Opioid Use Disorder Treatment

doctor holding a clipboard ready to write a prescription for opioid withdrawal drug buprenorphine

Opioid use disorder (OUD) is a devastating and multifaceted medical condition. At its core, it’s a chronic disease characterized by a problematic pattern of opioid use leading to clinically significant impairment or distress1. Given its complexities, treating OUD requires a combination of medical, psychological, and social approaches. In this essay, we’ll delve into the FDA-approved medication-assisted treatments (MAT) for OUD: methadone, buprenorphine, and naltrexone, as well as evidence-based therapies.

Treating Opioid Use Disorder is multifaceted. It’s important to understand the various MAT options and evidence-based therapies to find the most appropriate treatment. Remember, overcoming OUD is possible with the right combination of medical and therapeutic approaches. If you or someone you know is struggling, please suggest they seek medical guidance.

1. Medication-Assisted Treatment (MAT)

MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a holistic approach to OUD treatment. Notably, it has shown to improve patient survival, increase retention in treatment, and reduce illicit opioid use2. Here’s a deeper look into the three primary MATs:

  • Methadone
    • How it works: Methadone is a long-acting opioid agonist. It works by occupying the same brain receptors that opioids do, mitigating withdrawal symptoms and reducing cravings3.
    • Administration: It’s typically administered daily in specialized methadone clinics.
    • Benefits: Methadone has been used for decades and has a well-established track record of effectively treating OUD3.
    • Considerations: It can only be dispensed through certified opioid treatment programs.
  • Buprenorphine
    • How it works: Buprenorphine is a partial opioid agonist, which means it fills opioid receptors in the brain (but not as fully as methadone). It helps reduce cravings and withdrawal symptoms4.
    • Administration: Buprenorphine can be prescribed by certified doctors, making it more accessible than methadone for many patients.
    • Benefits: It has a ceiling effect, which means increased doses don’t result in full opioid effects, reducing the risk of misuse4.
    • Considerations: It’s crucial to begin treatment under the guidance of a medical professional.
  • Naltrexone
    • How it works: Unlike methadone and buprenorphine, naltrexone works as an opioid antagonist. It blocks opioids from acting on the brain, preventing any feeling of euphoria5.
    • Administration: Available as a daily pill or monthly injection.
    • Benefits: Since it’s not an opioid, there’s no risk of misuse or addiction.
    • Considerations: Patients must be fully detoxed from opioids before starting naltrexone to avoid sudden opioid withdrawal5.

2. Evidence-Based Therapies

Medications, while effective, are just one piece of the puzzle. Evidence-based therapies can be invaluable:

  • Cognitive Behavioral Therapy (CBT): This approach helps patients recognize and cope with situations where they are most likely to misuse opioids6.
  • Contingency Management: Provides incentives (often vouchers or small cash rewards) for negative drug tests, promoting drug-free behaviors6.
  • Motivational Enhancement Therapy: Helps patients harness their personal motivations to resist opioid use7.
  • 12-Step Facilitation Therapy: A structured approach to achieving and maintaining abstinence from opioids, often used in conjunction with groups like Narcotics Anonymous8.

References

Footnotes

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  2. Substance Abuse and Mental Health Services Administration (SAMHSA). (2019). Medication-Assisted Treatment (MAT).
  3. National Institute on Drug Abuse (NIDA). (2020). Methadone.2
  4. NIDA. (2020). Buprenorphine.2
  5. NIDA. (2020). Naltrexone.2
  6. McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics, 33(3), 511-525.2
  7. Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. Guilford press.
  8. Nowinski, J., Baker, S., & Carroll, K. (1995). Twelve Step Facilitation Therapy Manual. National Institute on Alcohol Abuse and Alcoholism.

Read about the ability of Buprenorphine to treat opioid use disorder

See Oregon’s opioid data

How Opioid Dependence Affects Families.