What Is Medication for Opioid Use Disorder (MOUD)? Plus, 8 More FAQs About This Treatment

If you or a loved one has been diagnosed with opioid use disorder, you may be wondering about the treatment options available. One approach, medication-assisted treatment (MAT) — also known as medication for opioid use disorder (MOUD) — combines medications with nonmedication treatments (like therapy and support groups) to treat opioid use disorder. 

MOUD has been used successfully to help people achieve remission, reduce the risk of opioid overdose, and improve quality of life.

Here, we’ll cover frequently asked questions about MOUD and the medications used as part of this treatment method.

In this article, we’ll use MOUD because it’s the most accurate term to describe the method of using medications to treat opioid use disorder.

1. What is medication for opioid use disorder (MOUD)?

Medication for opioid use disorder (MOUD) is the medical term for combining medications and nonmedication treatments to manage opioid use disorder. 

MOUD is the gold standard for treating opioid use disorder. Medications that may be used as part of MOUD include:

• Methadone liquid, tablets, and dissolvable powder and tablets (Methadose)

• Buprenorphine tablets and injection (Sublocade, Brixadi)

• Buprenorphine / naloxone tablets (Zubsolv) and sublingual film (Suboxone)

• Naltrexone tablets and injection (Vivitrol)

Nonmedication treatments may include:

• Cognitive behavioral therapy (CBT)

• Contingency management therapy

• Motivational interviewing

• Group therapy programs

2. MAT versus MOUD: Are they the same thing?

Yes, MAT and MOUD refer to the same thing: the use of medication along with therapy and counseling to treat opioid use disorder.

Several experts have shifted away from using the phrase MAT in recent years. Instead, they believe MOUD better represents the importance of medications in treating opioid use disorder. 

The term MOUD may also better represent the concept that medications can provide benefit to someone with opioid use disorder even if they aren’t in therapy or counseling.

3. How does MOUD work?

The two categories of MOUD — medications and therapy — work in different ways to treat opioid use disorder.

First, medications used in MOUD work quickly to balance chemicals in your brain. The three FDA-approved medications for MOUD work in the following ways:

• Methadone is an opioid that attaches to opioid receptors. It has the same expected effects as other opioids. But it works more slowly and lasts a long time, keeping levels steady in your blood. When used for OUD, methadone doesn’t cause a high the way other opioids can. Instead, it helps relieve opioid withdrawal symptoms and cravings.

• Buprenorphine has opioid properties, too. But it’s a partial opioid. It attaches strongly to opioid receptors (more strongly than most opioids), but it doesn’t fully active them like typical opioids do. Buprenorphine relieves opioid withdrawal symptoms and cravings.

• Naltrexone isn’t an opioid. It is an opioid blocker (antagonist), meaning it blocks opioid receptors. So it blocks the rewarding effects of opioids in your body and reduces cravings. But it doesn’t help reduce withdrawal symptoms.

Second, therapy and counseling can provide insight into the various factors and behaviors that may have led to opioid use disorder.

4. Does MOUD work?

Simply put, MOUD works. For most people, using medications along with therapy and counseling is better than using therapy and counseling alone for treating opioid use disorder. 

Research has found that when using medications to treat opioid use disorder:

• Using buprenorphine or methadone decreases opioid use and improves overall health in the short term (less than 6 months).

• Using buprenorphine or methadone reduces the risk of death, including from opioid overdose.

• Buprenorphine and methadone may reduce intravenous opioid use and therefore reduce HIV transmission.

• People who use medications are more likely to stay engaged in treatment than people who don’t use medications.

However, there are barriers to using MOUD. These include inadequate access to medications, stigma about using medications to treat opioid use disorder, and lack of social support for people with opioid use disorder. 

It’s important to remain engaged in a treatment program and keep in close contact with your prescriber if you’re receiving medications. To give MOUD the best chance of working, long-term treatment is often necessary.

5. How do you know which MOUD medication is best for you?

There isn’t one MOUD medication that’s best for everybody. The best medication for you depends on your individual needs and goals.

In general, methadone and buprenorphine are considered first-choice treatment options for opioid use disorder. Injectable naltrexone may also be a good option for some people. But research has shown that methadone and buprenorphine are typically more effective than injectable naltrexone. 

While we don’t have a lot of studies directly comparing these medications, it’s known that people using naltrexone have higher rates of stopping treatment for opioid use disorder. Still, studies of people who stick with injectable naltrexone treatment found that it’s more effective than placebo (an injection with nothing in it) at treating opioid use disorder. Of note, oral naltrexone isn’t usually recommended as part of MOUD, even though it's FDA approved for this reason.

Methadone has been used the longest for MOUD, so we have the most research on it. Some research shows that people taking methadone may be more likely to remain in treatment than people taking buprenorphine. But other research suggests that when buprenorphine is used at  higher doses, it’s just as effective as methadone.

Your treatment team can work with you to determine whether methadone, buprenorphine, or naltrexone is the best option for you. Below, we’ll go over a few things to consider.

Ability to attend a treatment facility daily

If you’re prescribed methadone, you’ll need to visit a certified opioid treatment program. Initially, you’ll need to visit the clinic daily to get your methadone dose. Once you're stable, it’s possible to receive a month’s supply at once.

However, any healthcare professional (HCP), including primary care providers, can prescribe buprenorphine if they have a Drug Enforcement Agency (DEA) license. You can pick up oral buprenorphine products at your local pharmacy.

If you’re prescribed the naltrexone injection, you’ll need to go to your prescriber’s office once a month to receive your dose. Any HCPl with prescribing abilities can prescribe oral naltrexone, and you can pick it up at your local pharmacy.

Whether you’re able to take a daily medication

Oral buprenorphine, methadone, and naltrexone are typically taken daily. 

But some injectable buprenorphine products and injectable naltrexone may be administered less frequently. A medical professional has to administer them in a healthcare setting. Subloclade and Vivitrol are given once monthly. Brixadi may be given once a month or once a week.

Whether you’re able to stop taking opioids before starting MOUD

You don’t have to wait a certain amount of time after your last opioid dose to start taking methadone.

However, you may need to avoid opioids for 7 to 10 days before starting naltrexone. This is because it blocks opioid effects, so starting it while you’re still taking opioids can cause opioid withdrawal symptoms. This may include nausea and vomiting, sweating, and agitation. 

Starting buprenorphine while you have opioids in your system can also cause withdrawal symptoms. This is because buprenorphine can block the effects of other opioids. Some prescribers may want you to wait a certain amount of time between your last opioid dose and taking buprenorphine. The exact amount of time may depend on what opioid you were using.

But some prescribers are using new methods for starting buprenorphine as part of MOUD. It’s possible that you can receive small buprenorphine doses if you still have opioids in your system. This eliminates the need to go through opioid withdrawal before starting buprenorphine.

Other health conditions you may have

In some instances, other health conditions you have may make one MOUD medication a better option for you. For example, methadone can cause heart rhythm problems. If you have an existing heart rhythm problem, buprenorphine or naltrexone may be a better option.

On the other hand, naltrexone and buprenorphine can rarely cause liver damage. So if you have existing liver problems, methadone may be a better option for you.

Make sure your prescriber knows your full medical history before starting a medication for opioid use disorder. This will help them decide whether one medication is safer than another.

Other medications you take

Methadone, buprenorphine, and naltrexone can interact with several other medications. So make sure to give your pharmacist and prescriber a list of all the medications you take. Include over-the-counter products as well. This will help them check for interactions. 

If a serious potential interaction exists, they may recommend one medication over another.

6. Is MOUD ‘replacing one drug for another’?

No. In fact, the assumption that MOUD is replacing one drug for another is a barrier to widespread use of MOUD.

There are several reasons that many people have these false assumptions about MOUD. One reason is that the original methadone clinics from several decades ago look and feel different than your typical doctor’s office. They were also located far away from healthcare facilities. This created a stigma around these clinics. With some clinics, this is still the case.

Additionally, traditional opioid use disorder programs emphasized quitting opioids without the use of medications. People using MOUD may receive pushback from employees in these programs. But when used under the care and guidance of an HCP, MOUD can be lifesaving. It can help with cravings and withdrawal symptoms, allowing you to focus on your recovery.

7. Does MOUD have any risks?

Like all medications, methadone, buprenorphine, and naltrexone can have side effects. But MOUD can save lives and is considered the safest option for treating opioid use disorder. So the benefits of MOUD usually outweigh the risks.

Still, we’ll cover some possible side effects below.

8. How long do you have to take medications for opioid use disorder?

How long you’ll need MOUD depends on several factors, including how severe your OUD is. In general, you’ll receive the greatest benefit if you use these medications consistently over a long period of time.

In general, 3 months is the minimum amount of time needed for MOUD and other treatments to work. And usually, significantly longer is needed. For example, experts recommend at least 12 months of methadone for effective treatment of opioid use disorder. And several people may need MOUD indefinitely.

Good to know: If you’re considering stopping medications for opioid use disorder, discuss the pros and cons with your prescriber. There are risks to stopping MOUD, including opioid cravings, relapse, and overdose. Additionally, stopping methadone and buprenorphine too quickly can cause opioid withdrawal symptoms. So your healthcare team will help you come up with a plan for reducing your dose slowly.

9. How can you get medications to treat opioid use disorder?

If you think you have opioid use disorder, reach out to your primary care provider right away. Signs of opioid use disorder include taking more opioids than what’s prescribed, using opioids in situations that are dangerous, and spending long amounts of time using opioids.

In some cases, your primary care provider can manage your treatment. They may be able to prescribe naltrexone or buprenorphine products. However, methadone for opioid use disorder can only be prescribed and obtained through an opioid treatment program.

In many cases, your primary care provider may refer you to an HCP who specializes in addiction medicine. They’ll be able to help you navigate treatment options. You can also use SAMHSA’s online treatment locator to search for programs in your area.

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.

Good to know: If you or someone in your household takes opioids or has opioid use disorder, it’s strongly recommended to carry naloxone (Narcan, Zimhi) on you at all times. This is a fast-acting medication that can reverse the effects of an opioid overdose. There are various ways to obtain it, including with or without a prescription and OTC.

How to save on MOUD

Typically, Medicare and Medicaid programs cover MOUD. Commercial insurance plans are required to offer some level of coverage as well. To learn exactly what’s covered by your insurance, contact your provider.

If you don’t have insurance, or you’re underinsured, there are other ways to save. GoodRx may be able to help you save over 70% off the average retail price of generic MOUD medications with a free discount. You may be able to pay as low as:

• $32.40 for oral naltrexone tablets

• $44.00 for oral buprenorphine tablets

• $51.97 for oral buprenorphine / naloxone tablets

• $50.09 for oral buprenorphine / naloxone film

You may also be able to save with a copay savings card or patient assistance programs from the manufacturer of:

• Suboxone: You may be eligible to pay as little as $5 per month if you have commercial insurance or no insurance.

• Zubsolv: You may be able to pay as little as $10 if you have commercial insurance or no insurance.

• Sublocade: If you have commercial insurance, you may be able to receive Sublocade for free each month.

• Brixadi: You may be able to receive Brixadi for free each month if you have commercial insurance

• Vivitrol: If you have commercial insurance, you may be able to save up to $500 a month on out-of-pocket costs.

Why trust our experts?

Written by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Jonathan Avery, MD

Jonathan Avery, MD, is the current vice chair of addiction psychiatry and an associate professor of clinical psychiatry at Weill Cornell Medical College and New York-Presbyterian Hospital.

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