Medications approved by the Food and Drug Administration (FDA) and prescribed by a health care provider are an effective and, for some conditions, a critical component of addiction treatment. Currently, there are FDA-approved medications for alcohol and opioid use disorder as well as smoking cessation. Although research is underway to determine whether existing addiction medications can be used to treat stimulant use disorder, there are currently no FDA-approved medications for stimulant addiction.
Medications for the treatment of opioid use disorder (MOUD) are the most effective, potentially lifesaving, treatment for opioid addiction. Studies show that these medications reduce drug use and overdose rates and help retain people in treatment longer, which is associated with better outcomes. These medications have also been shown to reduce criminal behavior and infectious disease risk and improve occupational, psychological, and family functioning.
Unfortunately, there is a widespread misconception among providers, policymakers and the public that “abstinence-based” or “medication-free” treatment– is best. Given the evidence supporting the effectiveness of MOUD, this philosophy is not supported by research and is potentially dangerous.
FDA-approved medications to treat opioid addiction include methadone, extended-release naltrexone and buprenorphine, which is often combined with naloxone. Extended-release naltrexone blocks the effects of opioids so people do not get intoxicated (high) if they use. Methadone and buprenorphine reduce cravings and withdrawal symptoms and allow individuals to improve their functioning in everyday life. When taken as prescribed, these medications do not cause the feeling of intoxication associated with opioid misuse. Because these medications have different mechanisms of action, different side effects and risks, and are available in different health service locations, the medication that is best for any individual will vary.
Methadone has been proven effective through over 40 years of research. There is also well-supported evidence for the effectiveness of buprenorphine. Extended-release naltrexone has not been studied as extensively as methadone and buprenorphine but data support its effectiveness for opioid use disorder treatment.
The length of treatment with MOUD depends on the duration and severity of the addiction, the patient’s physical and psychological health and preferences, and other factors affecting recovery. Research shows that patients who are maintained on MOUD for longer periods of time (for example 6-12 months) have significantly better clinical outcomes than those who discontinue use of the medications earlier. Some patients may need to take medication for many years or even the rest of their lives, just like people who have chronic health conditions like asthma, diabetes or heart disease.
The research supporting MOUD is strong enough to conclude that it is an “evidence-based” treatment, meaning, it has been proven to work. All opioid addiction treatment programs and providers should offer MOUD directly or through referral; those that do not should not be considered “evidence-based” providers. Federal and state agencies that pay for addiction treatment services should require that MOUD be made available to all patients with opioid use disorder treated in programs they support. Prohibiting or discouraging the use of MOUD or denying reimbursement for this service is unethical, discriminatory, and is inconsistent with acceptable medical practice.
For additional information about the research supporting MOUD, please see chapter 2 of Evidence Based Strategies for Abatement of Harms form the Opioid Epidemic.