Medication for Opioid Use Disorder
Medication for opioid use disorder should be initiated using one of the following evidence-based strategies: buprenorphine/naloxone, methadone, or buprenorphine/naloxone provided through an accredited opioid treatment program. [1] Extended-release naltrexone (intramuscular) should also be offered as an alternative medication strategy. [1] Medication treatment of opioid use disorder is associated with reduced overdose risk and reduced overall mortality. [2]
Medication Selection Algorithm
- Buprenorphine/naloxone should be used in any setting. [1]
- Methadone should be used when appropriate, including when provided through an accredited opioid treatment program. [1]
- Extended-release naltrexone (intramuscular) should be used when opioid withdrawal induction and contraindications allow. [1][2]
Initiation Thresholds and Contraindications for Naltrexone
- Extended-release naltrexone initiation should occur after a minimum of 7 to 10 days free of opioids to avoid precipitated severe opioid withdrawal. [2]
Monotherapy vs Combination Therapy
- Opioid use disorder pharmacotherapy should be initiated with a single selected medication strategy from buprenorphine/naloxone, methadone, or extended-release naltrexone rather than combining opioid agonist and antagonist therapy at initiation. [1]
- Adjunctive psychosocial interventions can be added to medication treatment, but no specific psychosocial intervention has evidence sufficient to dictate medication selection. [1]
Common Pitfalls to Avoid
- Delaying initiation because psychosocial treatment is unavailable should be avoided. [1]
- Initiating naltrexone without an adequate opioid-free interval should be avoided due to risk of precipitated severe opioid withdrawal. [2]
Treatment Goals and Monitoring
- Medication for opioid use disorder should be paired with addiction-focused medical management. [1]
- Ongoing follow-up should be used to support medication adherence and reduce overdose risk. [2]