Medications for opioid use disorder may help prevent cravings, block the euphoric effects of opioids, stabilize brain chemistry, and minimize the withdrawal effects.
Opioid use disorder is a type of substance use disorder in which a person
The Centers for Disease Control and Prevention (CDC) notes that
In combination with specialist therapy and other support services, a healthcare professional will prescribe medications to treat opioid use disorder, which include:
- buprenorphine
- methadone
- naltrexone (Vivitrol)
A person should discuss their medical history and current medications with a doctor before taking any medications for opioid use disorder to help prevent complications and severe side effects. It is essential to take the medications as instructed by a healthcare professional.
Treatment duration may range from months to a lifetime, depending on individual circumstances.
This article explores these medications in further detail, as well as some additional treatment options for people with opioid use disorder.
The Food and Drug Administration (FDA) has
Buprenorphine is an opioid partial agonist. This means it produces a weaker feeling of euphoria or respiratory depression than full opioid agonists, such as methadone, would.
Before starting buprenorphine treatment, a person ideally needs to have stopped using opioids for at least 2 days and started to show early signs of withdrawal.
Benefits
The main effects and benefits of buprenorphine include:
- reducing cravings
- blocking the effects of opioids
- reducing the effects of withdrawal
Side effects
Buprenorphine may produce side effects such as:
- dry mouth
- constipation
- headache
- nausea and vomiting
- fever
- drowsiness and fatigue
- insomnia
- dizziness
- tooth decay
- muscle aches and cramps
- heart palpitations
- sweating
- difficulty paying attention
- blurry vision or dilated pupils
- tremors
In some cases, it may cause more severe side effects, such as:
- adrenal insufficiency
- respiratory distress
- overdose
- withdrawal
- neonatal abstinence syndrome in newborns
- dependence
- pain at the injection site
Methadone is a slow-release opioid agonist. The it to treat opioid use disorder. It is a Schedule II controlled drug, which means there is a high potential for misuse, potentially leading to dependence. Unlike buprenorphine, a person must go to an approved outpatient facility to access methadone.
A person will receive the medication under the supervision of a healthcare professional. After a person’s stability improves, a doctor may provide the medication to use at home between visits.
Should someone wish to discontinue treatment, healthcare professionals will help a person reduce their methadone dosage to help prevent withdrawal.
Benefits
Methadone helps by:
- reducing opioid cravings
- blocking the effects of opioids
- reducing the effects of withdrawal
Side effects
Some possible side effects include:
- restlessness
- nausea or vomiting
- sexual problems
- itchy skin
- constipation
- heavy sweating
- slow breathing
In some cases, a person may develop more serious complications, including:
- hallucinations or confusion
- lightheadedness
- difficulty breathing or shallow breathing
- symptoms of anaphylaxis, such as hives and swelling of the face, lips, tongue, or throat
- chest pain
- rapid heartbeat
Other serious complications may include:
- adrenal insufficiency
- respiratory distress
- overdose
- withdrawal
- neonatal abstinence syndrome in newborns
- dependence
Learn more about methadone withdrawal.
Anaphylaxis: Symptoms and what to do
Anaphylaxis is a severe allergic reaction that can be life threatening. The symptoms develop suddenly and include:
- hives
- swelling of the face or mouth
- wheezing
- fast, shallow breathing
- a fast heart rate
- clammy skin
- anxiety or confusion
- dizziness
- vomiting
- blue or white lips
- fainting or loss of consciousness
If someone has these symptoms:
- Check whether they are carrying an epinephrine pen. If they are, follow the instructions on the side of the pen to use it.
- Dial 911 or the number of the nearest emergency department.
- Lay the person down from a standing position. If they have vomited, turn them onto their side.
- Stay with them until the emergency services arrive.
Some people may need more than one epinephrine injection. If the symptoms do not improve in 5–15 minutes, or they come back, use a second pen if the person has one.
The
A person must be opioid free for 7-14 days before starting naltrexone treatment to reduce the risk of withdrawal symptoms.
Before prescribing the medication, a doctor will complete a Risk Evaluation and Mitigation Strategy to help ensure that the benefits of the medication outweigh the risks.
Benefits
Naltrexone is an opioid agonist, so it works by:
- stopping the euphoric and sedative effects of opioids
- binding and blocking opioid receptors
- reducing opioid cravings
Side effects
This medication may cause side effects such as:
- toothache
- sleepiness
- nausea and vomiting
- dizziness
- headache
- loss of appetite
- muscle cramps
- trouble sleeping
- painful joints
- cold-like symptoms
Less common but more serious side effects of naltrexone may include:
- liver damage or hepatitis
- severe injection site reactions
- anaphylaxis
- depression
- pneumonia
Learn about potential side effects of Vivitrol (naltrexone).
Medications for opioid use disorder may only provide part of a person’s treatment plan. While taking the medications, a person typically engages in additional therapies, which may include:
- support groups, which may also benefit family members and friends of the person with opioid use disorder
- counseling services
- access to educational materials
- behavioral health therapy, such as cognitive behavioral therapy (CBT)
- access to social workers to help with managing medical bills and other aspects of care
A person with opioid use disorder should speak with a healthcare professional to determine which combination of treatments may work best for them. People may start their treatment journey with the Substance Abuse and Mental Health Services Administration’s (SAMHSA) anonymous and confidential treatment facility finder.
In the United States, healthcare professionals prescribe three main medications to treat opioid use disorder: buprenorphine, naltrexone, and methadone. A person may take them in conjunction with other therapies, such as counseling, behavioral health services, help from social workers, and access to educational materials.
Buprenorphine is the only treatment for opioid use disorder that a person can get directly from a doctor. Naltrexone and methadone require administration or observation in a healthcare setting.
A person should speak with a healthcare professional to determine which medications and therapies may work best for them and how long they may need to continue treatment.