Medication-Assisted Treatment for Opioid Use Disorder
People with opioid use disorder and opioid addiction often struggle to quit due to the drug’s powerful effect on the brain, and during treatment for this disorder often take medications to counteract opioid withdrawal symptoms. The gold standard medications in opioid treatment programs are buprenorphine, methadone, and naltrexone, which all work on receptors in the brain, curb opioid cravings, reduce the risk of relapse, and prevent opioid withdrawal symptoms.
Are you or a loved one struggling with opioid addiction? Medication-assisted treatment programs at Zinnia Health have helped thousands of individuals recover from opioid use disorder. Our fully accredited facilities provide one-on-one therapy, detox, and holistic care under one roof. For information about our treatment programs, call us at (855) 430-9439 today.
Why are Medications Used to Treat Opioid Use Disorder?
Opioids are powerful drugs made from a plant derivative called opium. These drugs work by creating changes in the brain, including triggering dopamine release. Dopamine is a neurotransmitter in the brain’s reward center called the basal ganglia, which is responsible for regulating:
Simultaneously, opioids bind to neurotransmitters in the brain, blocking pain signals — which is why prescription options such as Oxycodone and hydrocodone are often used to treat moderate to severe pain.
To break the connection that opioids produce in the brain, a person must withdraw from opioid use and often are prescribed medication to counteract the effects.
How Does Opioid Use Lead to Opioid Use Disorder?
Misusing prescription opioids or using them beyond the time recommended will result in tolerance. Using illicit opioids, like heroine for any amount of time can result in tolerance. When your brain becomes tolerant of a drug, the effects aren’t as pronounced, and you’ll need more of it to “feel good.” Over time, tolerance, and chronic opioid use form an opioid use disorder.
The National Library of Medicine defines opioid use disorder as chronic opioid use that causes significant distress or impairment.
Signs of an opioid use disorder include:
- Opioid tolerance
- Strong desire to use opioids
- Physical discomfort when opioid use discontinues
Without treatment, an individual with opioid use disorder can develop addiction or an opioid overdose. This is an advanced stage of OUD.
If you’re struggling to stop using opioids despite the adverse effects, you are not alone. Opioid use disorder affects more than 16 million Americans. To get help, contact Zinnia Health at (855) 430-9439 and ask about our opioid use disorder treatments.
What Medications Are Used to Treat Opioid Use Disorder?
Opioid use disorder will not go away on its own. Discontinuing the use of opioids without medical intervention can cause severe withdrawal symptoms. These include:
In some cases, withdrawal can be severe.
Opioid use disorder is treatable with opioid replacement medications. These include
All three drugs are FDA-approved to treat addiction to short-acting opioids and semi-synthetic opioids.
Buprenorphine reduces opioid cravings and withdrawal symptoms while treating pain simultaneously.
This is a generic medication from the opioid family and the first one that health care providers can prescribe and dispense from their offices as per the Drug Addiction Treatment Act of 2000. Though buprenorphine treats moderate to severe pain, it is a common prescription for opioid use disorder, according to SAMHSA. Physicians prescribing this medication must meet requirements set by the U.S. Drug Enforcement Administration, including monitoring their patients.
Buprenorphine comes in many forms and dosages. A physician decides which form is best for their patient based on the severity of their drug use.
Commonly prescribed buprenorphine tablets are Subutex, Suboxone, and Zubsolv.
Other forms of buprenorphine include:
- Probuphine Implants
- Bunavail (buprenorphine/naloxone combo) buccal film
- Sublocade (buprenorphine extended-release injections)
According to MedlinePlus, buprenorphine products can cause side effects. These side effects range in severity and can include headaches, trouble sleeping or falling asleep, constipation, and stomach pain.
Dosing Guidelines for Buprenorphine
According to the National Library of Medicine, an initial dose of buprenorphine is 2 to 4 mg, with the first day’s amount not to exceed 8 mg in total. However, the optimal dose for opioid use disorder is 8 to 16 mg daily.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), once the patient is stable, they can switch to alternate-day dosing. A patient’s time on buprenorphine varies, and some may stay on it indefinitely.
Methadone blocks the effects of opioids, including cravings and withdrawal symptoms. This schedule II-controlled substance is FDA-approved to treat opioid use disorder and pain in conjunction with detox and therapy. As a schedule-II controlled substance, methadone may cause addiction. However, the risk of addiction is low when taken as prescribed. Unlike buprenorphine, methadone is only available by prescription through a SAMHSA-certified OTP.
People using methadone must be monitored for stability, progress, and compliance. Once they meet these requirements, they can take methadone at home. FDA-approved methadone prescriptions include Dolophine tablets and Methadose oral concentrate. All forms of methadone are subject to causing side effects.
- Stomach pain
- Dry mouth
- Mood changes
- Difficulty sleeping or falling asleep
- Vision problems
- Difficulty urinating
Dosing Guidelines for Methadone
To treat opioid withdrawal in a detox facility, patients with opioid use disorder begin with an initial dose of 20 to 30 mg of methadone. This dose suppresses withdrawal, though regular assessments are necessary to monitor the patient’s needs. If the initial amount isn’t effective, it can be increased by 5 to 10 mg after waiting 2 to 4 hours.
According to the New York State Office of Addiction Services and Supports, daily doses shouldn’t exceed 40 mg on the first day, as deaths are known to occur due to accidental methadone toxicity.
The length of time a person with opioid use disorder stays on methadone varies, though the treatment should, at a minimum, last 12 months.
Naltrexone is a non-addictive medication called an opioid antagonist. It works by blocking the effects of opioids and opioid withdrawal. Although it is available as a pill, it is only FDA-approved for use in patients with OUD as an injection. According to the National Institutes of Health (NIH), providers should not administer this medication until their patient detoxes from opioids for at least 7 to 10 days.
Individual with OUD may not be forthcoming about their last opioid use, so practitioners must monitor their vital signs for indications of use or withdrawal. If either is positive, the physician cannot administer naltrexone. However, they may test the patient every 24 hours until these signs are no longer present, then administer it.
Unlike buprenorphine, which an outpatient clinic can prescribe, naltrexone is offered as part of a rehabilitation clinic’s medication-assisted treatment (MAT) program. The Food and Drug Administration only approved one brand – Vivitrol (naltrexone extended-release injectable suspension) – for OUD patients.
Common side effects of naltrexone include, but are not limited to:
- Stomach pain
- Digestive upset
- Loss of appetite
- Change in sleeping patterns
- Mood changes
- Energy changes
Dosing Guidelines for Naltrexone
Naltrexone is administered as a once-a-month injection at a dosage of 28 mg. If a person struggling with opioid use disorder relapses while on Vivitrol, they won’t feel any euphoric effects at this dose.
How Do Medications for Opioid Use Disorder Work?
MOUDs, like all opioids, are agonists. Agonists are medications that mimic the action of neurotransmitters in the brain. They bind to specific parts of the brain, triggering a reaction.
Methadone is a full opioid agonist. Buprenorphine and Naloxone are partial opioid agonists. Full opioid agonists bind to neurotransmitters in the brain, creating a complete response; partial opioid agonists produce a weaker effect.
With a full opioid agonist, the user will feel euphoric, giddy, and drowsy. This action takes place right away. Methadone is the exception since it suppresses these effects.
People who take these medications do so with the intent to stop using opioids. Using opioids during treatment with a MOUD can result in profound sedation and even death.