10
Treatment
Table 3. Medications for Treatment of OUD
Agent Dose Dosing
Buprenorphine
sublingual film, tablets
(generic)
PO: 2 mg, 8 mg film
and tablets
Initial: 2–4 mg (Increase by 2–4 mg )
Daily: ≥8 mg
Max: 24 mg/day
Methadone
tablets/liquid
(generic)
PO: 5 mg, 10 mg,
tablets;
10 mg/mL liquid
Initial: 10-30 mg (Reassess in 3–4 hours;
add ≤10 mg PRN)
Daily: 60-120 mg
a
Naltrexone XR
injection (Vivitrol
®
)
IV/IM: 380 mg
in 4 cc
Every 4 weeks
Naltrexone tablets
(generic)
PO: 50 mg
Daily: 50 mg (May give 2–3 daily doses
at once on M–W–F.)
Buprenorphine Combination Product (See Table 5)
a
e dose should be individualized and may be higher or lower than this usual dosage.
Table 4. Medication Comparison
Methadone
Buprenorphine
Extended Release
Naltrexone
Pharmacology Full agonist Partial agonist Full antagonist
Dosing Daily (but duration
oen longer)
Daily q4wks
Setting Specialty licensed
OTP
Office-based or OTP,
requires "x" waiver
Any medical setting,
requires injection
Induction No time restriction;
start low, go slow
Mild-mod withdrawal:
>8-12 hrs aer last
opioid
>7 days aer last
opioid
Adherence Intrinsically
reinforcing
Intrinsically
reinforcing
Long acting
Side Effect/
Safety
Sedation esp early
in treatment,
constipation. Caution
re: concurrent
benzos/alcohol
overdosing, drug-drug
interactions
Lower extremity
swelling, urinary
hesitancy,
constipation.
Caution re: concurrent
benzos/alcohol
Injection site rxns,
nausea, malaise.
Caution re:
precipitated
withdrawal if given
before opioid free
washout period
Other
advantages
Co-morbid pain,
high potency, high
structure of delivery
setting.
Safety compared to
methadone, co-morbid
pain, dosing flexibility,
lower burden of
OBOT delivery,
simple pharmacy
availability
Low diversion,
no dependence,
verifiable dosing.
lower stigma in some
settings compared to
agonists
Craving
reduction
+++ ++ +
