Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Medication for the Treatment of Opioid Use Disorder

  • Chapter
  • First Online:
Treating Opioid Addiction

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

Long-term medication treatment has been demonstrated to be the most effective treatment for opioid use disorder. This chapter covers the treatment of opioid withdrawal and the use of methadone, buprenorphine, and extended-release naltrexone, the three medications approved by the Food and Drug Administration (FDA) for long-term treatment of this condition. It includes an overview of the pharmacology of each medication, specific criteria for patient selection, and guidelines for clinical use of the medications. Other topics covered include federal methadone regulations, procedures for obtaining the Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine, criteria for an appropriate medication diversion control plan, care for pregnant women, patients with co-occurring psychiatric disorders, and the management of acute pain in patients on addiction pharmacotherapy. Guidance is provided for integrating medication into a comprehensive addiction recovery program that includes medical and psychiatric care, addiction counseling, and participation in mutual support programs. Addiction pharmacotherapy is presented as the most critical element in the successful management of an opioid use disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Musto DF. The American disease: origins of narcotic control. 3rd ed. New York: Oxford University Press; 1999.

    Google Scholar 

  2. Dole VP, Nyswander M. A medical treatment for diacetylmorphine (heroin) addiction: a clinical trial with methadone hydrochloride. JAMA. 1965;193:646–50.

    Article  CAS  Google Scholar 

  3. Kosten TR, Kleber HD. Buprenorphine detoxification from opioid dependence: a pilot study. Life Sci. 1988;42:635–71.

    Article  CAS  Google Scholar 

  4. Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302(2):123.

    CAS  PubMed  Google Scholar 

  5. Gowing L, Ali R, White J. Buprenorphine for the management of opioid withdrawal (Cochrane review). Cochrane Database Syst Rev. 2006;(2):CD002025.

    Google Scholar 

  6. Sullivan M, Bisaga A, Pavlicova M, et al. Long-acting injectable naltrexone induction: a randomized trial of outpatient detoxification with naltrexone versus buprenorphine. Am J Psychiatry. 2017;174:459–67.

    Article  Google Scholar 

  7. Handelsman L, Cochrane KJ, Aronson MJ, et al. Two new rating scales for opiate withdrawal. Am J Alcohol Abuse. 1987;13:293–308.

    Article  CAS  Google Scholar 

  8. Wesson D, Ling W. The clinical opiate withdrawal scale (COWS). Psychoactive Drugs. 2003;35(2):253–9.

    Article  Google Scholar 

  9. Polydorou S, Kleber HD. Detoxification of opioids. In: Galanter M, Kleber HD, editors. Textbook of substance abuse treatment. 4th ed. Washington, DC: American Psychiatric Publishing; 2008.

    Google Scholar 

  10. Kreek MJ, Wardlaw SL, Hartman N, et al. Circadian rhythms and levels of beta-endorphin, ACTH, and cortisol during chronic methadone maintenance treatment in humans. Life Sci. 1983;33(Suppl 1):409–11.

    Article  CAS  Google Scholar 

  11. Ling W, Amass L, Shoptaw S. A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid, detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction. 2005;100(8):1090–100.

    Article  Google Scholar 

  12. Weiss RD, Potter JS, Fiellin DA, et al. Adjunctive counseling and brief and extended buprenorphine-naloxone treatment for prescription opioid dependence. Arch Gen Psychiatry. 2011;68(12):1238–46.

    Article  CAS  Google Scholar 

  13. Ball J, Ross A. The effectiveness of methadone maintenance treatment. New York: Springer; 1991.

    Book  Google Scholar 

  14. Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.

    Article  Google Scholar 

  15. O’Connor PG, Waugh ME, Carroll KM, et al. Primary care-based ambulatory opioid detoxification: the results of a clinical trial. J Gen Intern Med. 1995;10:255–60.

    Article  Google Scholar 

  16. Riordan CE, Kleber HD. Rapid opiate detoxification with clonidine and naloxone (letter). Lancet. 1980;1:1079–80.

    Article  CAS  Google Scholar 

  17. Lee JD, Nunes EV Jr, Novo P, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial. Lancet. 2018;391:309.

    Article  CAS  Google Scholar 

  18. Gowing L, Ali R, White J. Opioid antagonists with minimal sedation for opioid withdrawal (Cochrane review). Cochrane Database Syst Rev. 2006;(1):CD002021.

    Google Scholar 

  19. United States Food and Drug Administration News Release. FDA grants marketing authorization of the first device for use in helping to reduce the symptoms of opioid withdrawal. Available at https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm585271.htm. Accessed on 30 July 2018.

  20. Miranda A, Taca A. Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: a multisite, retrospective assessment. Am J Drug Alcohol Abuse. 2018;44:56–63.

    Article  Google Scholar 

  21. Mattick RP, Hall W. Are detoxifications programmes effective? Lancet. 1996;347:97–100.

    Article  CAS  Google Scholar 

  22. O’Connor PG, Oliveto AH, Shi JM, et al. A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users vs a methadone clinic. Am J Med. 1998;105:100–5.

    Article  Google Scholar 

  23. Jones CM, Logan J, Gladden RM, et al. Vital signs: demographic and substance use trends among heroin users – United States, 2002–2013. MMWR Morb Mortal Wkly Rep. 2015;64(26):719–25.

    PubMed  PubMed Central  Google Scholar 

  24. Kakko J, Svanborg KD, Kreek MJ, et al. 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomized, placebo-controlled trial. Lancet. 2003;361(9358):662–8.

    Article  CAS  Google Scholar 

  25. Ling W, Charuvastra C, Collins JF, et al. Buprenorphine maintenance treatment of opiate dependence: a multicenter, randomized clinical trial. Addiction. 1998;93:475–86.

    Article  CAS  Google Scholar 

  26. Strain EC, Stitzer ML, Liebson IA, et al. Comparison of buprenorphine and methadone in the treatment of opioid dependence. Am J Psychiatry. 1994;151:1025–30.

    Article  CAS  Google Scholar 

  27. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Prescription drug use and misuse in the United States: results from the 2015 National Survey on Drug Use and Health: HSDUH data review. Retrieved from http://samhsa.gov/data/.

  28. Bhatraju EP, Grossman E, Tofighi B, McNeely J, et al. Public sector low threshold office-based buprenorphine treatment: outcomes at year 7. Addict Sci Clin Pract. 2017;12(1):7.

    Article  Google Scholar 

  29. Alford DP, LaBelle CT, Richardson JM, O’Connell JJ, Hohl CA, Cheng DM, Samet JH. Treating homeless opioid dependent patients with buprenorphine in an office-based setting. J Gen Intern Med. 2007;22(2):171–6.

    Article  Google Scholar 

  30. Potter JS, Marino EN, Hillhouse MP, Nielsen S, et al. Buprenorphine/naloxone and methadone maintenance treatment outcomes for opioid analgesic, heroin, and combined users: findings from starting treatment with agonist replacement therapies (START). J Stud Alcohol Drugs. 2013;74(4):605–13.

    Article  Google Scholar 

  31. Riggins DP, Cunningham CO, Ning Y, Fox AD. Recent incarceration and buprenorphine maintenance treatment outcomes among human immunodeficiency virus-positive patients. Subst Abus. 2017;38(3):297–302.

    Article  Google Scholar 

  32. Drug Addiction Treatment Act of 2000, Pub L, No. 106–310. Available at www.congress.gov/bill/106th-congress/house-bill/4365. Accessed 30 July 2018.

  33. Comprehensive Addiction and Recovery Act of 2016, Pub L, No. 114–198. Available at www.congress.gov/bill/114th-congress/senate-bill/524. Accessed 30 July 2018.

  34. Lee JD, Grossman E, DiRocco D, Gourevitch MN. Home buprenorphine/naloxone induction in primary care. J Gen Intern Med. 2009;24(2):226–32.

    Article  Google Scholar 

  35. Fareed A, Vayalapalli S, Casarella J, Drexler K. Effect of buprenorphine dose on treatment outcome. J Addict Dis. 2012;31(1):8–18.

    Article  Google Scholar 

  36. Hser YI, Saxon AJ, Huang D, Hasson A, et al. Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction. 2014;109(1):79–87.

    Article  Google Scholar 

  37. Greenwald MK, Comer SD, Fiellin DA. Buprenorphine maintenance and mu-opioid receptor availability in the treatment of opioid use disorder: implications for clinical use and policy. Drug Alcohol Depend. 2014;144:1–11, 25179217.

    Article  CAS  Google Scholar 

  38. Ling W, Casadonte P, Kampman KM, et al. Buprenorphine implants for treatment of opioid dependence: a randomized controlled trial. JAMA. 2010;304(4):1576–83.

    Article  CAS  Google Scholar 

  39. SUBLOCADE – Prescribing information. Indivior Inc. North Chesterfield, VA. November 2017.

    Google Scholar 

  40. Ling W, Hillhouse M, Ang A, et al. Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction. 2013;108(10):1788–98.

    Article  Google Scholar 

  41. Fiellin DA, Pantalon MV, Chawarski MC, Moore BA, Sullivan LE, O’Connor PG, Schottenfeld RS. Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence. N Engl J Med. 2006;355:365–74.

    Article  CAS  Google Scholar 

  42. VA/DoD SUD Practice Guidelines 2015, p. 23. Available at www.healthquality.va.gov. Accessed 30 July 2018.

  43. World Health Organization. Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Available at: http://apps.who.int/iris/bitstream/handle/10665/43948/9789241547543_eng.pdf?sequence=1.

  44. Jones HE, Kaltenbach K, Heil S, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med. 2010;363:2320–31.

    Article  CAS  Google Scholar 

  45. Jones HE, Fischer G, Heil SH, Kaltenback K, Martin PR, Coyle MG, Selby P, Stine SM, O’Grady KE, Arria AM. Maternal Opioid Treatment: Human Experimental Research (MOTHER) – approach, issues and lessons learned. Addiction. 2012;107(Suppl 1):28–35.

    Article  Google Scholar 

  46. Lund I, Fischer G, Welle-Strand G, O’Grady K, Debelak K, Morrone W, Jones H. A comparison of buprenorphine + naloxone to buprenorphine and methadone in the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes. Subst Abus. 2013;7:61–74.

    CAS  Google Scholar 

  47. Lee SC, Klein-Schwartz W, Doyon S, Welsh C. Comparison of toxicity associated with nonmedical use of benzodiazepines with buprenorphine or methadone. Drug Alcohol Depend. 2014;138:118–23.

    Article  CAS  Google Scholar 

  48. Sees KL, Delucchi KL, Masson C, Rosen A, et al. Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA. 2000;283(10):1303–10.

    Article  CAS  Google Scholar 

  49. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;(3):CD002209.

    Google Scholar 

  50. Code of Federal Regulations Title 42. Available at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-part8.pdf. Accessed on 30 July 2018.

  51. Methadone package insert. Available at https://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM142842.pdf. Accessed on 30 July 2018.

  52. Ferrari A, Coccia CP, Bertonlini A, Sternieri E. Methadone—metabolism, pharmacokinetics and interactions. Pharmacol Res. 2004;50(6):551–9.

    Article  CAS  Google Scholar 

  53. Benmebarek M, Devaud C, Gex-Fabry M, Powell Golay K, Brogli C, Baumann P, Gravier B, Eap CB. Effects of grapefruit juice on the pharmacokinetics of the enantiomers of methadone. Clin Pharmacol Ther. 2004;76(1):55–63.

    Article  CAS  Google Scholar 

  54. Bogen DL, Perel JM, Helsel JC, Hanusa BH, Thompson M, Wisner KL. Estimated infant exposure to enantiomer-specific methadone levels in breastmilk. Breastfeed Med. 2011;6(6):377–84.

    Article  Google Scholar 

  55. Demirci JR, Bogen DL, Klionsky Y. Breastfeeding and methadone therapy: the maternal experience. Subst Abus. 2015;36(2):203–8.

    Article  Google Scholar 

  56. Package insert for Vivitrol ®. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021897s015lbl.pdf (package insert for vivitrol). Accessed on 30 July 2018.

  57. Tanum L, Solli KK, Latif ZE, et al. Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: a randomized clinical noninferiority trial. JAMA Psychiat. 2017;74:1197.

    Article  Google Scholar 

  58. Fink DS, Schleimer JP, Sarvet A, Grover KK, et al. Association between prescription drug monitoring programs and nonfatal and fatal drug overdoses: a systematic review. Ann Intern Med. 2018;168(11):783–90.

    Article  Google Scholar 

  59. Opioid-associated life-threatening emergency (Adult) algorithm – New 2015. American Heart Association. Available at https://eccguidelines.heart.org/wp-content/uploads/2015/10/BLS-Opioid-Associated-Emergency-Algorithm.png. Accessed on 30 July 2018.

  60. Office of the Chief Medical Examiner, City and County of San Francisco. Fiscal year annual reports. Available at https://sfgov.org/medexaminer/.

  61. Substance Abuse and Mental Health Services Administration. Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health. Available at https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf. Accessed on 30 July 2018.

  62. Substance Abuse and Mental Health Services Administration. Treatment improvement protocol 63. Medications for opioid use disorder, for healthcare and addiction professionals, policymakers, patients, and families. Available at https://store.samhsa.gov/shin/content/SMA18-5063FULLDOC/SMA18-5063FULLDOC.pdf. Accessed on 30 July 2018.

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA

    John A. Renner Jr.

  2. Harvard South Shore Psychiatry Residency Training Program, Harvard Medical School, VA Boston Healthcare System, Brockton, MA, USA

    Mitchell B. Crawford

Authors
  1. John A. Renner Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mitchell B. Crawford
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John A. Renner Jr. .

Editor information

Editors and Affiliations

  1. Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine, Harvard Medical School, Boston, MA, USA

    John F. Kelly

  2. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Sarah E. Wakeman

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Renner, J.A., Crawford, M.B. (2019). Medication for the Treatment of Opioid Use Disorder. In: Kelly, J., Wakeman, S. (eds) Treating Opioid Addiction. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-16257-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16257-3_5

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-16256-6

  • Online ISBN: 978-3-030-16257-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation