---
title: Opioid Use Disorder Treatment
description: A comprehensive clinical reference on the diagnosis and evidence-based management of opioid use disorder.
keywords: [opioid use disorder, substance use disorder, medication-assisted treatment, buprenorphine, methadone]
category: clinical
---

## Diagnostic Criteria

Opioid use disorder is a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period:

1. Opioids are often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
4. Craving, or a strong desire or urge to use opioids.
5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
8. Recurrent opioid use in situations in which it is physically hazardous.
9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of opioids to achieve intoxication or desired effect or (b) a markedly diminished effect with continued use of the same amount of an opioid.
11. Withdrawal, as manifested by either of the following: (a) the characteristic opioid withdrawal syndrome or (b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.

The severity of opioid use disorder is classified as mild (2-3 criteria), moderate (4-5 criteria), or severe (6 or more criteria).

## Treatment Approach

The goal of treatment for opioid use disorder is to achieve long-term abstinence and recovery. The mainstay of treatment is medication-assisted treatment (MAT) with either methadone, buprenorphine, or naltrexone, in combination with psychosocial interventions.

### Medication-Assisted Treatment (MAT)

1. Methadone: A full opioid agonist administered daily in licensed opioid treatment programs. Typical dosing range is 60-120 mg/day. Methadone is highly effective but has a high risk of overdose, especially when combined with other central nervous system depressants.

2. Buprenorphine: A partial opioid agonist administered as a sublingual tablet or film. Typical dosing range is 8-24 mg/day. Buprenorphine has a "ceiling effect" that limits the risk of respiratory depression and overdose. It can be prescribed by certified providers in office-based settings.

3. Naltrexone: An opioid antagonist available as an oral tablet or extended-release injectable formulation. The injectable formulation (Vivitrol) is administered monthly and is effective in preventing relapse. Naltrexone is non-addictive and has no abuse potential, but requires complete opioid detoxification prior to initiation.

The choice of MAT agent is based on patient preference, treatment setting, insurance coverage, and provider experience. All three medications have been shown to be effective in treating opioid use disorder when combined with psychosocial interventions.

### Psychosocial Interventions

Psychosocial interventions are an essential component of comprehensive treatment for opioid use disorder. These include:

1. Cognitive-behavioral therapy (CBT): Helps patients identify and modify thoughts and behaviors that contribute to opioid use.
2. Contingency management: Uses tangible rewards to reinforce positive behaviors, such as abstinence from opioids.
3. Mutual-help groups: 12-step programs like Narcotics Anonymous provide peer support and a sense of community.
4. Family therapy: Involves the patient's family in the treatment process to improve family dynamics and support recovery.

The specific psychosocial interventions should be tailored to the individual patient's needs and preferences.

## Monitoring and Follow-up

Patients receiving treatment for opioid use disorder require close monitoring and follow-up to assess treatment response and identify any potential complications or adverse events.

### Laboratory Testing

1. Urine drug screens: Performed at each clinic visit to monitor for ongoing opioid use and other substance use.
2. Liver function tests: To monitor for hepatotoxicity, especially in patients receiving medications metabolized by the liver (e.g., methadone, buprenorphine).
3. HIV and hepatitis screening: Offered to all patients, as opioid use disorder is associated with an increased risk of these infections.

### Clinical Assessments

1. Opioid withdrawal symptoms: Assessed using the Clinical Opioid Withdrawal Scale (COWS) to guide medication adjustments.
2. Cravings: Evaluated using a visual analog scale to monitor treatment response and relapse risk.
3. Adherence: Assessed through pill counts, prescription refill records, and patient self-report.
4. Psychosocial functioning: Evaluated through regular assessments of employment, housing, relationships, and overall quality of life.

Patients should be seen regularly, with the frequency of visits determined by the stage of treatment and the patient's clinical stability.

## Complications and Contraindications

Opioid use disorder is associated with several medical and psychiatric complications that must be considered during treatment.

### Medical Complications

1. Opioid overdose: A life-threatening emergency requiring immediate administration of the opioid antagonist naloxone.
2. Infectious diseases: Increased risk of HIV, hepatitis C, and endocarditis due to injection drug use.
3. Chronic pain: Many patients with opioid use disorder also have underlying chronic pain conditions.

### Psychiatric Comorbidities

1. Depression and anxiety: Commonly co-occur with opioid use disorder and may require concurrent treatment.
2. Post-traumatic stress disorder (PTSD): Prevalent among individuals with opioid use disorder, often related to past trauma.
3. Suicidal ideation: Patients should be routinely screened for suicidal thoughts and behaviors.

Contraindications to specific MAT medications include:

- Methadone: Respiratory depression, concurrent benzodiazepine use, QT prolongation.
- Buprenorphine: Opioid withdrawal, concurrent benzodiazepine use, liver disease.
- Naltrexone: Opioid dependence, acute hepatitis or liver failure, severe depression.

Careful patient selection and close monitoring are essential to minimize the risk of complications and ensure the safe and effective management of opioid use disorder.

## Conclusion

Opioid use disorder is a chronic, relapsing condition that requires a comprehensive, evidence-based approach to treatment. Medication-assisted treatment, in combination with psychosocial interventions, is the standard of care and has been shown to be highly effective in achieving long-term recovery. Careful monitoring and management of potential complications are crucial to ensuring the best possible outcomes for patients.