What medications are used to treat opioid use disorder (formerly called opioid addiction)?
1. Methadone, which can only be given at a federally regulated out-patient treatment center known as “Methadone Clinics.”
2. Buprenorphine-naloxone, which can be prescribed by any medical provider who has a waiver from the DEA to prescribe this medication.
3. Naltrexone extended release (Vivitrol) is used for those who do not want to or cannot be on an opioid like methadone or buprenorphine. It is not as effective as methadone or buprenorphine-naloxone.
What is Suboxone?
Suboxone is the brand name of buprenorphine combined with naloxone. This is the preferred medication for opioid use disorder. This combination is used to help prevent abuse of this medication. The naloxone (Narcan) is an anti-opioid and if injected causes withdrawal symptoms.
How long do I have to be on this medication?
Evidence based guidelines recommend long term treatment as being more effective preventing relapse, overdose and death. Treatment can go on for the rest of your life if it is effective.
Do you prescribe plain buprenorphine?
This medication is used during pregnancy and for those who have had an allergic reaction to Suboxone. Documentation of the allergic reaction must be provided. There are rare occasions where a person cannot tolerate buprenorphine-naloxone and may need plain buprenorphine. Again, documentation of the intolerance must be provided.
Do I have to attend counseling or AA/NA meetings to get my prescription?
According to ASAM and SAMHSA guidelines, medication should be prescribed regardless of counseling. If the patient does not want counseling or it is not available, and the medication is helping the patient stay sober by preventing cravings, then the medication should be prescribed.
Many people with opioid use disorder have other conditions like depression, anxiety, bipolar disorder, ADD/ADHD, PTSD, childhood trauma, etc. and may benefit from counseling and other medications. Many people have already been through counseling and no longer benefit from it. No one will be forced to attend AA/NA meetings to get their prescription.
Do you automatically taper people off their buprenorphine-naloxone medication?
Forced tapering is not recommended and may lead to increased cravings, relapse and overdose death. If a person wants to taper, that should be their decision to make with the advice of an addiction specialist. If you want to taper, it should be done very cautiously and slowly.