Medications for Opioid Use Disorder (MOUD)

Clinicians with the Center for Addiction Medicine and Policy in conjunction with colleagues in Pharmacy and Penn Pathways, developed two algorithms for patients seeking treatment for opioid use disorder and for the management of opioid withdrawal symptoms while in our EDs or hospitals. The right medication will depend on the individual patient and may change over time.

Goals of Implementing Hospital-based MOUD:

Alleviate withdrawal symptoms and craving to facilitate treatment of other medical issues.
Provide evidence-based, patient-centered care to our patients experiencing opioid withdrawal symptoms.
Mitigate patients from leaving Against Medical Advice and reducing re-admissions.
Facilitate referral to outpatient treatment

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.

"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."