What percentage of patients with opioid use disorder can achieve and maintain sobriety with treatment?

Sobriety Rates in Opioid Use Disorder Treatment

Only about 20% of patients with opioid use disorder achieve and maintain sobriety with treatment, with medication-assisted treatment showing the highest success rates. 1

Medication-Assisted Treatment Outcomes

Medication-assisted treatment (MAT) is the most effective approach for treating opioid use disorder and has the strongest evidence for maintaining sobriety:

• Buprenorphine treatment shows approximately an 80% reduction in illicit opioid use among patients who remain in treatment 2
• However, overall treatment retention remains a significant challenge, particularly for adolescents and young adults who struggle more with staying in treatment than older adults 2
• Less than 2% of adolescents identified as having opioid use disorder receive medication-assisted treatment, despite its proven effectiveness 2

Factors Affecting Sobriety Rates

Several factors influence the likelihood of maintaining sobriety:

• Treatment Access: Only 8.5% of adolescents who need substance use treatment actually receive it 2
• Medication Availability: Despite effectiveness, MOUD availability is sparse in treatment facilities:
  • Only 29.8% of residential facilities offer extended-release naltrexone
  • Only 33.3% offer buprenorphine
  • Only 2.1% offer methadone 3
• Treatment Setting: In states that expanded Medicaid, MOUDs were used in 17.7% of admissions compared to only 1.9% in non-expansion states 3
• Provider Limitations: Less than 4% of prescribers (approximately 37,000 physicians) had buprenorphine waivers as of 2016 2

Treatment Effectiveness by Approach

The effectiveness of different treatment approaches varies significantly:

• Medication-Assisted Treatment: Has the strongest evidence for maintaining sobriety

  • Methadone and buprenorphine reduce mortality, opioid use, and disease transmission while increasing treatment retention 4
  • Among primary care patients with documented OUD across six health systems, only 21% received buprenorphine treatment 5

• Behavioral Therapy: When combined with medication shows improved outcomes compared to medication alone 1

• Detoxification Alone: Lacks scientific evidence for effectiveness and has high relapse rates 6

Key Considerations for Treatment

• Discontinuation Risk: Stopping pharmacotherapy significantly increases relapse risk; patients should be encouraged to continue treatment indefinitely 4
• Comprehensive Approach: Most effective treatment combines medication with evidence-based behavioral therapies 1
• Monitoring: Regular monitoring through urine drug testing and frequent visits is essential to verify adherence and prevent relapse 1
• Naloxone Access: Prescribing naloxone and educating patients and families on its use is recommended to prevent fatal overdoses 1

Common Pitfalls to Avoid

• Premature Discontinuation: Discontinuing medication-assisted treatment increases relapse risk significantly
• Inadequate Behavioral Support: Neglecting the behavioral therapy component can lead to poor outcomes
• Insufficient Monitoring: Failure to regularly monitor patients through drug testing and follow-up visits
• Stigma-Based Treatment Decisions: Policies or attitudes that prevent patients from accessing effective medications can harm patient health 2

The chronic, relapsing nature of opioid use disorder means that while successful recovery is possible with appropriate treatment, there remains a persisting propensity to relapse 6. Understanding this reality helps set appropriate expectations for both patients and providers regarding the long-term management of this condition.