Medications That Transform Treatment Outcomes for Opioid Use Disorder.

Opioid use disorder is treatable with approved medications that reduce cravings and risk. Know the medications used to treat opioid use disorder including methadone, buprenorphine, and naltrexone, which have strong evidence for safety and effectiveness. This presentation explains how these treatments work, the benefits over withdrawal-only approaches, and factors influencing treatment choice. View this presentation to understand these therapeutic options better and support informed decisions about addiction care.
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1. Medications Used to Treat Opioid Use Disorder Medication-assisted treatment (MAT) is a vital approach for addressing opioid use disorder. This presentation examines the efficacy, mechanisms, and practical applications of the medications currently approved for OUD treatment in the United Kingdom and beyond.

2. Understanding Opioid Use Disorder (OUD) Opioid Use Disorder is a chronic, relapsing brain disorder characterised by the compulsive use of opioids despite harmful consequences. It involves physical dependence, psychological cravings, and significant behavioural changes. Diagnostic Criteria Inability to control opioid use Continued use despite negative consequences Development of tolerance Withdrawal symptoms when use stops Health Impact Increased risk of overdose and death Infectious disease transmission Mental health comorbidities Cardiovascular complications Societal Impact NHS burden (£300+ million annually) Lost productivity Family disruption Criminal justice involvement In the UK, approximately 138,000 people received treatment for opioid dependence in 2020/21.

3. Role of Medications in OUD Treatment Medications are a cornerstone of effective OUD treatment , working in tandem with psychosocial interventions to address both the biological and behavioural aspects of addiction. Normalise Brain Function Restore balance to brain circuits disrupted by opioid misuse Reduce Cravings Diminish psychological urges to use opioids Manage Withdrawal Alleviate physical symptoms during detoxification Medication-assisted treatment has been shown to decrease opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission.

4. Overview of FDA-Approved Medications Three primary medications have been approved for OUD treatment, each with distinct mechanisms of action and delivery methods. 1 Methadone Type: Full opioid agonist Duration: Since 1960s in UK Availability: Specialised clinics, daily dosing initially Formulation: Liquid, tablets 2 Buprenorphine Type: Partial opioid agonist Duration: Since early 2000s Availability: GP prescribing, pharmacy dispensing Formulation: Sublingual tablets, film, implant 3 Naltrexone Type: Opioid antagonist Duration: Since 1984 (ER version more recent) Availability: Specialist prescribing Formulation: Oral tablets, extended-release injection NICE guidelines recommend that all three medications be available as treatment options, with selection based on individual patient factors and preferences.

5. Methadone How It Works As a full opioid agonist, methadone activates the same receptors as heroin or morphine, but with a slower onset and longer duration, preventing withdrawal while reducing euphoria. Administration Daily supervised consumption initially Dispensed through specialised clinics or community pharmacies Average maintenance dose: 60-120mg daily Evidence Base Longest-established treatment with robust evidence showing 70% reduction in mortality and significant decreases in illicit opioid use. Considerations: Requires careful dose titration. Risk of respiratory depression if misused. Potential for QT interval prolongation. Significant drug interactions.

6. Buprenorphine & Buprenorphine/Naloxone (Suboxone) Mechanism of Action Buprenorphine is a partial opioid agonist with high receptor affinity but limited activity, creating a "ceiling effect" that reduces overdose risk while managing withdrawal and cravings. When combined with naloxone (as in Suboxone), the formulation discourages injection misuse, as naloxone precipitates withdrawal when injected but has minimal effect when taken sublingually as prescribed. Advantages Lower overdose risk than methadone Can be prescribed by GPs with special training Easier transition to abstinence-based treatments Fewer drug interactions Less stigmatising collection process

7. Advantages No physical dependence No potential for misuse Convenient monthly dosing Extended-Release Naltrexone Unique Mechanism Unlike methadone and buprenorphine, naltrexone is an opioid antagonist that blocks opioid receptors completely, preventing any euphoric effects if opioids are used. Extended-Release Formulation Monthly intramuscular injection (Vivitrol) maintains therapeutic blood levels for 28 days, addressing the poor adherence issues associated with daily oral naltrexone. Suitable for highly motivated patients Challenges Requires complete detoxification first Risk of overdose if treatment stops Limited availability in the UK Higher cost than other options Extended-release naltrexone is particularly suitable for patients who have completed detoxification and are committed to abstinence, such as healthcare professionals, individuals in safety-sensitive occupations, or those with strong recovery support systems.

8. Other Medications & Supportive Treatments Lofexidine (BritLofex) An alpha-2 adrenergic agonist approved specifically for managing opioid withdrawal symptoms: Reduces autonomic withdrawal symptoms like sweating, chills, and muscle aches Non-opioid alternative for short-term detoxification support Typically used for 7-10 days during acute withdrawal Can be combined with symptomatic medications Adjunctive Medications Used to manage specific withdrawal symptoms: Symptom Medication Nausea/vomiting Ondansetron, metoclopramide Diarrhoea Loperamide Muscle pain NSAIDs, paracetamol Anxiety/insomnia Short-term benzodiazepines The NHS Addiction Provider Alliance recommends individualised symptom management approaches alongside evidence-based medications for opioid use disorder.

9. Comparing OUD Medications Selection of the optimal medication should be based on individual patient factors, preferences, and treatment history. Feature Methadone Buprenorphine Naltrexone ER Receptor action Full agonist Partial agonist Antagonist Overdose risk Higher Moderate Lower Flexibility Daily dosing Daily to monthly Monthly Accessibility Most restricted Moderate Least restricted Retention rates 60-80% 50-70% 30-50% Key Considerations: Patient preferences, treatment history, comorbidities, psychosocial support, access to care, cost, and treatment goals (harm reduction vs. abstinence) should all factor into medication selection. The most effective treatment approaches combine appropriate medication with counselling, peer support, and addressing social determinants of health.

10. Contact Us [phone] [email protected] DrLeeds.com 3290 NE 33rd St, Fort Lauderdale, FL 33308 Mark Leeds, D.O.