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Medications to Treat OUD

Buprenorphine Sublocade™ (extended-release injection), generics
Buprenorphine and naloxone Suboxone® (under-tongue film), Zubsolv® (tablets), Bunavail® (cheek film), generics
Methadone Dolophine®, Methadose, generics
Extended-release naltrexone Vivitrol® (injection)
  • All FDA-approved medications for OUD should be available and accessible to individuals within the justice system. Treatment should be individualized. (See The ASAM National Practice Guideline for the Treatment of OUD, 2020 Focused Update)
  • Buprenorphine and naltrexone for OUD can be prescribed in an office-based setting or opioid treatment program (OTP).
  • Methadone can be dispensed only in an OTP.
  • Buprenorphine and methadone can immediately treat opioid withdrawal in addition to preventing OUD recurrence and overdose.
  • Buprenorphine and methadone can treat chronic pain disorders along with OUD.3
  • Extended-release naltrexone can prevent OUD recurrence and overdose in persons who have not used opioids for at least seven days.

Benefits of Medication for OUD

FDA-approved treatments are evidence-based and proven effective in reducing opioid craving, recurrence of use, overdose, and death in persons with OUD. These medications:

  • Reduce HIV and hepatitis C transmission and reduce other infections such as bloodstream infections and endocarditis (heart valve infection).
  • Does not produce euphoria (“high”) or sedation when appropriately dosed.
  • Help participants feel normal, help them in their recovery, and prevent overdose.
  • Do not substitute one addictive drug for another.
  • Have specific actions on neurotransmitter receptors in the brain that lead to reduced cravings to use, shorten the length of any recurrences, and improve overall addiction and recovery outcomes.
  • Save lives by reducing the chance of overdose.
  • Significantly increase treatment entry and retention among individuals on probation and parole.
  • Do not preclude any other ongoing psychosocial addiction treatment.

Successful OUD treatment, including medications, can increase participant recovery capital in multiple domains. Recovery capital is predictive of treatment outcomes and is described as the breadth and depth of all internal and external resources that can be brought to bear on the initiation and maintenance of SUD remission and recovery.

Medication for OUD and Treatment Courts

Some treatment court team members may be unaware of the benefits of medication for OUD. It is important for treatment court team members to have knowledge of the evidence-based treatments that are available for OUD.

  • Methadone, buprenorphine, and extended- release naltrexone are the most effective treatments available for OUD.
  • Medication for OUD reduces opioid cravings, opioid use, overdose, and death.
  • Medication for OUD supports courts' efforts to reduce recidivism.
  • Medication for OUD should be initiated as soon as possible. That includes when individuals are in treatment court, pretrial, probation, jail, prison, parole, and reentry statuses.
  • Treatment court clinicians and clinical case managers are instrumental in linking participants to providers who can prescribe or dispense medications for OUD, no matter where they are in the treatment court process.
  • Individuals attempting to enter, progress through, or complete treatment court should not be forced to discontinue or be prevented from initiating medication for OUD.
    • It is a violation of citizen constitutional rights (Eighth Amendment) to not have access to medical care while incarcerated. Methadone can be dispensed only in regulated settings, such as OTPs. Some jails and prisons include medical units where methadone is dispensed.
      • OTPs are federally designated locations where persons with OUD can go to receive medication for treatment.
      • OTPs provide medication for OUD, including methadone, and counseling to participants with OUD. They are approved by the Substance Abuse and Mental Health Services Administration (SAMHSA) and regulated at the federal level.
  • The duration of medication treatment should not be predetermined. There is no recommended length of time for continuing medication for OUD. It is dependent on the severity of illness, outcome, response to treatment, and desires of the patient. Some patients will continue to benefit from medication for many years.
  • Treatment courts should support the continued use of medication for OUD throughout the treatment court program process.
  • Treatment courts should facilitate access for medication for OUD.
  • Treatment courts should avoid using jail sanctions for participants prescribed medication for OUD unless the medication can be continued without interruption during incarceration.
  • Incarceration is not an effective overdose prevention strategy. Even brief incarceration without medication for OUD increases the risk of overdose immediately after release.