Medication For Opioid Use Disorder (MOUD)

While many valuable resources in the Safer Prescribing Toolkit still use the term “MAT,” our website will refer to it as “MOUD” as this term generally carries less stigma.

The goal of MOUD is to reduce or eliminate harmful opioid cravings and illicit use, encourage treatment engagement, and improve the patient’s quality of life. Any clinician with a DEA license can prescribe buprenorphine for OUD since the elimination of the federal waiver requirement in 2022. There is no “one-size-fits-all” approach for MOUD initiation, and the basic steps listed below should be tailored to individual needs. Please look at the resources listed below for comprehensive information.

Buprenorphine and methadone are first-line medications

There are three evidence-based medications to treat opioid use disorder:

Buprenorphine is a partial opioid agonist and the most practical option for primary care clinicians. Buprenorphine is available in various formulations with and without naloxone.

The FDA-approved formulations include:

Suboxone or Bunavail – sublingual films
Zubsolv or Subutex – sublingual tablets
Sublocade – monthly subcutaneous injection
Brixadi – monthly subcutaneous injection

Methadone is a full opioid agonist and requires daily dispensing at federally certified opioid treatment programs

Extended-release naltrexone is an opioid antagonist that requires patients to abstain from opioids for approximately one week before the first dose to avoid precipitated withdrawal

There are three methods for buprenorphine initiation

Consider engaging with an expert – OPEN has free support for primary care providers initiating MOUD.

Method 1: Low-Dose Initiation

This method is a slow increase in dose of buprenorphine over 5 to 7 days while patient continues to use current opioid.

This is best for patients who are not actively in withdrawal or do not want to experience withdrawal. This also requires that the patient follow instructions carefully.

Method 2: Standard Initiation

This method is for patients starting buprenorphine while in withdrawal.

This is best for patients experiencing moderate withdrawal symptoms. If the patient is not in withdrawal, the patient should stop the opioid for 8-72 hours and start buprenorphine when in withdrawal. This method often requires some monitoring during the initial withdrawal period.

Method 3: High-Dose Initiation

This method is for patients who would benefit from receiving rapid initiation of buprenorphine.

This is best for patients in an emergency department practice needing a quick switch to buprenorphine. This should not be done in the community setting.

Methadone is distributed at physical locations

Often, patients with chronic pain are good candidates for methadone treatment. Patients must go to physical opioid treatment programs (OTPs) to receive their medication daily. Physicians can refer to a facility nearby by searching findtreatment.gov.

Extended-release naltrexone is injected monthly by a healthcare provider

For a patient not actively using opioids, naltrexone can be a good option. It requires monthly injections that can be administered by any healthcare professional. There are some medication interactions and patients must be free of opioid withdrawal signs and symptoms, so it is beneficial to discuss these with your patients.

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Bridge to Treatment: Buprenorphine Hospital Start – Low-Dose Bup Initiation with Opioid Continuation

This organization has extensive resources for primary care, hospital, and ED providers including detailed flow charts for high dose / standard dose / low dose buprenorphine initiation.