Approach to medication treatment for opioid use disorder^*¶

LAI: long-acting injectable; OUD: opioid use disorder.

* This algorithm assumes the individual is not pregnant or breastfeeding. Refer to UpToDate content for information on treatment of OUD in pregnant or breastfeeding individuals.

¶ In addition to pharmacotherapy, we treat all patients with opioid use disorder with psychosocial intervention if the patient agrees to it. Refer to UpToDate content on psychosocial treatments for OUD.

Δ Physical dependence is defined as evidence of tolerance or withdrawal. Refer to UpToDate content on opioid use disorder for details.

◊ Supervised daily oral naltrexone is a reasonable alternative to LAI naltrexone in highly motivated patients who refuse injection and are adherent to medications.

§ The preferred goal for individuals with OUD is abstinence from use of all opioids. However, other responses may include lower frequency of use, diminished craving, and/or improved psychosocial functioning.

¥ We treat OUD as a chronic disorder in all individuals. We continue to treat indefinitely.

‡ Methadone treatment is an acceptable alternative for these individuals if they have not previously tried it and have access to methadone treatment.