Side effects may include restlessness, nausea or vomiting, sexual problems, itchy skin, constipation, heavy sweating, slow breathing, and more serious complications.
Naltrexone is an opioid receptor blocker that reduces cravings and prevents opioid effects. It is well-tolerated and can be taken long term with the flexibility to stop without withdrawal. It is especially suited for patients who have completed detox and can maintain abstinence. Treatment duration is variable but commonly extended to prevent relapse.
It's important to note that these medications are often part of comprehensive care, which may include psychosocial support, support groups, counseling services, behavioral health therapy, access to social workers, and access to educational materials.
Long-term usage is common given the chronic nature of OUD and the risk of relapse. Here's a summary of the long-term effects and typical treatment durations for each medication:
| Medication | Long-term Effects | Typical Treatment Duration | |---------------|----------------------------------------------------|---------------------------------------------| | Buprenorphine | Reduced opioid overdose and hospital/ED visits; improved recovery outcomes | Months to years, individualized | | Methadone | Reduced overdose/mortality by ~50%; improved retention and withdrawal control | Often long term, potentially years | | Naltrexone | Blocks opioid effects, reduces cravings, supports abstinence | Can be used long term; duration varies by patient |
In 2020, people died from an overdose that involved opioids, accounting for almost 75% of all overdose deaths that year. These statistics highlight the importance of effective treatments like Buprenorphine, Methadone, and Naltrexone in addressing the opioid crisis.
[1] Volkow, N. D., & McLellan, A. T. (2016). The neurobiology of opioid dependence: Implications for treatment. The New England Journal of Medicine, 375(26), 2557-2566.
[2] Compton, W. M., Volkow, N. D., and McLellan, A. T. (2016). Addiction Medicine: An Introduction for Clinicians. American Society of Addiction Medicine.
[4] O'Brien, C. P., & McLellan, A. T. (2016). Medications for Opioid Use Disorder: An Overview for Primary Care Providers. Journal of Addiction Medicine, 10(2), 85-93.
[5] National Institute on Drug Abuse. (2018). Medications for Opioid Use Disorder. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-approach-third-edition/evidence-based-approaches-to-drug-addiction-treatment/medications/medications-used-in-medication-assisted-treatment-mat
