Methadone
Methadone is a full agonist opioid which acts at opioid receptors in the brain and is used to treat opioid use disorder. It reduces opioid withdrawal symptoms and opioid cravings, decreases the risk for opioid overdose with return to opioid use, and leads to positive effects with respect to the health and wellbeing of persons taking it.
Methadone is approved by the Food and Drug Administration (FDA) for the treatment of opioid use disorder and only can be dispensed in Opioid Treatment Programs (OTPs) with certification from the Drug Enforcement Administration (DEA), SAMHSA, and NYS OASAS.
You can use the OASAS Provider Directory to locate substance use disorder treatment providers, including Opioid Treatment Programs, near you. The searchable directory allows you to filter by county, region, city, zip code and proximity to help narrow your search.
To find an Opioid Treatment Program in the OASAS Provider and Program Directory:
- Select Treatment Programs under Program Type
- Select Opioid Treatment Program from the Search by drop down menu
- Filter by location and/or proximity
Naltrexone
Naltrexone is an opioid receptor antagonist that attaches to opioid receptors in the brain and blocks the effects of opioids at the receptors. Naltrexone comes in oral (ReVia) and long-acting injectable (Vivitrol) formulations. Both formulations are indicated for alcohol use disorder, but only the long-acting injectable formulation is indicated to treat opioid use disorder.
Information about naltrexone for the treatment of alcohol use disorder can be found in the section on medications for alcohol use disorder. For opioid use disorder, naltrexone binds to opioid receptors and blocks the effects of opioids, which may reduce opioid use. An individual must have a trial of the oral formulation before starting the long-acting injectable formulation to ensure that they do not have an allergic response or intolerable side effects.
Due to the risk of precipitated, protracted opioid withdrawal, naltrexone is contraindicated in people who are using opioids, whether prescribed to treat chronic pain or taken illicitly who have used opioids in the past 7-10 days, and who have a positive urine toxicology test for opioids and/or fail a naloxone challenge test. It is also contraindicated in people with acute and/or severe liver disease, and in people with an allergy to naltrexone. It should be used with caution in pregnant persons.
Buprenorphine
Buprenorphine is a Food and Drug Administration (FDA) approved medication for the treatment of opioid use disorder. Buprenorphine is a partial opioid agonist at opioid receptors in the brain. It reduces opioid withdrawal symptoms and opioid cravings and protects against opioid overdose with a return to opioid use.
As a partial agonist, it has a ceiling effect, meaning, once the receptors are occupied, additional dosing does not produce additional effects. This means buprenorphine is safer than other opioids with a reduced risk for overdose and death associated with it. It also means that persons who have physical dependence to opioids will not experience euphoria when taking buprenorphine.
Buprenorphine is available in several formulations: sublingual or buccal dissolvable tablets or films (Suboxone, Zubsolv, Bunavail, Subutex), and long-acting injectable (Sublocade) formulations. Sublingual and buccal formulations combine buprenorphine with naloxone, in a 4:1 ratio, intended to deter both medication diversion and use of the medication by injection.
Typically, an individual must already be experiencing moderate opioid withdrawal to initiate buprenorphine. If individuals initiate buprenorphine before they are experiencing moderate withdrawal, this can cause opioid withdrawal. With the wide availability of illicitly manufactured fentanyl and its analogues in substances acquired on the street and because fentanyl and its analogues can remain in fatty tissue, nonconventional strategies, such as buprenorphine micro-induction dosing or macro-induction dosing, may need to be utilized instead of conventional approaches to initiate buprenorphine successfully. Currently, there is no consensus on best practice for these protocols.
- The Drug Addiction Treatment Act of 2000 (DATA-2000) and its revisions allow physicians, physician assistants, and advanced practice nurses to prescribe medications that are Schedule III, IV, V or combinations of such medications, for the treatment of opioid use disorder.
- For providers intending to prescribe buprenorphine to 30 or fewer persons at any given time, no education is required to obtain a waiver to prescribe buprenorphine.
- For providers intending to prescribe buprenorphine to 31 or more persons at any given time, there are educational requirements which must be completed before applying for a waiver to prescribe buprenorphine.
For more information on obtaining a waiver to prescribe buprenorphine, see the SAMHSA website here.
Training
- Despite the removal of the educational requirement before obtaining a DEA waiver for providers intending to prescribe buprenorphine to 30 or fewer persons at any given time, it still is recommended that providers familiarize themselves with buprenorphine, particularly its pharmacology, before prescribing it. Persons may still opt to do the entire waiver training or may choose shorter educational options.
- Mentoring options for newer buprenorphine prescribers can be found through several sites:
For more information about buprenorphine from the New York State Department of Health, including helpful materials for providers developed for their Buprenorphine Public Health Detailing Initiative, visit the NYS DOH Buprenorphine page.