When combined with counseling and behavioral therapies, opioid use disorder medications are part of a comprehensive plan that supports long-term recovery.

Opioid use disorder (OUD) occurs when problematic opioid use behaviors continue in your life despite negative consequences.

As a type of substance use disorder, OUD affects 6.7 to 7.6 million adults in the United States.

If you have OUD, recovery is possible. Treatment is often multifaceted and demands long-term commitment to manage and avoid recurrence.

OUD medications, behavioral modification, and support services can all be part of helping you achieve the best outcome possible.

What medications are used to treat opioid use disorder?

Several medications can treat OUD. The most common contain:

methadone
buprenorphine
naltrexone

Methadone

Methadone belongs to a class of medications called opioid agonists. It’s a synthetic opioid that works in your body similarly to other opioids like heroin, oxycodone, and morphine.

While it might seem odd to use an opioid medication in OUD, controlled methadone use helps relieve withdrawal symptoms that might otherwise prompt you to return to OUD behaviors.

Like other opioids, methadone binds to the natural opioid receptors in your brain. In this way, it fulfills your “need” for an opioid, relieving withdrawal symptoms.

Unlike other opioids, however, methadone doesn’t produce euphoria, or a pleasurable high. It’s also longer lasting, which means it can help relieve OUD symptoms consistently throughout the day.

When prescribed for OUD, methadone is available as a liquid or as a tablet.

It must be dispensed from an accredited opioid treatment program.

Buprenorphine

Buprenorphine is a medication used for a variety of medical purposes. It’s a partial opioid agonist. It also binds to the opioid receptors in your brain but doesn’t activate them as strongly as full opioid agonists like methadone.

Partial opioid agonists can still effectively relieve withdrawal symptoms. They may produce a sensation of pleasure, but not to the extent of problematic OUD substances. And they have a “ceiling effect,” which means after a certain dose, they don’t produce greater effects.

Your doctor may select buprenorphine over another drug for its added ability to treat depression and anxiety by blocking the activation of kappa-opioid receptors.

Buprenorphine also has a lower risk of respiratory depression than full opioid agonists, so it may be safer for certain people.

In clinical settings, buprenorphine is available alone as a tablet that goes under the tongue and as an extended-release injection. It’s also available in combination with naloxone as a film or tablet that goes under the tongue.

Naltrexone

Naltrexone is an opioid antagonist. It works by blocking the activation of opioid receptors in your body, which means it prevents an opioid from producing desirable effects, like euphoria.

Unlike other OUD medications, naltrexone doesn’t stop withdrawal symptoms. It’s typically used to help prevent relapse after completing an opioid detoxification process.

In clinical settings for OUD treatment, naltrexone is only available as an extended-release injection.

Which opioid use disorder medication is the most effective?

OUD affects everyone differently. The “best” OUD medication is one that works with your individual needs and preferences.

For overall effectiveness, methadone currently has the best current evidence supporting its use and has the longest history of use in the treatment of OUD.

Talk with your care team to figure out what medications may be the best for you.

Side effects of medication-based treatment for opioid use disorder

Each OUD medication comes with its own set of side effects, also known as adverse reactions.

Methadone

Common side effects of methadone include:

nausea or vomiting
dry mouth
drowsiness
constipation
weight gain

Less common side effects include:

low blood pressure
respiratory depression
irregular heart rhythm

Buprenorphine

Common side effects of buprenorphine include:

nausea or vomiting
sweating
headaches
fatigue
constipation
abdominal discomfort
insomnia
dry mouth

Less common side effects include:

allergic reaction
medication-induced withdrawal symptoms
elevated liver enzymes
memory loss
sexual dysfunction
urinary retention

Naltrexone

Common side effects of naltrexone include:

nausea or vomiting
elevated blood pressure
headache
feelings of anxiety or nervousness
low energy
body aches and pain
insomnia

Less common side effects include:

diarrhea
constipation
increased thirst
irritability
sexual dysfunction
skin rash
chills
low mood
agitation
abdominal discomfort
medication-induced withdrawal symptoms

This is not an exhaustive list of side effects. OUD medications may affect each person differently, and other uncommon reactions are possible.

Any medication that’s available as an injection has the potential to cause injection site pain or reaction, such as itching, swelling, and redness.

Alternative and additional treatment methods

OUD treatment can involve a variety of non-medication interventions, some of which may be able to support recovery in certain cases.

Psychotherapy

Psychotherapy is a broad term for different types of therapist-directed “talk” therapies. In OUD, psychotherapy can involve different frameworks of behavioral modification and counseling, such as:

cognitive behavioral therapy (CBT)
motivational interviewing
individual or group counseling
family therapy
contingency management
dialectical behavioral therapy (DBT)

In OUD, these psychotherapy approaches restructure unhelpful patterns of thinking and behaving, improve your interpersonal and social function, and help you cope with psychological distress.

Peer support groups

Spending time with people who understand and share your OUD experiences can help you feel supported and empowered.

Different peer groups can offer structured programs (like 12-step programs), or a place to develop self-reliance and practice new behavioral skills.

Psychosocial support

Psychosocial support can help keep you on track during recovery by setting you up for success in other areas of life and in continued OUD treatment.

Case management, for example, can help coordinate your doctors’ appointments, link you to housing opportunities, or connect you to support networks at school or work.

Vocational training, another type of psychosocial support, can help you learn a new skill set and prepare for resume building, interviewing, and job hunting.

Non-traditional options

Many non-traditional interventions are being explored for their benefits in OUD. Some current areas of research include:

deep brain stimulation
ketamine-assisted therapy
psychedelic-assisted therapy
mindfulness-based interventions
GLP-1 agonists

It’s important to note that these options are not approved by the Food and Drug Administration, and results have been mixed so far.

If you’re interested in ongoing studies involving these options and your healthcare professional gives you the OK, check ClinicalTrials.gov to learn more.

How to get help for opioid use disorder

Finding help for OUD can start right now.

You can learn more about the recovery process or find resources in your area by calling the SAMHSA National Helpline at 800-662-4357. The call center is available 24/7, and all conversations are confidential. (SAMHSA is the Substance Abuse and Mental Health Services Administration.)

While you might be reluctant to talk with your primary care doctor about OUD, remember: Your doctor wants you to be well. Your mental and physical health is a priority to them. They are there so you can have these difficult conversations with someone you trust.

If you need help starting the conversation, consider approaching it from a place of positive change. Let your doctor know you’ve been experiencing problematic opioid use and want to find treatment to improve your overall well-being.

Come prepared with a list of questions, and consider asking a loved one to join you. Not only can they provide emotional support, but a loved one can also help you take notes and offer a fresh perspective after the appointment.

Takeaway

Opioid use disorder (OUD) medications include methadone, buprenorphine, and naltrexone. They work by affecting the opioid receptors in your brain in different ways, either reducing withdrawal symptoms or preventing opioids from being effective.

If you’re living with OUD, recovery is possible. Counseling, behavioral therapy, and a variety of support networks can help you achieve the best outcome.

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