Medications to treat opioid use disorder
A decision guide for you and your prescriberGet the guide
October 2020 (updated January 2022)
If you have had issues with opioid use, there is medication available to support your recovery. The three FDA-approved medications to treat opioid use disorder are methadone, buprenorphine, and naltrexone. Research shows that these medications are effective in treating opioid use disorder and helping with withdrawal symptoms and psychological cravings. In a national study of over 40,000 individuals, people who took medication for opioid use disorder (MOUD) had a great reduction in overdose (76% reduction in overdose at 3 months and a 59% reduction in overdose at 12 months). This guide provides information on the three forms of MOUD. It also lists questions for you to think about the pros and cons of each medication to help you make an informed decision about the best option for your personal recovery. This can be a helpful tool whether or not you have used MOUD previously.
This decision guide is available to all interested in using it. If you will be implementing it in your program/agency, please contact Tamarie Willis so we can track usage and provide you with the newest version as it is updated.
Frequently Asked Questions
- What is the purpose of the guide, and how should it be framed for clients?
The guide provides information on the three forms of MOUD and is intended to help prepare clients to make an informed decision about the medication best suited for them, if any. It is NOT meant to take the place of consultation with a medical professional. It is important that clients know this guide is NOT a program screen or assessment. It is a self-driven and client-centered decision guide designed to provide education and empower the client in making an informed decision and be actively engaged in decisions about their own treatment.
- Which staff should help the client compete this guide?
It is recommended that either a case manager, peer support specialist (PSS), recovery coach, or other trusted support person assist the client in the completion and discussion of this guide. Whenever possible, share the guide with the client after a relationship and rapport have been established and you feel confident in having a discussion with open and honest feedback.
- When should the guide be used by the client?
Because program intake involves numerous screens and assessments, this guide should NOT be presented at the same time as other assessments so that clients do not interpret it as "just another assessment". Instead it should be presented as interactive content during a session on opioid use disorder (OUD) treatment, including medications for OUD. For MIREP staff, it could be integrated into Dual Recovery Therapy (DRT) Session 4 on Developing a Personal Recovery Plan, Session 5 with the Decisional Matrix, or Session 9 on the Relapse Prevention Plan. It could also be integrated into PSS Session 10 on Medicine Maintenance.
Aside from the MOUD guide, general discussion and education on OUD and MOUD should occur throughout the client's time in the program. If the client experiences a change in status or a critical event, such as release from a correctional facility, apparent changes in motivation, a relapse, or an overdose, the guide should be revisited.
- Who should this guide be used with?
It is recommended that the guide be used with everyone who reports any level of opioid use history, regardless of the level of severity or past use of MOUD. Other information already gathered regarding the client's substance use history (e.g., substance type, frequency of use, severity of use) should be in hand for reference during the discussion. For programs such as MIREP, the NIDA Quick Screen would serve as a useful reference and objective criteria on severity.
For clients who:
- …have used MOUD before: This can serve as an educational document on all three forms of MOUD and may confirm what they already think about their preferred medication.
- …have OUD and/or lengthy opioid use history but have never used MOUD before: The guide can help them make a decision about whether MOUD is right for them and if so, which one they believe is the best fit for them.
- …have used opioids but do not have a diagnosable OUD or a high-severity opioid use (based on objective criteria): Based on an objective screen, such as the NIDA Quick Screen, if opioid use is determined to be low-severity/low-risk, the guide may still be used. Clients may find it useful in thinking about their own history or patterns of use. If alcohol is a problem substance for the client, the guide provides an opportunity to discuss naltrexone as a medication for alcohol use disorder (AUD). Clients can also keep the guide as a source of information for associates, friends, or family for whom the information may be relevant.
- What should I do with the guide once it is completed?
A copy of the completed guide should be provided to the client for their own reference and continued use, and program staff should keep a copy in the client's file. For MIREP clients, staff should share a copy with the WSU CBHJ MIREP team within one week of completion; If you complete the guide more than once with the same client for any reason, please share the newly completed guide with the WSU CBHJ MIREP team.
If you are completing the guide as an individual or with a client and would be willing to connect to MIREP staff regarding your experience, please contact Julie Hanna.