This TIP reviews three Food and Drug Administration-approved medications for opioid use disorder treatment—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support people in recovery.

Contents

• Executive Summary
• Part 1. Introduction to Medications for Opioid Use Disorder Treatment: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families
  • The Approach to OUD Care
  • Overview of Medications for OUD
  • Duration of Treatment With OUD Medication
  • Treatment Settings
  • Challenges to Expanding Access to OUD Medication
  • Resources
  • Notes
• Part 2. Addressing Opioid Use Disorder in General Medical Settings: For Healthcare Professionals
  • Scope of the Problem
  • Screening
  • Assessment
  • Treatment Planning or Referral
  • Resources
  • Part 2 Appendix
  • Notes
• Part 3. Medications for Opioid Use Disorder: For Healthcare Professionals
  • Chapter 3A: Overview of Medications for Opioid Use Disorder
    • Introduction to Medications That Address OUD
    • Principles of OUD Medications
    • Overview of Medication Indications and Dosing
  • Chapter 3B: Methadone
    • Formulations
    • Pharmacology
    • Bioavailability
    • Dosing Considerations
    • Contraindications
    • Initiating Methadone Treatment
    • Duration of Methadone Treatment
    • Methadone Dosing Summary
    • Enhancing Access to OUD Medication in OTPs
    • Chapter 3B Appendix
  • Chapter 3C: Naltrexone
    • Formulations
    • Pharmacology
    • Dosing Considerations
    • Naltrexone Dosing Summary
    • Chapter 3C Appendix
  • Chapter 3D: Buprenorphine
    • Formulations
    • Pharmacology
    • Bioavailability
    • Dosing Considerations
    • Initiating Buprenorphine Treatment
    • Duration of Buprenorphine Treatment
    • Chapter 3D Appendix
  • Chapter 3E: Medical Management Strategies for Patients Taking OUD Medications in Office-Based Settings
    • Patient Selection
    • Patient Management and Treatment Monitoring
    • Administrative Considerations
    • Emergency Protocols and Patient Safety Measures
    • Recommendations for Staff Member Training
    • Chapter 3E Appendix
  • Chapter 3F: Medical Management of Patients Taking OUD Medications in Hospital Settings
    • Hospitalized or ED Patients Taking Medication for OUD
    • Hospitalized or ED Patients Not Taking Medication for OUD
    • Medical Management Plan
    • Notes
• Part 4. Bringing Together Addiction Treatment Counselors, Clients, and Healthcare Professionals: For Healthcare and Addiction Professionals
  • Overview and Context
  • Quick Guide to Medications
  • Counselor–Prescriber Communications
  • Creation of a Supportive Counseling Experience
  • Other Common Counseling Concerns
  • Notes
• Part 5. Resources Related to Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families
  • General Resources
  • Resources for Counselors and Peer Providers
  • Resources for Clients and Families
  • Provider Tools and Sample Forms
  • Notes

This publication was prepared under contract numbers 270-14-0445 and 283-17-4901 by the Knowledge Application Program (KAP) for the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Suzanne Wise served as the Contracting Officer's Representative, and Candi Byrne served as KAP Project Coordinator.

Suggested citation:

Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63 Publication No. PEP21-02-01-002. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021.

The views, opinions, and content expressed herein are the views of the consensus panel members and do not necessarily reflect the official position of SAMHSA or HHS. No official support of or endorsement by SAMHSA or HHS for these opinions or for the instruments or resources described is intended or should be inferred. The guidelines presented should not be considered substitutes for individualized client care and treatment decisions.