6
Treatment
Treatment Options
Î MAJOR REVISION – All FDA-approved medications for the treatment of
OUD should be available to all patients. Clinicians should consider the
patient's preferences, past treatment history, current state of illness,
and treatment setting when deciding between the use of methadone,
buprenorphine, and naltrexone.
Î NEW – There is no recommended time limit for pharmacological
treatment.
Î MAJOR REVISION – Patients' psychosocial needs should be assessed,
and patients should be offered or referred to psychosocial treatment
based on their individual needs.
• However, a patient's decision to decline psychosocial treatment or the absence of
available psychosocial treatment should not preclude or delay pharmacotherapy,
with appropriate medication management.
• Motivational interviewing or enhancement can be used to encourage patients to
engage in psychosocial treatment services appropriate for addressing individual needs.
ÎThe venue in which treatment is provided should be carefully considered.
• Methadone can be provided only in opioid treatment programs (OTPs) and acute
care settings (under limited circumstances).
• Buprenorphine can be prescribed by waivered clinicians in any setting including
OTPs and office based opioid treatment (OBOT) in accordance with Federal law
(21 CFR §1301.28).
• Naltrexone can be prescribed in any setting by any clinician with the authority to
prescribe medication.
• Clinicians should consider a patient's psychosocial situation, co-occurring
disorders, and risk of diversion when determining which treatment setting is
most appropriate (see The ASAM Criteria
1
for additional guidance).
Î Patients with active co-occurring alcohol use disorder or sedative,
hypnotic, or anxiolytic use disorder (or who are in treatment for a
substance use disorder involving use of alcohol or other sedative
drugs including benzodiazepines or benzodiazepine receptor agonists)
may need a more intensive level of care than can be provided in an
office-based setting.
• Persons who are regularly using alcohol or other sedatives, but do not meet the
criteria for diagnosis of a specific substance use disorder related to that class of
drugs, should be carefully monitored.
Î MAJOR REVISION – The prescribing of benzodiazepines or other
sedative-hypnotics should be used with caution in patients who are
prescribed methadone or buprenorphine for the treatment of an OUD.
• While the combined use of these drugs increases the risk of serious side effects, the
harm caused by untreated OUD can outweigh these risks.
• A risk-benefit analysis should be conducted when deciding whether to co-
prescribe these medications.
