Medications for Opioid Use Disorder (MOUD)

What treatments are available for patients with opioid use disorder?

Buprenorphine

Buprenorphine is a schedule III opioid medication and a partial opioid agonist. It is an evidence based medication for opioid use disorder that mitigates risk of nonfatal and fatal overdose because of it's ceiling effect on respiratory depression. The most common formulations are sublingual as the monoproduct (i.e. Subutex) or in combination with naloxone (ie. Suboxone).

Methadone

Methadone is a full opioid agonist, which binds to the opioid receptor and can attenuate opioid withdrawal symptoms and be continued for maintenance treatment in an Opioid Treatment Program (OTP).

Naltrexone

Extended-release naltrexone is an opioid antagonist that is available as a monthly depot injection. It is an option for maintenance in patients who have been abstinent from opioids for a sufficient period (at least 7 days) to prevent adverse reactions and acute withdrawal.

Clinicians at the Center for Addiction Medicine and Policy strongly recommend medication for opioid use disorder (MOUD) as first-line treatment for OUD. Treatment with buprenorphine and methadone has been shown to decrease the morbidity and mortality associated with OUD over other treatments. The right medication will depend on the individual patient and may change over time. Our clinicians work in both the outpatient, ED, and inpatient settings, all of which are appropriate settings to initiate MOUD.

Here, we provide resources to clinicians working in the hospital setting and advocate for initiation of MOUD with the goals of:

Alleviating withdrawal symptoms and craving to facilitate treatment of other medical issues
Providing evidence-based, patient-centered care to our patients experiencing opioid withdrawal symptoms
Mitigating patients from leaving the hospital by Patient Directed Discharge and reducing re-admissions
Facilitating referral to outpatient and inpatient treatment

Clinicians can use this pathway to help them select the most appropriate MOUD for their patients. Those working within UPHS can access the pathway directly through PennPathways.

Check out our decision making tool to help patients decide which treatment pathway is right for them!

"Patients treated with buprenorphine are less likely to overdose, die, use illicit opioids, develop Hepatitis C or HIV, suffer other infections complications, or have contacts with the criminal justice system."