AAAP, Buprenorphine, Methadone, Module, Naltrexone
Direct providership by American Academy of Addiction Psychiatry Adam Bisaga, MD | Professor of Psychiatry, Columbia University Medical Center, New York, NY Module Description […]Read More
While PCSS-MAT provides trainings on a broad range of substance use disorder treatments, its primary focus is on treatment of opioid use disorders (OUD).Opioids include a class of drugs often prescribed for pain—morphine, fentanyl, oxycodone, and hydrocodone—as well as illicit drugs, such as heroin. The Federal Drug Administration (FDA) has approved three medications for the treatment of OUD: methadone, buprenorphine, and naltrexone.
This introductory module below is a case-based discussion of the general approach to evaluation and treatment of patients presenting with problematic opioid use. Benefits and limitations of available medications and differences between them are described. An approach to choosing first and second line treatments is also presented.
Methadone: works by activating opioid receptors in the brain, and blocking the effects of heroin and painkillers. Patients taking methadone often have less craving for heroin/opioids and less withdrawal symptoms. As a result, they tend to use less heroin, have fewer medical complications, and often have improved social and work functioning. Methadone is one of the most effective medications we have, however it is a potent medication and can cause sedation, even death. Therefore, dispensing methadone is highly regulated and it can only be used in Opioid Treatment Programs.
Buprenorphine: works similarly to methadone, but only partially activates opioid receptors, often reducing drug use and protecting patients from overdose. Because buprenorphine is considered safer than methadone, less monitoring is needed, and it can be prescribed by primary care providers who complete a special training course.
Naltrexone: works differently from methadone or buprenorphine. It completely blocks opioid receptors, and is used after detoxification to prevent relapse. It has no abuse potential, no overdose risk, and there is no withdrawal when the medication is stopped. Naltrexone can be administered in a primary care physician’s office with single doses effective for up to 30 days.