Medication-Assisted Treatment: Options and How It Works

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recoveryroute-editorial-team

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medication-assisted treatment

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opioid, mat, prescription

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Clinical

Medication-assisted treatment is an older term commonly used for treatment that combines medication with counseling and other supports. For opioid use disorder, many federal agencies now prefer the term medications for opioid use disorder, or MOUD, because medication is a central evidence-based treatment rather than merely an add-on.

The U.S. Food and Drug Administration has approved three medications for opioid use disorder: buprenorphine, methadone, and naltrexone. A qualified clinician should help determine whether one of these options fits a person’s medical history, current opioid use, treatment goals, pregnancy status, other medications, and access to care.

What medications are used for opioid use disorder?

Buprenorphine

Buprenorphine is a partial opioid agonist. When taken as prescribed, it can reduce withdrawal symptoms and cravings while producing weaker opioid effects than full agonists. It is available in several formulations, including products combined with naloxone and long-acting injections. Many appropriately licensed clinicians with controlled-substance prescribing authority can prescribe buprenorphine, subject to applicable state requirements.

Methadone

Methadone is a long-acting full opioid agonist that can reduce withdrawal and cravings and blunt the effects of other opioids. In the United States, methadone used to treat opioid use disorder is generally dispensed through a SAMHSA-certified opioid treatment program. Treatment may include medical, counseling, and recovery-support services.

Naltrexone

Naltrexone is an opioid antagonist, which means it blocks opioid receptors rather than activating them. Extended-release injectable naltrexone is FDA-approved for opioid use disorder. A person must be opioid-free for an appropriate period before starting it, because beginning naltrexone too soon can trigger withdrawal. A clinician should determine when it is safe to start.

How these medications support recovery

These medications work differently, but each can be part of a broader treatment plan. Depending on the medication and the person’s needs, treatment may help reduce cravings, control withdrawal symptoms, block opioid effects, and support continued engagement in care. Medication may be combined with counseling, behavioral therapies, peer support, recovery coaching, medical care, and help with housing, employment, or family needs.

Medication treatment is not simply replacing one addiction with another. FDA and SAMHSA describe these medications as evidence-based treatments for opioid use disorder. Treatment length varies. Some people use medication for months, while others benefit from treatment lasting years or longer. Medication should not be stopped suddenly or changed without guidance from the prescribing clinician.

How is the right medication selected?

A clinician may consider:

• Current opioid use and time since last use
• Withdrawal symptoms and overdose history
• Previous treatment experiences
• Other medications and health conditions
• Pregnancy or plans for pregnancy
• Ability to attend an opioid treatment program when methadone is being considered
• Preference for a daily medication or a long-acting injection
• Risk of returning to opioid use after a period of abstinence

No single medication is best for everyone. Access, comfort, medical safety, and personal preference all matter.

Safety considerations

Buprenorphine and methadone can cause dangerous sedation or slowed breathing, especially when combined with alcohol, benzodiazepines, sedatives, or other substances that depress breathing. Patients should tell their clinician about every prescribed medication, over-the-counter product, and substance they use.

Naltrexone lowers opioid tolerance during treatment. After stopping naltrexone or after a period without opioids, returning to a previously used opioid dose can increase overdose risk.

Naloxone is an opioid-overdose reversal medication and is separate from medications used for ongoing treatment. People at risk of opioid overdose and their families should ask a pharmacist, clinician, or local health department how to obtain naloxone and how to use it.

Emergency warning

Call 911 immediately if someone is unresponsive, cannot be awakened, has slow or stopped breathing, makes choking or gurgling sounds, or has blue, gray, or pale lips or skin. Give naloxone if available and follow emergency-dispatch instructions. Do not leave the person alone.

How to find medication treatment

FindTreatment.gov lists state-licensed treatment providers and programs. SAMHSA also maintains an opioid treatment program directory. When contacting a provider, ask which medications are offered, whether new patients are being accepted, how quickly treatment can begin, what insurance or payment options are available, and what counseling or recovery supports are included.

Questions to ask a provider

• Which medications for opioid use disorder do you offer?
• Who completes the medical assessment and prescribing?
• How quickly can treatment begin?
• What happens if I am already taking opioids or experiencing withdrawal?
• Do you provide naloxone education or naloxone kits?
• What counseling and recovery supports are available?
• How do you handle missed appointments or a return to use?
• What are the costs and insurance requirements?

Frequently Asked Questions

Is medication-assisted treatment only for opioid addiction?
The term has been used broadly, but this article focuses on medications for opioid use disorder. FDA-approved medications also exist for alcohol use disorder and tobacco use disorder.

Is counseling required?
Counseling and behavioral supports can be valuable, but medication itself is an evidence-based treatment. Program requirements differ, and care should be individualized.

How long does treatment last?
There is no universal deadline. Treatment can continue as long as it remains beneficial and medically appropriate. Decisions to reduce or stop medication should be made with the treating clinician.

Can someone overdose while taking these medications?
Overdose risk is lower when medications are taken exactly as prescribed, but dangerous sedation or overdose can occur, particularly when opioids are mixed with alcohol, benzodiazepines, or other sedatives. Keep naloxone available when overdose risk is present.

Sources

U.S. Food and Drug Administration. Information about Medications for Opioid Use Disorder (MOUD). https://www.fda.gov/drugs/food-and-drug-administration-overdose-prevention-framework/information-about-medications-opioid-use-disorder-moud

Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. https://www.samhsa.gov/resource/recovery/medications-opioid-use-disorder

Substance Abuse and Mental Health Services Administration. Treatment Options for Substance Use Disorder. https://www.samhsa.gov/substance-use/treatment/options

Substance Abuse and Mental Health Services Administration. Buprenorphine. https://www.samhsa.gov/substance-use/treatment/options/buprenorphine

Substance Abuse and Mental Health Services Administration. Methadone. https://www.samhsa.gov/substance-use/treatment/options/methadone

Substance Abuse and Mental Health Services Administration. Naltrexone. https://www.samhsa.gov/substance-use/treatment/options/naltrexone

Substance Abuse and Mental Health Services Administration. 42 CFR Part 8 Frequently Asked Questions. https://www.samhsa.gov/substance-use/treatment/opioid-treatment-program/42-cfr-part-8/faqs