Medication for Opioid Use Disorder: What Works Best for Your Schedule?
It’s estimated approximately 2 million people in the United States suffer from opioid use disorder. Opioid use disorder can develop from the misuse of prescription pain medications such as oxycodone (Oxycontin) or hydrocodone (Vicodin), synthetic opioids such as fentanyl, and the illegal drug heroin.
Recovery from opioid addiction can be quite challenging, as withdrawal symptoms and ingrained coping mechanisms can create daunting obstacles, but medication-assisted treatment (MAT) can significantly boost your likelihood of success. Specific medications have been approved to reduce symptoms of opioid withdrawal, lessen cravings, and decrease the risk of relapse during the recovery process. Some are taken daily, while others are given as a monthly injection. All are effective, but only if you take them as prescribed and stick to a schedule. Work with your doctor to determine the treatment that’s most amenable to your daily routine and lifestyle.
Three primary medications are used as opioid use disorder therapy, though they can come in different formulations. They are:
- Methadone: This medication activates the same receptors in your brain as prescription or illegal opioids. But, when it’s given once a day at carefully regulated doses, methadone (Dolophine, Methadose) can minimize withdrawal symptoms and make it easier to function without making you feel “high.” You’ll have to go to a treatment center each day to get your medication in the beginning. If you do well over time, you may be allowed to take home a week’s worth of medication as long as you continue to check in. If not taken as directed, methadone can be abused or overdosed just like other opioids. This drug works best for people who are able to get to a treatment center daily and who don’t mind taking a pill every day.
- Buprenorphine: This drug also helps with withdrawal and cravings by binding to the opioid receptors in your brain. However, it’s less likely to be abused or to result in a fatal overdose, especially when it’s combined with another medication called naloxone (this buprenorphine and naloxone combination drug is called Suboxone). It’s commonly taken as a daily tablet that dissolves under your tongue or as an injection. Buprenorphine also comes in injection form (Sublocade) that provides a steady dose of medication over the course of a full month. Patients only need to see their doctor once a month to receive this injection. This longer-term option can be helpful for people who find it challenging to take a daily medication.
- Naltrexone: Naltrexone (Vivitrol) works in a different way. It blocks the pleasurable sensations of opioids. To avoid severe withdrawal symptoms, it should only be taken after being opioid-free for several days. It comes in the form of a monthly injection, so there’s no need to remember a daily pill.
Your doctor or addiction medicine specialist will consider several factors when deciding which medication is most appropriate. This includes:
- When you last used opioids or if you’ve fully detoxed
- Whether you’ve tried other treatments for opioid use disorder
- Whether you’d benefit from supervised daily dosing
- If you’re likely to adhere to daily medication on your own or would benefit more from monthly appointments for an injection
- If you suffer from chronic pain that’s managed with medication
- Your preferences for treatment
- Social, emotional, and environmental factors that may influence your adherence
There’s no one-size-fits-all approach to treating opioid use disorder. It requires close collaboration with your treatment team. Dosing adjustments or a change in medication may be needed along the way. If you find that your schedule or lifestyle makes it hard to take your opioid use disorder treatment as prescribed, don’t hide this from your doctor. It doesn’t mean you’ve failed; it means you haven’t found the medication that’s doable for you. With so many treatment options and dosing schedules available, you can find what works. Remember also, the addition of counseling to your medication-assisted treatment may provide additional benefits during your recovery process.