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

Which treatment would be the best option for me?

Ask Yourself:

“What has and has not worked for me in the past?” Consider trying again if you had some successes prior; sometimes starting new can have a better result than it did before.

Patients treated with either buprenorphine or methadone are more likely to be engaged in treatment at one year. They are less likely to get HIV or Hepatitis C and less likely to die from complications related to opioid use.

Suboxone / Buprenorphine

Patients treated with Suboxone were 75% more likely to be engaged in treatment after 1 year, compared to those not on medication.
Suboxone can be accessed in the privacy of an office along with treatment for blood pressure, asthma or any other illness.
Weekly appointments and options to receive once-monthly injections of Sublocade to decrease pharmacy and clinic visits.
Are you worried about precipitated withdrawal? We can start off slowly with a low dose pathway that is well tolerated by patients who do not have withdrawal symptoms.

Methadone

Patients treated with methadone for 3 months had a 32% risk reduction in serious opioid-related complications, compared to people not on medication.
Your clinic must be located in the county in which you have your health insurance.
We can help you start methadone tomorrow by doing some pre-testing in the ED today.
Methadone may take a few weeks to get to a dose that works for you; it must be increased very slowly for safety and based on federal regulations.
Continuing methadone means daily visits to your clinic. Some people find this difficult to do with their life dynamics, so consider this commitment when choosing treatment options.

The Important Difference Between Inpatient Treatment and Detox

Detox tapers patients off of all substances, so at discharge there are no medications in your system to prevent you from overdosing if you get a craving to return to use. This is not a safe option for people in the early stages of recovery.
Inpatient treatment WITH MEDICATION (like Suboxone or Methadone) can be life saving in a safe, controlled environment until they can be stabilized and have support for discharge.
Patients who go more than 24 hours without using drugs and do not have Suboxone or Methadone in their system are HIGHEST RISK to experience a fatal overdose if they return to use.

Source: Wakeman SE, Larochelle MR, Ameli O, et al. Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Netw Open. 2020;3(2):e1920622. doi:10.1001/jamanetworkopen.2019.20622

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.

"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."