Understanding Medication to Treat Opioid Use Disorder for Treatment Court Participants

They work differently in the brain:

• Methadone and buprenorphine are safe and effective medications that treat opioid addiction because they act on the same parts of the brain as opioid drugs. They help reduce the desire to use opioids and prevent withdrawal symptoms.
• Methadone plugs in and fully activates the receptor.
• Buprenorphine plugs in but only partially turns the receptor on.
• Naltrexone is like a plug cover that blocks the receptor without activating it. Naltrexone cannot be used until about 7 to 10 days after the last opioid use. It does not treat withdrawal or pain but can reduce or eliminate cravings.

Buprenorphine

What forms does buprenorphine come in?

Buprenorphine comes in different forms: a daily film or tablet that dissolves under the tongue (most common), and an injection.

Sublocade (extended-release injection) is a form of buprenorphine injected under the skin in the abdomen that lasts for a month. It comes in two doses: 300 mg (about the same as 16 to 24 mg of buprenorphine taken daily) and 100 mg (equivalent to 8 to 12 mg of buprenorphine taken daily).

What does buprenorphine do?

• It reduces cravings and relieves withdrawal symptoms.
• It partially blocks the effects of other opioid drugs.
• It can treat current pain caused by major trauma or surgery. Please tell the nurse or doctor treating your pain so they know you are taking buprenorphine.
• It prevents overdose and death.

What are the side effects?

• Taking buprenorphine right after taking other opioids can cause withdrawal symptoms.
• Other side effects include constipation and nausea.

What are the typical dosages?

• Normal dosage is 8 to 24 mg (film or tablet).
• When in film and tablet form, buprenorphine is typically taken once or twice per day.
• Injections are given once every month.

What do I need to know about taking buprenorphine?

• Doses should always be stored safely due to the potential for fatal overdose when taken by others, particularly children.
• Injectable forms must be given by a trained clinician in a medical treatment area and are not dispensed by a prescription to be filled in a pharmacy.

How do I know if buprenorphine is working for me?

• You should not have cravings or withdrawal symptoms.
• You will not feel high or sleepy.

What if I stop taking buprenorphine without talking to my doctor?

• Stopping the medication suddenly will result in withdrawal symptoms.
• Make sure to plan ahead so the medication won't run out.
• Try not to miss scheduled appointments.

Methadone

What does methadone do?

• It relieves withdrawal symptoms and cravings.
• Its effects last longer than other opioids (such as heroin or oxycodone), preventing the cycles of highs and lows.
• Methadone can be taken at the beginning of recovery even before withdrawal symptoms have started.
• It can treat current pain caused by major trauma or surgery.

What are the side effects?

• Sleepiness
• Constipation
• Heart arrythmias (abnormal heartbeat) at high doses (your doctor will monitor for this if needed)
• Tell the doctor if you are taking other medications.

What are the typical dosages?

• To start, 40 mg will usually help with reducing withdrawal symptoms. Next, doses will slowly be increased to decrease craving; these doses tend to be higher than 60 mg a day.
• It may take several weeks to get to a stable dose.
• Methadone is taken once per day in liquid form, but the dosing may change over time.
• The doctor will work closely with you to find the right dose that reduces cravings without causing you to feel drowsy or sedated.

What do I need to know about taking methadone?

• People who are in stable recovery may be provided a supply of medication to take at home. Take-home doses should always be stored in a locked box due to the potential for fatal overdose when taken by others, particularly children.
• Do not drive or operate machinery until a stable dose is achieved. This can take a few weeks. Once you are on a stable dose, there are no driving restrictions.
• It is given only at specially licensed treatment centers called opioid treatment programs or OTPs.

What if I stop taking methadone without consulting a doctor?

• Stopping the medication abruptly will result in withdrawal symptoms.
• People taking it must plan to ensure that they have an adequate supply and do not miss scheduled appointments.

Extended-Release Naltrexone

What does naltrexone do?

• Naltrexone works by blocking opioids from acting on the brain. This prevents the effects of taking opioid drugs. It’s like a plug cover that blocks the receptor without activating it.
• Naltrexone cannot be used until about 7 to 10 days after the last opioid use.
• Both the pill and injection forms of naltrexone are effective for treating alcohol use disorder.
• It cannot be used to treat current opioid withdrawal.
• It can be used to reduce or eliminate cravings and help prevent you from returning to opioid use.
• It cannot treat pain.
• If you are prescribed pain medications, be sure to tell the doctor that you are taking extended-release naltrexone.

What are the side effects?

• Because it is an injection in the buttock, it can cause swelling and pain.
• Other side effects include nausea and headaches.
• In rare cases, it can cause an abscess or skin infection.

What do I need to know about taking naltrexone?

• Opioid addiction is treated using the extended-release form, and it is injected into the buttocks every 28 days.
• The pill form of naltrexone is not effective in treating opioid use disorder. It is effective for alcohol use disorder.
• Naltrexone cannot be started if other opioids are in the body; if there are, it can cause severe withdrawal.
• Naltrexone has not been shown to be safe during pregnancy, and you may need to stop taking it if you are pregnant or trying to become pregnant.

What is the typical dosage?

• Extended-release naltrexone has only one dose: a 380 mg intramuscular injection.

What if I stop taking extended-release naltrexone without consulting a doctor?

• You will not go through withdrawal.
• You will be at high risk of overdose and death if you return to opioid use.