Medications for Opioid Use Disorder (MOUD)

Understanding Medications for Opioid Use Disorder (MOUD)

Opioid use disorder (OUD) is a chronic medical condition characterized by the compulsive use of opioids despite harmful consequences. It affects millions of people worldwide and is associated with a significant risk of overdose and death. Opioids are involved in more overdose fatalities than any other class of drugs. Medications for Opioid Use Disorder (MOUD) are highly effective frontline treatments that can reduce opioid use, improve treatment retention, and lower the risk of overdose. ^[1][3]

There are three medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of OUD, which each have a slightly different mechanism of action. Methadone and buprenorphine activate opioid receptors in the brain to varying degrees, helping to relieve withdrawal symptoms and cravings. Naltrexone is an opioid antagonist that blocks these receptors, preventing opioids from producing rewarding effects. Unlike buprenorphine and methadone, naltrexone does not help to prevent or minimize withdrawals, but can provide some relief from cravings. ^[1][2]

In the past, treatment with these medications was often referred to as Medication-Assisted Treatment (MAT). Although this term is still sometimes used, Medications for Opioid Use Disorder (MOUD) has become the preferred terminology. The shift reflects an effort to recognize medication as a primary component of evidence-based treatment for OUD, rather than ‘assisting’ treatment.

Why MOUD is considered the gold standard

MOUD is considered the gold standard of care because extensive research has shown that these medications improve treatment retention, reduce illicit opioid use, and lower the risk of overdose and death compared with treatment approaches that do not include medication. ^[1][3][4]

While behavioral therapies can help people identify triggers and develop healthier coping skills, many people in recovery from OUD struggle with painful withdrawals and intense drug cravings, especially early in the recovery process. MOUD can significantly reduce or even eliminate these symptoms, making it easier for people to abstain from using opioids. ^[3]

Why MOUD is underutilized

FDA-approved medications for OUD

There are three FDA-approved medications for opioid use disorder: buprenorphine, methadone, and naltrexone. Each of these medications has a slightly different mechanism of action, but all work to support long-term recovery from OUD by reducing cravings, withdrawal symptoms, and/or removing the rewarding effects of opioid drugs.

Below is information detailing the three medications, how they work, and the intended effects. ^[1][2][3]

• Buprenorphine: A partial opioid agonist that binds to mu-opioid receptors to reduce cravings and withdrawal symptoms, while limiting euphoric effects. This medication can be given as a sublingual tablet, film, or extended-release injection administered in clinics or prescribed for at-home use.
• Methadone: An opioid agonist that binds to opioid receptors but activates them more slowly than traditional opioids, reducing cravings and withdrawals while minimizing the euphoric and rewarding effects. This medication is typically given as an oral medication administered in clinics, but can be given to established patients in limited quantities for at-home use.
• Naltrexone: An opioid antagonist that blocks opioid receptors, preventing rewarding or euphoric effects. This medication can be prescribed for individuals struggling with alcohol or opioid dependence and reduces the rewarding effects of these substances. Some people also report fewer or less intense cravings. When used for OUD, this medication is typically given as a long-acting injection administered once a month.

Comparing MOUD medications

All three FDA-approved MOUD medications have been proven to be effective, but buprenorphine and methadone have greater efficacy than naltrexone in reducing the risk of relapse and overdose. Individuals who receive one of these two medications are more likely to remain in treatment, remain abstinent, and have a lower risk of overdose. ^[1][2][3]

Buprenorphine and methadone both help to reduce or eliminate withdrawals, while naltrexone does not and should only be used after an individual has completed the detox and withdrawal phase. While outcomes are similar for individuals who receive either buprenorphine or methadone, some research shows that people who receive methadone are more likely to remain in treatment. ^[1]

Each of the three FDA-approved MOUD medications has differences in the way they work and their particular effects. Below is a table to understand the similarities and differences between buprenorphine, methadone, and naltrexone. ^[1][2]

Side effects and risks of MOUD

While buprenorphine, methadone, and naltrexone are all safe medications when taken as prescribed, side effects can still occur. Each of these medications has a slightly different side effect and risk profile.

MOUD treatment: What to expect

Because MOUD is considered a frontline treatment for OUD, most licensed health and mental health professionals will recommend this treatment to people who report opioid dependence. Depending on the setting, you may be provided with a prescription for an MOUD medication or receive a referral to a specialty clinic that provides this treatment. Being open and honest about your opioid use, including how much and how often you are using, will help to ensure you receive the proper medication and dose.

Depending on the specific medication recommended, you may need to make daily or frequent visits to a clinic. In most places, individuals starting methadone treatment are required to go to a clinic daily to receive their medications. Buprenorphine may also require periodic visits to a clinic to receive doses of your medication. Over time, you may be provided with a limited number of take-home doses, provided you are in compliance with the requirements of the clinic, which may involve attending counseling and consenting to urine drug screens.

Individuals who receive naltrexone can expect fewer restrictions, since naltrexone does not carry a risk for misuse or addiction. Often, naltrexone is given as a monthly injection in MOUD treatment, which can be administered in a medical or specialty addiction treatment clinic.

Cost and insurance coverage for MOUD

The cost of MOUD treatment will vary depending on a number of factors, including the specific medication and formulation prescribed. Generally speaking, methadone is the least expensive MOUD medication, but there can be additional fees charged by the clinic dispensing the medication. Extended-release injections of naltrexone tend to be the most expensive of the three, but are usually only administered once a month in MOUD treatment.

Many people use health insurance to help offset the costs of MOUD treatment, which can significantly lower out-of-pocket expenses. The specific amount of coverage and cost of treatment when using insurance will depend on the particulars of each policy. Calling the number on the back of the insurance card or logging into the portal to estimate healthcare costs is often the best way to find in-network providers and determine costs for MOUD treatment.