Learning objective
Demonstrate the importance of access to naloxone and medications for the
treatment of OUD.
Imagine if there was a safe, effective vaccine for HIV. Would you not give the vaccine to your patients because it would encourage people to practice unsafe sex?
Of course not. However, we have effective treatments for opioid use disorder (OUD) but these treatments are not in widespread use. Why?
Let’s briefly review various pharmacotherapies available to treat OUD and the data that support their use. There are several effective, safe medicines to treat OUD.
Buprenorphine, methadone and naltrexone are often referred to as medication-assisted treatment (MAT). However, the term “medication assisted” may increase stigma towards these life-saving treatments as it reinforces the false notion that appropriately prescribing medication for treatment “replaces one addiction for another.”1 Insulin is not medication-assisted treatment for diabetes. Rather, insulin is medication for the treatment of diabetes. Similarly, buprenorphine, methadone, and naltrexone are medications approved for the treatment of OUD. Medications that treat OUD are safe, effective, and save lives.2
Medications approved for the treatment of OUD:
● Decrease mortality3,4
● Reduce risk of infection, including HIV and HCV5,6
● Increase engagement in treatment and reduces opioid use following release from incarceration7
“Medication-based treatment is effective across all treatment settings studied to date. Withholding or failing to have available… medication for the treatment of opioid use disorder in any care setting is denying appropriate medical treatment.”
National Academy of Medicine Consensus Report, 2019
Buprenorphine and methadone cut overdose death rates in half while decreasing drug use, decreasing HIV and hepatitis C transmission, and improving patient retention in treatment. Buprenorphine in particular has a very low risk of addiction, due to the way the drug works in the brain.
Drug-free treatment is not as effective as medications for OUD in preventing deaths. Recurrences of use and deaths are common as patients try to maintain abstinence, since strong cravings persist for years after last use.9
Twelve step and other abstinence-based approaches may be helpful for many substance use disorders, but they only succeed in 10% to 15% of people with OUD when used alone. MOUD is effective for 50% to 80% of patients with OUD.9
Most people who take illicit buprenorphine are taking it to avoid withdrawal, detoxification or relapse prevention and not to get “high”.10 Buprenorphine is a long-acting opioid receptor partial agonist– this characteristic makes it very difficult to get any euphoric effect from buprenorphine. When it is sold on the street, it is most commonly used to treat withdrawal symptoms in patients with low access to medical treatment.10 People who have used illegal buprenorphine are more likely to stay in treatment once they start treatment.8
Long-acting opioid that reduces cravings and eliminates withdrawal
Patient typically attends clinic daily and takes the medication while supervised by staff
Dispensed as a liquid
Minimal euphoria
Full agonist at opioid receptors
Overdose risk
Reduces cravings and treats withdrawal
Usually given in a one-week supply, so no need to go daily to a clinic to obtain medicine
Most commonly given as a sublingual film
Minimal euphoria (less than methadone)
Partial agonist at opioid receptors
Low overdose risk. (Use of concurrent benzodiazepines can increase that risk.)
Reduces cravings and blocks opioid effects
Typically administered as a once-monthly injection
No euphoria
Antagonist at opioid receptors
No overdose risk
Expensive
Requires a 7 to 10 day abstinence period from opioids before it can be started
Rapidly reverses opioid overdoses
Administered in the outpatient setting as an intranasal spray or injection
No euphoria
Antagonist at opioid receptors
No overdose risk
Often carried by first responders and laypeople in the community
Drag and drop a medication used to treat OUD to the empty opioid receptor to learn how it works.
