Medications for opioid use disorder
Medications used to treat opioid use disorders are considered the “gold standard” of treatment. Medications for opioid use disorder (MOUD) help stabilize brain chemistry, reduce or block the euphoric effects of opioids (the “high”), and relieve cravings so that the patient can engage in other aspects of treatment such as counseling.
Methadone is an agonist medication—an opioid that binds to the same opioid receptors in the brain and body as other opioids. Its longer stay in the body prevents withdrawal. Methadone for the treatment of opioid use disorder can be dispensed only through federally-regulated opioid treatment programs (OTPs) (LaRochelle, 2018).
Buprenorphine is also called “bupe” and is distributed under various brand names. A partial agonist, it binds to the same receptors as methadone and other opioids, but produces a less intense effect. It can be dispensed by an OTP or prescribed by physicians, nurse practitioners, or physician assistants in an office-based setting if the prescriber has completed required training and obtained a waiver from the Drug Enforcement Administration (DEA). Brand names Subutex® and Suboxone® (a combination of buprenorphine and naloxone) are available, as well as an implant (Probuphine®), or a long-acting injectable (Sublocade®).
Naltrexone is an antagonist that prevents opioids from binding to opioid receptors in the brain. Patients do not develop a dependence on naltrexone and it cannot be misused (SAMHSA, 2019). Physicians, nurse practitioners, and physician assistants can prescribe and administer naltrexone without an additional license. A long-acting injectable naltrexone formulation is available under the brand name Vivitrol®.