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Treatment for Opioid Use Disorder

Opioid use disorder (OUD), sometimes called opioid addiction, is a chronic health condition. OUD is defined as a problematic pattern of opioid (such as fentanyl, heroin and Oxycontin) use that leads to serious impairment or distress.

OUD can consist of the following:

  • Compulsive need to use opioids
  • Spending a significant amount of time finding, getting and using opioids
  • Difficulty fulfilling major social or work obligations
  • Causing physical or psychological harm related to opioid use

Someone with OUD cannot reduce or stop using opioids, even when they want to or when their opioid use interferes with daily life.

Medication

OUD is treatable with medication. The benefits of medication for opioid use disorder include:

  • Decreasing the likelihood of a fatal overdose
  • Supporting the choice to reduce or stop opioid use
  • Reducing cravings for or urges to use opioids
  • Protecting overall health, including reducing the risk of infectious disease transmission such as HIV, hepatitis C and other bloodborne diseases

Listen to these New Yorkers’ stories of how treatment helped them move on from opioid use disorder.

Currently, there are three types of medications approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder:

  1. Buprenorphine
  2. Methadone
  3. Extended-release injectable naltrexone

Buprenorphine and methadone are the gold standard for treatment. There are decades of evidence proving their effectiveness. Buprenorphine and methadone treatment are associated with improved social wellbeing and functioning, and reduced rates of drug use and death.

A health care provider must prescribe medications for opioid use disorder. Patients may use these medications for several months, years or for life. Patients may combine medication use with counseling or supportive care.

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Buprenorphine

Buprenorphine is a medication that treats opioid use disorder. It can be taken orally or by injection. Buprenorphine is a partial opioid agonist. This means that it activates the opioid receptors in the brain, but less strongly than full opioid agonists like fentanyl or heroin. Suboxone and Zubsolv are common brand names.


Benefits of Buprenorphine:

  • Buprenorphine reduces cravings and withdrawal while blocking the euphoric effects of other opioids. This makes it easier to stop using opioids or cut down, allowing for greater focus on other areas of life.
  • Buprenorphine is available by prescription from physicians, nurse practitioners, and physician assistants. With a prescription, buprenorphine can be obtained at a pharmacy and taken at home, just like any other medication.
  • Medicaid, Medicare and most other health plans will pay for buprenorphine, just like any other medication.

How to Access Buprenorphine:

There are several ways for New Yorkers to find a health care provider who offers buprenorphine treatment for opioid use disorder:

  • Talk to your health care provider: Many general physicians, nurse practitioners and physician assistants prescribe buprenorphine. Ask your primary care provider if they offer buprenorphine treatment.

  • Office-based buprenorphine (including primary care): Visit the NYC HealthMap.

  • New York State Office of Addiction Services and Support (OASAS) Provider and Program Search: Search online for a substance use treatment provider or program on New York State’s Treatment Availability Dashboard.

  • Substance Abuse and Mental Health Services Administration’s (SAMHSA) directory of buprenorphine providers: Call in advance to ensure that the provider’s information is still accurate. SAMHSA also has a treatment locator at 1-866-287-2728.

  • Syringe Service Programs (SSPs)
    • Syringe Service Programs (PDF) provide services like safer drug use equipment and health education, access to naloxone, care coordination and referrals to other services. Some programs offer buprenorphine treatment services onsite or through telehealth, or can help connect people to buprenorphine treatment elsewhere.

  • Emergency Departments: Some emergency departments can provide an emergency short supply of buprenorphine until a patient can obtain an appointment with a buprenorphine treatment provider.

  • 988 is a free, confidential 24/7 hotline available to all New Yorkers seeking support for substance use and many other issues. Call or text 988 for assistance.

Methadone

Methadone is a full opioid agonist and activates the opioid receptors in the brain. It is taken orally, usually as a liquid. Patients usually take it daily at opioid treatment programs.


Benefits of Methadone:

  • Methadone eliminates withdrawal symptoms and relieves cravings, blocking the euphoric effects of opioids. This makes it easier to stop using opioids or cut down, allowing for greater focus on other areas of life.
  • Methadone might be effective when other medications, such as buprenorphine or extended-release naltrexone, are not wanted or have not been ideal.
  • Methadone is provided in a highly supervised setting where additional services may be provided onsite, such as counseling.

How to Access Methadone:

Methadone can only be accessed in registered opioid treatment programs, formerly known as methadone clinics. Opioid treatment programs typically only dispense methadone, though some also offer buprenorphine and extended-release naltrexone. Opioid treatment programs are the only setting within which methadone can be legally prescribed. Generally, patients must visit an opioid treatment program almost daily to take medication under staff supervision. In some cases patients may take medication home.

Opioid treatment programs must also provide counseling and other behavioral care services.

Currently there are over 70 opioid treatment programs in NYC. Some opioid treatment programs across New York State offer delivery service for methadone. Contact the program to see if it offers delivery service and if you are eligible.

Extended-Release Injectable Naltrexone

Naltrexone blocks the euphoric and sedative effects of opioids. Vivitrol is the brand name of the extended-release (XR) injectable formulation used to treat opioid use disorder.

  • XR injectable naltrexone is a long-acting opioid antagonist that blocks the effects of any opioid. It works for up to 21 to 28 days after the injection. XR injectable naltrexone may be useful for patients for whom buprenorphine or methadone were not successful. Patients cannot use opioids for seven to ten days before starting XR injectable naltrexone.
  • XR naltrexone may be more expensive than alternative medications. Not all insurance plans cover it.
  • There is an increased risk of opioid overdose during and after XR injectable naltrexone treatment. See the section on loss of tolerance after treatment for opioid use disorder.

Loss of Tolerance After Treatment for Opioid Use Disorder

When a person has been opioid-free for a while, their tolerance for opioids is lower. Lower tolerance increases the risk of overdose. People who have recently gone through treatment with XR injectable naltrexone, incarceration or hospitalization are at high risk.

Even a small amount of opioids can cause an overdose. The presence of fentanyl in the illicit drug supply means that exposure to opioids might occur even when using non-opioid drugs.

Medication Safety

Follow these tips to take medications safely:

  • Take medications as they are prescribed.
  • Avoid taking more than one substance at a time. Overdose is more likely when an opioid is combined with alcohol, cocaine, benzodiazepines or other drugs.
  • Keep all medications in their original containers and store them safely.
  • Keep all medications out of sight and reach of children, family members, and house guests.
  • Talk to a health care provider for more information on the safe disposal of unused medications or visit the FDA’s webpage about disposing of unused medicines.

Additional Resources