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Opioid Use Disorder Treatment: Medication and More

Opioid Use Disorder Treatment: Medication and More
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Updated on March 13, 2026
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Opioid use disorder (OUD) means that a person gets used to the presence of an opioid medication or substance in their body. The body can then only achieve normal function when taking opioids. It can make stopping opioid use challenging.

 Over the past two decades, the opioid epidemic has affected millions of people across the United States. According to the National Center for Drug Abuse Statistics, around nine million individuals abused opioids in 2023, and the substance accounted for more than 70 percent of overdose deaths.

Treatments for opioid use disorder can significantly reduce deaths, but not enough people use them. The Centers for Disease Control and Prevention reports that 4 percent of adults in the United States needed treatment for OUD in 2022, but only one-quarter of those people received OUD medications. Around 30 percent of people with OUD received nonmedication therapies.

If you think you or a loved one is living with opioid use disorder, the first step is to reach out to someone for help, such as a healthcare professional. They can help you figure out a safe way to treat your own use disorder or that of a loved one. There are a number of different options available to treat opioid use disorder, including medicines (which are the primary treatment), counseling, and behavioral therapies. Typically, healthcare providers recommend medications for opioid use disorder as the primary treatment. Other resources include mutual peer support, like Narcotics Anonymous, or assistance with accessing education or employment after treatment.

Medications

Several different medications can treat opioid addiction. Methadone and buprenorphine are two drugs that decrease withdrawal symptoms and cravings. These help people stop or lessen opioid use, reduce withdrawal, and prevent overdose deaths. People with opioid use disorder who receive methadone or buprenorphine treatment are less likely to have an overdose or die, compared with those who don’t receive treatment. Naltrexone blocks the effects of opioids and can reduce cravings and the risk of opioid deaths, but it doesn’t reduce withdrawal symptoms.

Opioid Receptor Agonists

Medications in this class interact with the same targets in the brain as other opioids, but without creating a high. This partially or fully blocks their effects, reducing cravings without producing feelings of pleasure.

 Opioid receptor agonists also treat withdrawal symptoms to help a person stop misusing opioids.

Opioid receptor agonists include:

  • buprenorphine (Brixadi, Subutex, Suboxone, Zubsolv, Sublocade)
  • methadone (Methadose, Dolophine)

“Buprenorphine is a partial agonist of the opioid receptor. This means that it only partially turns on the opioid receptors, which are primarily located in the brain,” explains Sarah Leitz, MD, national physician lead for harm reduction and addiction medicine at Kaiser Permanente. “It also attaches really tightly to the opioid receptor, which makes it hard for other substances like heroin, fentanyl, or other opioids to knock it off. This helps an individual who is in a lot of withdrawal to start to feel better and less sick with fewer cravings to use.”

Dr. Leitz also cleared up some key differences between methadone and buprenorphine. “Methadone, in contrast to buprenorphine, fully turns on the opioid receptor, but it also is slow to onset, binds tightly, and stays attached for a long time,” Leitz says. “So, by gradually starting methadone and taking it once daily, individuals will find that their withdrawal symptoms improve and their cravings to use decrease. They also don’t get any ‘high’ or euphoria because the onset is so gradual.”

Since opioid receptor agonists fall into the same class of medications as the ones that can lead to opioid use disorder, you’ll need to enroll in a treatment program to use them. Methadone is only available at a specially licensed opioid treatment program facility under clinical supervision, or you may be able to start it in the hospital.

 While methadone is available as an oral tablet or liquid medication, buprenorphine is taken as an under-the-tongue tablet or film or as an injection.

 Injectable buprenorphine is available through pharmacies and healthcare professionals registered with a specific opioid use disorder treatment program (specifically, the Brixadi and Sublocade REMS).

 However, people can also access buprenorphine through other outpatient clinics or physicians who offer office-based opioid treatment.
Methadone side effects may include headaches, nausea, vomiting, sweating, constipation, drowsiness, and reduced libido. Buprenorphine can cause similar side effects as methadone, as well as insomnia. Both medications can cause withdrawal symptoms if a person suddenly stops taking them. If a healthcare professional advises that stopping use is safe, they’ll recommend a slow taper off of the drugs.

Doctors generally recommend that people use these medications long term, although fewer than half of all people who get treatment for opioid use disorder continue taking them.

 People who stop taking methadone or buprenorphine within one to two years of starting it have a higher risk of relapse and overdose, according to the Leonard Davis Institute of Health Economics.

Opioid Antagonists

Instead of activating opioid receptors like methadone or buprenorphine, this type of medication blocks receptors altogether. This means that those misusing opioids can no longer experience pleasurable sensations after taking them.

  • naltrexone (Depade, ReVia)

Naltrexone is available in a daily pill form and as a long-lasting monthly injection, and any healthcare professional can administer it. Usually, people start taking naltrexone after completely stopping opioid use for 7 to 14 days, to prevent withdrawal symptoms, which can make it more challenging to start than methadone or buprenorphine.

“We typically recommend taking these medications for at least 6 to 12 months, but many people choose to take them for longer,” Leitz says. “Once someone has found stability with their medication and feels that their opioid use disorder is not an active part of their lives, they may want to try reducing or stopping their OUD medication.”

Centrally Acting Alpha-2 Adrenergic Agonists

Opioid withdrawal symptoms can make treating OUD challenging. Centrally acting alpha-2 adrenergic agonists relax blood vessels to support better blood flow, which may reduce withdrawal symptoms, including nausea, stomach cramps, muscle spasms, chills, a pounding heartbeat, aches, pain, and muscle tension, insomnia, and excessive yawning.

  • lofexidine (Lucemyra)
Lofexidine is a short-term treatment for opioid use disorder, with courses usually lasting up to 14 days and involving four daily tablets for use at around the same time daily. The medication can temporarily support ongoing treatment by helping decrease withdrawal symptoms and improve comfort. Despite this, it may not completely prevent withdrawal, and it may cause side effects, including insomnia, a dry mouth, tinnitus, fainting, or dizziness.

If you are on medication to treat opioid use disorder and would like to stop, talk to your healthcare provider to determine a plan for stopping, rather than attempting to stop on your own. They’ll work with you to map out a very slow tapering schedule, in which you gradually use less and less medication over time.

“To explore a dose reduction or stopping buprenorphine or methadone, it is recommended that the individual meet with their addiction medicine prescriber and their addiction counselor and discuss a taper plan,” advises Leitz. “These taper plans can be adjusted throughout the process, but having an idea of what it might look like to start is a good idea. It is also important to set up regular check-ins to see how the taper is going.”

A typical taper involves dose changes, check-ins, and flexibility. “I like to make changes in the dose every two to four weeks and to speak with patients about every three to four weeks while they are tapering down,” Leitz says. “Often, the individual increases withdrawal symptoms or cravings for one to two weeks after a dose decrease, but that should stabilize.”

Leitz affirms that the need to slow or stop the tapering process doesn’t indicate failure. It just means that the dose needs to be adjusted to ensure success.

The goal is to prevent a relapse. The danger of a relapse, Leitz explains, is that they may have built up a high tolerance during their previous period of use that they no longer have. Tolerance means needing to take more of a substance to experience the same effect that a lower dose gave someone before.

“If a person returns to substance use, specifically with fentanyl or heroin, they may attempt to use the same amount they previously used,” says Leitz. “However, this dosage is often far too high for their tolerance level at that point. This can lead to an unintentional overdose, which can be fatal.”

Leitz emphasizes that it’s extremely important to ensure that naloxone (Narcan), a medication for treating overdoses, is always available, especially if a person has stopped medications for OUD, and that individuals returning to opioid use remember not to use  alone.

Rehabilitation

While most opioid use disorder treatment takes place as outpatient consultations, some residential services offer live-in recovery programs known as therapeutic communities. In these places, people recovering from opioid addiction can receive education, redirection, and training to nurture new approaches to living opioid-free.

A residential program typically lasts about 15 months and has enabled meaningful transformations for some individuals. However, many people drop out of these programs relatively early, and more evidence is needed to support their efficacy, accessibility, and benefits.

Pain Management

Living with OUD often means adjusting how you manage acute, severe pain. While opioid medications are highly effective pain relief medications, taking them may trigger a relapse of misuse, especially if a person:

  • Faces challenges with controlling their dosage or how often they use opioid pain relief
  • Experiences cravings
  • Continues to use opioid medications even when it negatively impacts mental or physical health
Taking opioids to manage pain, even short term, can lead to physical dependence. However, the risk of opioid use disorder is higher when you take them in a method other than that recommended by your doctor (for example, crushing up pills and snorting them or taking more than prescribed). Those without opioid dependence should use opioids for a maximum of three days, only for severe, acute pain, like after a fracture or surgery.

Non-opioid pain medications are available for long-term pain management. For example, some people with nerve pain benefit from a prescription of antidepressant drugs, which may reduce this type of pain.

 Other options might include muscle relaxants, like baclofen, or sleep aids to support restful sleep while living with pain.

Physical therapy, yoga, or general exercise programs may help people manage ongoing pain, depending on the underlying condition. Stress can also worsen pain, so doctors may also recommend talk therapy to help individuals living with pain.

 This may also help reduce stress, which can act as a pain trigger in some people.

Some people who take maintenance medications like buprenorphine or methadone to manage opioid use disorder find that it also helps them manage chronic pain. However, pain management may still be challenging while living in OUD recovery. A healthcare professional may refer an individual to a pain management clinic or a pain specialist if the other available options aren’t reducing pain.

Mental Health Treatment

Several approaches are available for managing the psychological elements of opioid addiction, alongside medication.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of talk therapy that mental health practitioners use to treat many disorders, including depression, anxiety, and insomnia. It can help treat opioid use disorder by supporting patients in recognizing and stopping nonproductive patterns of thinking and behavior that can lead to the desire to use opioids.

CBT builds on the theory that when someone develops a harmful behavior, such as opioid misuse, learning plays a central role. CBT helps patients identify problematic behaviors that maintain maladaptive habits and develop strategies to address them.

Specific techniques include exploring the positive and negative consequences of continuing to use opioids, learning to recognize cravings early and identify the situations and environments that trigger a desire to use drugs, and developing problem-solving and coping strategies to quell those cravings and avoid those situations.

CBT has been shown to be effective for treating many psychiatric conditions and substance use disorders. But research has yielded mixed results in terms of how beneficial it is for opioid use disorders specifically.

Other Forms of Counseling

Counseling, which can include individual, group, and family counseling, can also be beneficial when undergoing treatment for opioid use disorder.

Individual counseling may include setting goals, discussing setbacks, and celebrating progress. It can consist of cognitive behavioral therapy, as well as motivational enhancement therapy, which helps build motivation to stick with a treatment plan, and contingency management, which focuses on incentives for positive behaviors, like staying off opioids.

Group counseling, led by a trained counselor and consisting of others dealing with opioid use disorder, can help you feel less isolated. You will hear others’ stories of difficulties and successes, which can, in turn, help you learn new strategies for addressing your own situation.

Finally, family counseling can help improve your interpersonal relationships by including your spouse and other close family members in your treatment plan.

The Takeaway

  • Medications for opioid use disorder, an approach that combines medications like methadone or buprenorphine with counseling and behavioral therapies, is a recognized and effective method for treating opioid use disorder.
  • Nonmedication treatments such as cognitive behavioral therapy or other talk therapies and mutual peer support sessions like 12-step programs can complement medication by addressing psychological aspects of opioid use disorder.
  • Full opioid blockers like naltrexone provide an alternative by preventing opioids from having a pleasurable effect, but they require individuals to be completely off of opioids long enough first, to avoid worsening withdrawal.
  • If you or a loved one is experiencing symptoms of opioid use disorder, seek immediate help from a healthcare professional to explore personalized treatment options and reduce the risk of an overdose.

Resources We Trust

EDITORIAL SOURCES
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Resources
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  4. Opioid Use Disorder (OUD) Treatment. MedlinePlus. March 27, 2024.
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Heidi Green, MD

Medical Reviewer
Castle Connolly Top Doctor, Member of American College of Lifestyle Medicine
Heidi Green, MD, is board certified in psychiatry, addiction medicine, and lifestyle medicine. She currently divides her time between maintaining a small private practice and working at specialized opioid treatment programs in North Carolina.

In her private practice, Dr. Green provides psychiatric consultative services and offers an office-based buprenorphine maintenance program to support recovery from opioid addictions. She enjoys offering lifestyle medicine consultation to those interested in maximizing their emotional and physical health by replacing unhealthy behaviors with positive ones, such as eating healthfully, being physically active, managing stress, avoiding risky substance use, improving sleep, and improving the quality of their relationships.

At the opioid treatment programs, Green serves as medical director, working with a team of counselors, nurses, and other medical providers. The programs provide evidence-based treatment (including buprenorphine, methadone, and naltrexone) for persons suffering from opioid use disorders (such as addictions to heroin, fentanyl, or prescription pain medications).

Previously, Green has worked in community health and mental health settings where she provided consultation to behavioral health teams, integrated care teams, substance abuse intensive outpatient programs, and a women’s perinatal residential program. She also enjoyed supervising residents in her prior role as assistant consulting professor to the department of psychiatry at Duke University School of Medicine. During her training at the UNC department of psychiatry, she was honored to serve as chief resident, clinical instructor of psychiatry, and psychotherapy supervisor.

Green is passionate about the years we can add to our life and the life we can add to our years through lifestyle medicine! She focuses on maintaining her own healthy lifestyle through work-life balance, contemplative practices, and eating a plant-based diet. She finds joy through a continual growth mindset, shared quality time with her partner, and time spent outdoors backpacking and mountain biking.
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Adam Felman

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Adam is a freelance writer and editor based in Sussex, England. He loves creating content that helps people and animals feel better. His credits include Medical News Today, Greatist, ZOE, MyLifeforce, and Rover, and he also spent a stint as senior updates editor for Screen Rant.

As a hearing aid user and hearing loss advocate, Adam greatly values content that illuminates invisible disabilities. (He's also a music producer and loves the opportunity to explore the junction at which hearing loss and music collide head-on.)

In his spare time, Adam enjoys running along Worthing seafront, hanging out with his rescue dog, Maggie, and performing loop artistry for disgruntled-looking rooms of 10 people or less.

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