Currently, opioid use disorder is one of only two substance use disorders to have approved medications for their treatment, with many other medications being tested for treatment of methamphetamine use, cocaine use, and other substances. 

Addiction is a chronic brain disease characterized by compulsive drug seeking and use, despite harmful consequences. It disrupts the brain’s reward system, leading to intense cravings and difficulty controlling behavior. Opioids are one of the most common substances of use, and thankfully, medication advancements offer a powerful tool in the fight against addiction.

This article delves into the world of medications for opioid use disorder (OUD). We’ll explore how these medications work, their effectiveness, and how they fit into a comprehensive treatment plan.

NOTE: This article is for informational purposes necessary and is not intended for use in deciding on a medication. Seek guidance from a medical professional if considering medications for opioid or alcohol use disorder.

Why Medications?

Before we look specifically at medications for OUD, we need to acknowledge the role of medications. Addiction fundamentally alters the brain’s chemistry. Over time, repeated substance use disrupts the reward system, making it difficult to experience pleasure without the substance. This creates intense cravings and withdrawal symptoms, which can include physical discomfort like nausea and sweating, as well as psychological distress like anxiety and depression. Medication can help normalize brain chemistry, ease withdrawal symptoms, and reduce cravings. This not only makes the initial stages of recovery more manageable but also allows individuals to focus on behavioral therapy and other strategies to address the underlying causes of addiction and build the life they want moving forward. 

It’s important to acknowledge that withdrawal from any substance is distressful. Furthermore, withdrawal from alcohol or benzodiazepines can result in death. If you or someone you know is experiencing withdrawal from alcohol or benzodiazepines, consider seeking medical attention. 

Opioid Use Disorder

Opioid use has maintained significant attention the past 10+ years as the opioid crisis continues to grip the United States. Millions are struggling with addiction to prescription painkillers and illicit substances. Fortunately, there are four FDA-approved medications proven to be highly effective in managing OUD: methadone, buprenorphine, and naltrexone.

• Methadone: Often considered the gold standard for OUD treatment, methadone is the medication that has been used to treat addiction for the longest period of time. Originally developed in the 1930s in Germany during World War II as a potential replacement for morphine. It wasn’t until the 1960s that methadone’s potential for treating opioid addiction gained traction. Methadone is a full opioid agonist which binds to the same brain receptors as other opioids, which reduces the cravings and withdrawal symptoms. It is typically dispensed at specialized clinics known as an Opioid Treatment Program. Methadone is distributed in a liquid form and must be taken daily.
  • STIGMA: Historically, methadone has faced significant stigma despite extensive evidence to demonstrate its efficacy. Often perceived as replacing “one addiction for another,” methadone is frequently viewed unfavorably. In reality, methadone addresses the biochemical impact of ongoing substance use, enabling the individual to work on other aspects impacting their use.
• Buprenorphine: Originally discovered in the 1960s, like methadone, buprenorphine was initially explored as an alternative for pain relief with a lower potential for dependence than morphine. A partial opioid agonist, buprenorphine partially activates the brain’s opioid receptors, which reduces cravings and withdrawal symptoms. Unlike methadone (the full agonist), buprenorphine has a “ceiling effect,” meaning taking more buprenorphine won’t produce a “high” or “stronger high.” As a result, buprenorphine is less likely to be misused. Buprenorphine comes in various forms, including tablets, films, and long-acting injectables. Unlike methadone, it can be prescribed by general practitioners and is not limited to OTPs. Because of ongoing concerns about misuse, buprenorphine is commonly combined with naltrexone (discussed below).
  • STIMGA: While less stigmatized than methadone, buprenorphine can still be looked down upon by the general public, employers, and individuals in recovery. The average person does not understand the unlikelihood of buprenorphine misuse, thus the ability for them to inappropriately assume it is being misused.
• Naltrexone: Developed in 1965 at Endo Laboratories during research into medications that block the effects of opioids at the brain receptor level, naltrexone was also explored as a potential pain reliever. However, because naltrexone is short-acting, it had limited effectiveness as a pain relief medication. Its potential use for treating opioid use started in the 1970s and 1980s. Naltrexone is an opioid antagonist, meaning it not only blocks the effects of opioids by stopping the opioid from connecting to the opioid brain receptor. Naltrexone can also be used in combination with buprenorphine to discourage misuse or ongoing concurrent opioid use. Ingesting opioids while naltrexone is in the person’s system can cause withdrawal. Naltrexone is available in pill and long-acting injectable forms. It is also an FDA-approved medication for alcohol use disorder.
  • STIGMA: Naltrexone is the least stigmatized medication for OUD. This is likely because it is an opioid antagonist. 

How Effective Are Medications for OUD?

Research overwhelmingly supports the effectiveness of medications for OUD. Studies show that medication significantly reduces:

• Opioid use: People on medications are more likely to refrain from opioid use or significantly reduce their use.
• Return to use risk: Medication helps individuals stay in treatment longer, leading to sustained recovery.
• Overdose deaths: Medications like naltrexone can prevent fatal overdoses by blocking the effects of opioids. Additionally, because withdrawal symptoms are managed through medications, there is less likelihood an individual will consume a substance to avoid withdrawal symptoms. 

Is Medication Alone Effective?

Previously, medications for opioid use disorder were referred to as “medication assisted treatment.” However, research and advocates have demonstrated that medication alone is an effective approach to opioid use disorder. By previously emphasizing “medication assisted treatment,” many individuals were forced to choose between no medications or forced participation in services they felt they didn’t need or which they didn’t want. Recognizing the efficacy of medication alone, similar to how we would view medication for diabetes, high blood pressure, etc., increases accessibility and decreases stigma.