Medications for management of opioid use disorder
Abstract
Purpose: The use of buprenorphine, methadone, and long-acting naltrexone for treatment of opioid use disorder (OUD) is discussed, including a review of current literature detailing treatment approaches and action steps to optimize treatment in acute care and office-based settings. Summary: The U.S. epidemic of opioid-related deaths has been driven by misuse of prescription opioids and, increasingly, illicit drugs such as heroin, fentanyl, and fentanyl analogs, necessitating a refocusing of treatment efforts on expanding access to life-saving, evidence-based OUD pharmacotherapy. Inpatient treatment of opioid withdrawal includes acute symptom control through a combination of nonopioid medications and long-term pharmacotherapy to lessen opioid craving and facilitate stabilization and recovery. Methadone and buprenorphine reduce opioid craving, increase treatment retention, reduce illicit opioid use, and increase overall survival. Buprenorphine has logistical advantages over methadone, such as greater flexibility of treatment setting and less risk of adverse effects. Studies have shown the efficacy of long-acting injectable naltrexone to be comparable to that of buprenorphine if patients are detoxified prior to initiation of therapy; however, patients with active OUD are often not able to complete the week-long period of opioid abstinence needed prior to initiation of naltrexone injections. Although buprenorphine is preferred by many patients and can be prescribed in office-based settings, there remains a paucity of physicians certified to prescribe it. Conclusion: Buprenorphine has become the medication of choice for many patients with OUD, but its use is limited by the low number of physicians certified to prescribe the agent. Other agents studied for treatment of OUD include methadone and naltrexone.
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There are three medications used worldwide and approved by the FDA - methadone, buprenorphine and naltrexone - but there are no evidence-based guidelines to guide selection, which is most often constrained by availability.
“There are three medications used world wide and approved by the FDA - methadone, buprenorphine and naltrexone - but there are no evidence- based guidelines to guide selection, which is most often constrained by availability 188 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [188]
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- Authors
- Koehl, J. L., Zimmerman, D. E., & Bridgeman, P. J.
- Affiliations
- Massachusetts General Hospital (US)
- Duquesne University (US)
- Rutgers, The State University of New Jersey (US)
- Corresponding author
- Koehl, Jennifer L
- Venue
- American Journal of Health-System Pharmacy
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-07-18
- Volume
- 76
- Issue
- 15
- Pages
- 1097-1103
- ISSN
- 1079-2082 (ISSN-L)
- 1535-2900
- OpenAlex
- W2963093289
- Cited by
- 90
- References
- 33
- Citations by year
- 2026: 7 · 2025: 18 · 2024: 7 · 2023: 24 · 2022: 10 · 2021: 16 · 2020: 7
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- American Journal of Health-System Pharmacy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid use disorder, buprenorphine, methadone, opioid withdrawal, opioid craving, office-based opioid treatment, opioid epidemic, opioid-related deaths, treatment retention
- MeSH terms
- Analgesics, Opioid, Buprenorphine, Humans, Methadone, Naltrexone, Narcotic Antagonists, Opioid-Related Disorders, Drug Prescriptions, Evidence-Based Medicine, Opiate Substitution Treatment
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