What are the treatment options for opioid use disorder (OUD)?

From the Guidelines

Treatment for opioid abuse should involve a comprehensive approach combining medication, counseling, and support services, with medication-assisted treatment (MAT) being the gold standard, using medications like methadone, buprenorphine, or naltrexone to reduce cravings and withdrawal symptoms, as recommended by the CDC guideline for prescribing opioids for chronic pain--united states, 2016 1.

Key Components of Treatment

• Medication-assisted treatment (MAT) with buprenorphine or methadone in combination with behavioral therapies is the recommended treatment for patients with opioid use disorder, as stated in the CDC guideline for prescribing opioids for chronic pain--united states, 2016 1.
• Behavioral therapy, such as cognitive-behavioral therapy or contingency management, should be included in the treatment plan, typically lasting at least 3-6 months but often continuing for years.
• Patients should also be connected with support groups like Narcotics Anonymous and receive regular monitoring for relapse.
• For acute overdose situations, naloxone (Narcan) should be readily available as a rescue medication.

Medication Options

• Buprenorphine (Suboxone) is a partial opioid agonist that can be used to treat opioid use disorder, with a typical dose of 8-24 mg daily, as mentioned in the medication-assisted treatment of adolescents with opioid use disorders study 1.
• Methadone is a full opioid agonist that can be used to treat opioid use disorder, with a typical dose of 60-120 mg daily.
• Naltrexone (Vivitrol) is an opioid antagonist that can be used to treat opioid use disorder, with a typical dose of 380 mg monthly injection.

Importance of Individualized Treatment

• Treatment plans should be individualized based on the patient's specific needs, severity of addiction, and co-occurring mental health conditions, as emphasized in the health and public policy to facilitate effective prevention and treatment of substance use disorders involving illicit and prescription drugs: an american college of physicians position paper 1.
• Clinicians should assess for opioid use disorder using DSM-5 criteria and offer or arrange for patients with opioid use disorder to receive evidence-based treatment, as recommended by the CDC guideline for prescribing opioids for chronic pain--united states, 2016 1.

From the FDA Drug Label

1. 1 Addiction, Abuse, and Misuse Buprenorphine Sublingual Tablets contain buprenorphine, a Schedule III controlled substance that can be abused in a manner similar to other opioids, legal or illicit. To reduce the risk of precipitated withdrawal in patients dependent on opioids, or exacerbation of a preexisting subclinical withdrawal syndrome, opioid-dependent patients, including those being treated for alcohol dependence, should be opioid-free (including tramadol) before starting naltrexone hydrochloride treatment

Treatment for Opioid Abuse:

• Buprenorphine: can be used to treat opioid abuse, but it is a controlled substance that can be abused in a manner similar to other opioids.
• Naltrexone: can be used to treat opioid dependence, but patients should be opioid-free for at least 7 to 10 days before starting treatment to reduce the risk of precipitated withdrawal. The choice of treatment should be individualized and based on the patient's specific needs and circumstances 2 3.

From the Research

Treatment Options for Opioid Abuse

• Medication-assisted treatment (MAT) is a widely used approach for treating opioid dependence, with significant benefits and various therapeutic options available 4, 5, 6, 7, 8.
• The most commonly used drugs in MAT include buprenorphine, methadone, and naltrexone-based regimens, each with its own pharmacological profile, effectiveness, and safety considerations 4, 5, 6, 7, 8.

Comparison of Medication-Assisted Treatment Options

• Buprenorphine is considered the second most effective MAT in harm reduction and relapse prevention, with a low risk of overdose, but requires initiation and maintenance through primary care and moderate withdrawals 6.
• Methadone is currently the gold standard in MAT, effective in any stage of withdrawal, but requires administration at a specialty clinic and has a lengthy titration process to an effective dose 5, 6, 7.
• Naltrexone, particularly in its extended-release intramuscular injection form, has shown promise in reducing relapse and improving quality of life, but requires individuals to be opioid-free for 7-14 days before initiation 5, 6, 8.

Implementation and Accessibility of Medication-Assisted Treatment

• Primary care providers are well-positioned to provide MAT, especially in rural settings, but more research is needed to compare outcomes of different MAT models of care and guide future efforts in expanding MAT accessibility 7.
• The COVID-19 pandemic has led to changes in MAT care management, with a need for novel point-of-care approaches to ensure continued access to treatment 7.
• Increasing the availability of MAT treatment is crucial for providing comprehensive care and setting the standard for accessibility of novel OUD treatments 7, 8.