OUD Treatment Protocols
OUD Treatment Protocols
Medication-Assisted Treatment (MAT)
MAT is the gold standard for opioid use disorder treatment. It combines FDA-approved medications with counseling and behavioral therapies.
Why MAT Works
- Reduces cravings and withdrawal symptoms
- Blocks euphoric effects of opioids
- Normalizes brain chemistry
- Allows focus on recovery and life rebuilding
- Reduces overdose risk by 50%+
The Three FDA-Approved Medications
How we speak about addiction affects patient care and recovery. Use person-first language to reduce bias.
1. Buprenorphine (Suboxone, Subutex)
Mechanism: Partial opioid agonist—activates receptors enough to prevent withdrawal but not enough for euphoria.
| Aspect | Details | |--------|---------| | Administration | Sublingual tablet/film, monthly injection | | Setting | Office-based (OBOT), can take home | | Ceiling Effect | Yes—overdose risk lower | | Induction | Must be in mild withdrawal first |
Induction Protocol (Simplified):
- Patient abstains from opioids 12-24 hours
- Confirm withdrawal (COWS score ≥ 8)
- Start with 2-4mg buprenorphine
- Additional doses every 2 hours as needed
- Target 8-16mg/day for most patients
2. Methadone
Mechanism: Full opioid agonist—fully activates receptors, long half-life.
| Aspect | Details | |--------|---------| | Administration | Daily oral liquid | | Setting | Licensed OTP clinic only | | Ceiling Effect | No—overdose possible | | Induction | Can start immediately |
Key Considerations:
- Requires daily clinic visits initially
- Take-home doses earned over time
- Higher stigma but very effective
- Better for high-dose opioid users
3. Naltrexone (Vivitrol)
Mechanism: Opioid antagonist—blocks receptors completely.
| Aspect | Details | |--------|---------| | Administration | Monthly injection or daily pill | | Setting | Any healthcare setting | | Ceiling Effect | N/A—no opioid activity | | Induction | Must be opioid-free 7-14 days |
Key Considerations:
- No abuse potential
- Requires complete detox first (challenging)
- If patient uses, no effect—may try to overcome with high doses (overdose risk)
- Good for highly motivated patients
Comparing Medications
| Factor | Buprenorphine | Methadone | Naltrexone | |--------|---------------|-----------|------------| | Retention | High | Highest | Moderate | | Overdose Risk | Low | Moderate | Low (but risk if stopped) | | Accessibility | High (office) | Low (clinic only) | High | | Withdrawal Prevention | Yes | Yes | No (must be off opioids) | | Patient Freedom | High | Low initially | High |
Indian Context: Available Treatments
Buprenorphine in India
- Available as Addnok, Norphin
- Can be prescribed by registered doctors
- Often used in OST (Opioid Substitution Therapy) centers
- NACO guidelines for dosing
Methadone in India
- Limited availability
- Only at licensed OST centers
- Primarily in high-burden states
Naltrexone in India
- Available but underutilized
- Nodict, Naltima brands
- Often used after detox programs
Psychosocial Treatments
Medication alone is not enough. Combine with:
Counseling Approaches
- Motivational Interviewing (MI): Building motivation for change
- Cognitive Behavioral Therapy (CBT): Identifying triggers, coping skills
- Contingency Management: Rewards for negative drug tests
- 12-Step Facilitation: AA/NA connection
Support Systems
- Family involvement and education
- Peer support specialists
- Case management for housing, employment
- Support groups (NA, SMART Recovery)
Treatment Planning
Initial Assessment
- Substance use history (substances, amounts, routes)
- Medical history (HIV, Hepatitis, other conditions)
- Mental health screening
- Social supports and barriers
- Previous treatment experiences
- Patient preferences and goals
Shared Decision-Making
"What matters most to you in your treatment?"
Help patients choose based on:
- Lifestyle and work requirements
- Previous treatment responses
- Support system availability
- Personal preferences
📚 Learn More
Learning Resources
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