What is Medication for Opioid Use Disorder (MOUD)?
MOUD is the use of FDA-approved medications in combination with counseling and behavioral therapies to provide a “whole-patient” approach to the treatment of substance use disorders.1
The goals of MOUD are to:
- Stabilize abnormal brain activity;2
- Reduce cravings and strengthen coping capacity;3
- Allow patients to focus on behavioral therapies;3
- Increase periods of abstinence and self-efficacy;3 and
- Improve clinical outcomes for patients and reduce impact on family and loved ones.3
Effective prevention and treatment strategies exist for opioid misuse and opioid use disorder. They are highly underutilized across the United States. Research indicates that methadone, buprenorphine, and naltrexone all reduce opioid use and opioid use disorder-related symptoms. Compared to psychosocial treatment on its own, these medications also reduce the risk of infectious disease transmission, and criminal behavior associated with drug use.
- Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families (TIP 63). Rockville, MD 20857: Substance Abuse and Mental Health Services Administration; 2018.
- https://www.samhsa.gov/medication-assisted-treatment
- U.S. Department of Health & Human Services Centers for Disease Control and Prevention (CDC). Assessing and Addressing Opioid Use Disorder. CDC.; 2017.
What is Methadone?
- Has been used for decades as treatment for addiction to heroin and narcotic pain medication;
- Helps people sustain long-term success and to reclaim active and meaningful lives;
- Reduces opioid craving and withdrawal and blocks the effects of opioids;
- Is available in various forms such as liquid, powder, tablets, and diskettes;
- Is only administered to individuals engaged in a licensed opioid treatment program (OTP); and
- Is prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs.
- Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families (TIP 63). Rockville, MD 20857: Substance Abuse and Mental Health Services Administration; 2018.
What is Buprenorphine?
- Was approved for clinical use in October 2002 by the Food and Drug Administration (FDA);
- Is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access;
- Offers another form of medication when a methadone clinic is not preferred or convenient;
- Has a “ceiling effect” where effects from the medication level off at a moderate dose, and do not increase with further dosing;
- This lowers the risk of misuse, dependency, and side effects;
- Patients may not have to take it every day.
- Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families (TIP 63). Rockville, MD 20857: Substance Abuse and Mental Health Services Administration; 2018.
What is Naltrexone?
- Is a medication approved by the Food and Drug Administration (FDA) to treat opioid use disorder and alcohol use disorder;
- Blocks the euphoric and sedative effects of drugs such as heroin, morphine, and codeine;
- Is available in a pill form or as an injectable;
- Can be prescribed by any health care provider who is licensed to prescribe medications;
- Has the possibility of putting a patient into precipitated withdrawal. To reduce this risk:
- Patients are warned to abstain from illegal opioids and opioid medication for a minimum of 7-10 days before starting naltrexone.
- If switching from methadone to naltrexone, the patient must be completely withdrawn from the opioids.
- Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families (TIP 63). Rockville, MD 20857: Substance Abuse and Mental Health Services Administration; 2018.
Does medications for opioid use disorder (MOUD) substitute one drug or addiction for another?
No.
- Addiction is defined as: “the repeated use of a drug despite negative mental, physical, and social effects”.1 It is not defined by the presence or absence of a drug.
- A person living with an addiction who takes medication under the advice and care of a physician is like a patient who takes medication to treat other chronic diseases.
MOUD has been found to decrease opioid misuse, overdose deaths, criminal activity, and infectious disease transmission.2
MOUD has been shown to reduce drug cravings without causing the euphoric effect of opioids, stabilize brain chemistry, and relieve withdrawal symptoms3. Since MOUD manages the physical symptoms of addiction, patients can attend counseling, group therapy, or support groups to focus on identifying the underlying causes of substance use and work toward recovery. Additionally, research also shows that MOUD increases retention in treatment and social functioning compared to treatment that does not include medication.
- National Institute on Drug Abuse. “The Science of Drug Use and Addiction: The Basics.” NIDA, https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics
- Treatment Approaches for Drug Addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
What should I do if I am worried about talking to my doctor and others about my opioid use?
Remember, your health and safety are your doctor’s priority.
- He or she wants to help you. Having problems not being able to stop using opioids probably means you have a brain disease and requires treatment like any other disease.
How long should patients remain in MOUD?
The duration of MOUD is different for each patient.
- No maximum treatment duration exists if a patient is benefitting from treatment. Some patients can successfully complete treatment more quickly while other patients may need long-term treatment.1
- Research shows that patients who receive MOUD for at least one to two years have the greatest rates of long-term success.1
- Effective Treatments for Opioid Addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction
What is Screening, Brief Intervention and Referral to Treatment (SBIRT)?
Screening, brief intervention, and referral to treatment (SBIRT) is a comprehensive and integrated public health approach to the delivery of early intervention and treatment services through universal screening for persons with SUD and those at risk of developing these disorders.1 Research has demonstrated SBIRT’s many benefits, including reductions in healthcare costs, severity of substance use, and trauma.2-9
Universal Screening
- The use of validated procedures to quickly assess patient substance use risk and select appropriate care.10
Brief Intervention
- A 5-15-minute discussion that aims to increase patient understanding of the risks and build toward behavior change.10
Referral to Treatment
- A linking of appropriate patients to appropriate SUD treatment (specialty care).10
Why Implement SBIRT?
- SBIRT Decreases Healthcare Costs2
- Multiple studies have shown that investing in SBIRT can result in healthcare cost savings that range from $3.81 to $5.60 for each $1.00 spent.
- SBIRT Decreases Severity of Substance Use9
- Data from SAMHSA grant programs has demonstrated a reduction in substance use 6 months after receiving intervention: 41% of respondents reported abstinence from drugs and/or alcohol, compared to 16% at baseline.
- SBIRT Decreases Physical Trauma9
- Data from SAMHSA grant programs demonstrated 33% fewer nonfatal injuries, 37% fewer hospitalizations, 46% fewer arrests, and 50% fewer motor vehicle crashes.
- Babor TF, DelBoca F, Bray JW. (2017). Screening, Brief Intervention and Referral to Treatment: Implications of SAMHSA’s SBIRT Initiative for Substance Abuse Policy and Practice. Addiction 112, 110-117.
- Fleming MF, Mundt MP, French MT, et al. (2000). Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings. Medical Care, 38, 7–18.
- Pringle JL, Kelley DK, Kearney SM, et al. (2018). Screening, Brief Intervention, and Referral to Treatment in the Emergency Department: An Examination of Health Care Utilization and Costs. Medical Care, 56, 146–152.
- Estee S, Wickizer T, He L, Shah MF, Mancuso D. (2010). Evaluation of the Washington state screening, brief intervention, and referral to treatment project: cost outcomes for Medicaid patients screened in emergency departments. Medical Care, 48, 18-24.
- Quanbeck A, Lang K, Enami K, Brown RL. (2010). A cost-benefit analysis of Wisconsin’s screening, brief intervention, and referral to treatment program: adding the employer’s perspective. WMJ, 109, 9–14.
- Gentilello LM. (2007). Alcohol and injury: American College of Surgeons Committee on Trauma requirements for trauma center intervention. Journal of Trauma, 62, S44–S45.
- Gentilello LM, Rivara FP, Donovan DM, et al. (1999). Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Annals of Surgery, 230, 473-480.
- Miller WR, & Wilbourne PL. (2002). Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction, 97, 265–277.
- Unpublished data from SAMHSA’s Services Accountability Improvement System, July 2012.
- Gordon AJ. (2006). Screening the drinking: Identifying problem alcohol consumption in primary care settings. Johns Hopkins Adv. Stud. Med 6, 137-147.