Understanding Various Treatments for Opioid Use Disorder

Opioid use disorder (OUD) affects over 9 million Americans but only 30% of people living with OUD receives treatment.

Opioid use disorder (OUD) affects over 9 million Americans but only 30% of people living with OUD receives treatment. This is unfortunate because people living with OUD who receive a medication for opioid use disorder (MOUD) are 76% less likely to experience an overdose and 50% less likely to die from one. While these medications are becoming much easier to access, many people have questions about them. Currently, there are three Food and Drug Administration (FDA) approved medications available: methadone, buprenorphine, and naltrexone. While all three medications bind to opioid receptors in the body, like a key in a lock, each “key” works on the same “lock” in a unique way. It’s also important to know that these medications are not “opioid replacement” as they work differently at the opioid receptor and have different effects than opiates like heroin and fentanyl.

Methadone

Methadone has been used for treating OUD since the 1970’s and was the “gold standard” for many years. Methadone is known as a “full agonist”. This means that when methadone attaches to the opioid receptor in the body, it fully activates it, but without the euphoric effects or “high”. This helps to curb cravings for opiates and helps to reduce symptoms of withdrawal from opioids like anxiety, nausea, insomnia, and restlessness.

Methadone is usually given as a liquid medicine once daily at an opioid treatment program (OTP), a specially licensed clinic that provides counseling and other medical services. Because the effects of methadone last a long time, once daily dosing helps people begin to stabilize, eliminating the need to take opioids several times a day and the time spent recovering from the effects. Daily dosing also helps patients get to an effective dose of medicine quickly and allows staff to closely monitor patients. When new to treatment or working on stabilizing, patients dose at the clinic daily until they can stop using non-prescribed substances and become eligible for “take home” medication. Once this is established, the patient only needs to come to the clinic once or twice a month. Some patients choose to gradually reduce their dose of methadone, known as “tapering”, because opioid use disorder never goes away, others choose to stay on the medication long term.

Buprenorphine

Buprenorphine was first approved for treating OUD in 2002 and is a “partial agonist” meaning it doesn’t fully activate the opioid receptor when it attaches. Buprenorphine treatment can only be started when someone is already experiencing opioid withdrawal symptoms and should only be taken under the direction of an experienced medical provider. If it’s started too early, buprenorphine will push other substances off the opioid receptor and cause severe withdrawal symptoms. Buprenorphine is most often given once daily as a film strip or a tablet that is held under the tongue until absorbed but it can also be given as a weekly or monthly injectable medication. Buprenorphine, like methadone, helps to reduce cravings and withdrawal symptoms with similar side effects to methadone but with a lower risk of respiratory depression. While buprenorphine can be prescribed at an OTP, many primary care, mental health, and other community providers prescribe buprenorphine as well.

Naltexone

Naltexone is also used to treat opioid use disorder but can be helpful for people also struggling with alcohol use disorder. Naltrexone is an opioid receptor “antagonist”, meaning that naltrexone attaches to but doesn’t activate opioid receptor. It also blocks the effects of other opioids (including MOUD) and can also push other opioids off of the opioid receptor. Like buprenorphine, naltrexone can only be started after someone has stopped using opioids long enough to avoid withdrawal. Naltrexone can help with opioid cravings because it blocks the “rewarding” effects of using opioids and doesn’t have the same side effects of methadone or buprenorphine, like sedation. Naltrexone can be taken as a once daily pill or a once monthly injection and is available at OTPs and through many community medical providers.

Choosing a medication for OUD can sometimes feel overwhelming and there are many other factors to consider. Connecting with a provider who can assess your personal health history is important when seeking help for OUD, but you don’t have to wait to see a provider. West Ridge Center in Rutland offers “open access” walk-in services Monday through Friday 6am-11am for patients who are interested in starting treatment or exploring their options with an addiction medicine provider. No appointment is necessary. Call 802.776.5800 for more information.

By Ben Mahoney, APRN, a provider at the West Ridge Center, a clinic of Rutland Regional Medical Center.