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Î Methadone is recommended for patients who may benefit from
daily dosing and supervision in an OTP, or for patients for whom
buprenorphine for the treatment of OUD has been used unsuccessfully
in an OTP or OBOT setting.
Î NEW – Opioid dosing guidelines developed for chronic pain, expressed
in morphine milligram equivalents (MME), are not applicable to
medications for the treatment of OUDs.
Î Oral naltrexone for the treatment of OUD is often adversely affected by
poor medication adherence and should NOT be used except under very
limited circumstances.
• Clinicians should reserve its use for patients who would be able to comply with
special techniques to enhance their adherence, for example, observed dosing.
• Extended-release injectable naltrexone reduces, but does not eliminate, issues with
medication adherence.
Î The Prescription Drug Monitoring Program
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(PDMP) should be
checked regularly for the purpose of confirming medication adherence
and to monitor for the prescribing of other controlled substances.
Î NEW – Naloxone, for the reversal of opioid overdose, should be
provided to patients being treated for, or with a history of, OUD.
Patients and family members/significant others should be trained in
the use of naloxone in overdose.
Treating Opioid Withdrawal
Î Using methadone or buprenorphine for opioid withdrawal management
is recommended over abrupt cessation of opioids. Abrupt cessation
of opioids may lead to strong cravings and/or acute withdrawal
syndrome, which can put the patient at risk for relapse, overdose, and
overdose death.
Î Opioid withdrawal management (i.e., detoxification) on its own,
without ongoing treatment for OUD, is not a treatment method for OUD
and is NOT recommended.
• Patients should be advised about the risk of relapse and other safety concerns,
including increased risk of overdose and overdose death.
• Ongoing maintenance medication, in combination with psychosocial treatment
appropriate for the patient's needs, is the standard of care for treating OUD.
Î Assessment of a patient undergoing opioid withdrawal management
should include a thorough medical history and physical examination
focusing on signs and symptoms associated with opioid withdrawal.
