Medication Assisted Treatment (MAT)
Types of medications that help in treating opioid use disorder
Ample evidence shows that methadone, buprenorphine, and naltrexone all decrease opioid use and opioid use disorder-related symptoms, and they decrease the chance of infectious disease transmission as well as criminal behavior associated with drug use. These medications also improve the likelihood that a patient will continue treatment, which itself is associated with lower risk of overdose mortality. Also a decreased risk of HIV and HCV transmission, reduced criminal justice involvement, and a higher likelihood of employment. The FDA has approved several different medications to treat opioid addiction dependence.
Methadone medication has been in practice the longest for opioid use disorder treatment, going back to 1947. A vast number of studies support methadone's effectiveness at decreasing opioid use. A comprehensive Cochrane review in 2009 compared methadone-based treatment (methadone plus psychosocial treatment) to placebo with psychosocial treatment and found that methadone treatment was effective in decreasing opioid use, opioid use-associated transmission of infectious disease, and crime. Patients on methadone had 33 percent fewer opioid-positive drug tests and were 4 times more likely to stay in treatment. Methadone treatment significantly improves outcomes, even when provided in the absence of regular counseling services; long-term (beyond 6 months) outcomes are more beneficial in groups receiving methadone, regardless of the frequency of counseling received.
Buprenorphine, which was first authorized in 2002, is currently prepared in two forms: By itself (Sublocade™, Probuphine®, Bunavail®) and in combination with the opioid receptor antagonist naloxone ( Zubsolv®, Suboxone®). Both formulations of buprenorphine are effective for the treatment of opioid use disorders, though some studies have recorded high relapse rates amongst patients tapered off of buprenorphine compared to patients maintained on the drug for an extended period.
Naltrexone was initially approved for opioid use disorder treatment in a daily pill form. It does not produce withdrawal or tolerance. Poor treatment adherence has primarily limited the real-world effectiveness of this formulation. As a result, there is lacking evidence that oral naltrexone is a useful treatment for opioid use disorder. Extended-release injectable naltrexone (XR-NTX) is given once monthly, which eliminates the need for daily dosing. While this formulation is the latest form of medication for opioid use disorder, evidence to date suggests that it is effective.