Methadone is a full agonist at opioid receptors in the brain, and is the longest-standing and most scientifically proven medication treatment for opioid use disorder. It reduces opioid withdrawal and cravings, and protects against opioid overdose, in addition to improving numerous other health and social outcomes. Only the oral formulation of methadone is approved for the treatment of opioid use disorder, and it can only be provided in Opioid Treatment Programs (OTPs) with certification from the Drug Enforcement Administration, SAMHSA, and NYS OASAS.
You can use the OASAS Provider Directory to locate addiction 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.
- Select Treatment Programs under Program Type
- Select Opioid Treatment Program from the Search by drop down menu
- Narrow by location and/or proximity
Naltrexone is an opioid receptor antagonist that comes in oral (brands: ReVia, Depade) and long-acting injectable (brand: Vivitrol) formulations. Both formulations are indicated for alcohol use disorder, and the long-acting injectable formulation is indicated to treat opioid use disorder. For alcohol use disorder, naltrexone works by blocking opioid transmission in the brain’s reward pathway, thereby reducing the pleasurable effects of drinking alcohol. It is helpful for both reducing recurrence in someone who is abstinent from alcohol and reducing binges/heavy drinking episodes in someone who is not abstinent. For opioid use disorder, it blocks the rewarding effects of opioid use and protects against overdose. It also may reduce opioid cravings over time. The oral formulations are dosed 50mg PO daily, 100mg PO every other day, or 150mg PO every third day. The long-acting injection is given 380mg IM every 4 weeks. Due to the risk of medically serious protracted opioid withdrawal, naltrexone – especially the long-acting injection – is contraindicated in people who need to be on opioids for pain, in people who have used opioids in the past 7-10 days, and in people who have a positive urine drug screen for opioids and/or fail a naloxone challenge test. It is also contraindicated in people with acute and/or serious liver disease, in people with an allergy to naltrexone, and during pregnancy and nursing.
Buprenorphine for the treatment of opioid use disorder comes in sublingual/buccal dissolvable (brands: Suboxone, Zubsolv, Bunavail, Cassipa, Subutex), long-acting implantable (brand: Probuphine), and long-acting injectable (brand: Sublocade) formulations. It is a partial opioid receptor agonist (i.e., agonist and antagonist properties) at opioid receptors in the brain. Like most partial agonists, it exhibits a ceiling effect, which means that once a certain receptor occupancy desired dosage level has been achieved, additional dosing does not produce additional effects, including greatly reducing the typical possible opioid overdose effects of respiratory depression and/or death. Sublingual formulations that combine it with naloxone, in a 4:1 ratio, are meant to prevent both diversion of the drug and intravenous injection. The withdrawal syndrome seen with buprenorphine is much milder than that of other full agonist opioids, though if started prior to a patient entering mild-to-moderate opioid withdrawal, it can cause a highly uncomfortable precipitated withdrawal. It reduces opioid withdrawal and cravings, and protects against opioid overdose. Doses for the sublingual/buccal formulations range from 2 mg to 32 mg, with the average being approximately 16 mg. The dose for the implantable formulation is 320mg every 6 months, and the dose for the long-acting injection is 100-300mg SC monthly.
The Drug Addiction Treatment Act of 2000 (DATA-2000) revised the legislation allowing physicians to prescribe narcotic drugs in schedule III, IV,V or combinations of such drugs, for the treatment of opioid dependence. Physicians qualified to prescribe buprenorphine for addiction in New York State are those who:
- Have a subspecialty certification in Addiction Psychiatry from the American Board of Medical Specialties; or
- Are certified in Addiction Medicine by the American Society of Addiction Medicine (ASAM) or by the American Osteopathic Academy of Addiction Medicine (AOAAM); or
- Have completed not less than 8 hours of approved training or have participated as an investigator in a clinical trial of buprenorphine.
- The Comprehensive Addiction and Recovery Act (CARA) of 2016 and the Substance Use-Disorder Prevention Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act of 2018 authorized eligible nurses (NP/CNM/CNS/CRNA) and physicians assists to prescribe buprenorphine for opioid use disorder after completing 24 hours of training.
- The Providers Clinical Support System has free, online buprenorphine waiver training.
- ASAM Buprenorphine is a eight-hour course and a four-hour follow-up course
- Department of Health Buprenorphine Mentoring Program - If you are qualified to treat opioid addiction but are not prescribing buprenorphine, you may join a buprenorphine mentorship program. For information, please email [email protected]v.
For more information about buprenorphine from the New York State Department of Health, including helpful materials for clinicians developed for their Buprenorphine Public Health Detailing Initiative, visit the NYS DOH Buprenorphine page.