Written by Shannon Markus
Spoon Feed
Medications for opioid use disorder—such as buprenorphine, methadone, and naloxone—are highly effective treatments across the spectrum of OUD, from withdrawal management to overdose reversal, but continue to be underutilized despite strong evidence of benefit.
Beyond naloxone: meds that change the course of OUD
Opioid use disorder (OUD) affects millions globally and carries high mortality, with nearly 20% of people with severe OUD dying from overdose. Despite effective treatments, only ~25% of patients receive medications for OUD. Buprenorphine and methadone are first-line treatments that reduce illicit opioid use, improve quality of life, and lower mortality by ~50–60%, which is huge! Methadone has slightly higher treatment retention but requires dispensing through licensed programs. Naltrexone has lower initiation and retention rates. Importantly, detoxification without MOUD increases relapse and overdose risk.
This review was packed with good information, so I summarized the key medications into a quick-reference table you can save for use on shift.
- Opioid Use Disorder (MOUD) medications: buprenorphine, methadone, naltrexone
- Opioid Withdrawal medications: buprenorphine, methadone, α2-agonists (clonidine, lofexidine)
- Symptomatic adjuncts include loperamide (for diarrhea), ondansetron (nausea), NSAIDs (myalgias), antihistamines or benzodiazepines (anxiety/insomnia).
- Opioid Overdose Medications: naloxone/“Narcan” (opioid antagonist)
How does this affect my practice?
For me, this review reinforces that opioid use disorder is a treatable condition and also provides clear recommendations on starting ED treatment that can and will save many lives. With our high exposure to OUD in the ED, we play a big role in recognizing withdrawal, offering medication-assisted treatment, and ensuring patients leave with overdose prevention tools like naloxone spray. Rather than considering these visits as isolated in-and-out events, the ED can serve as an entry point to long-term recovery for patients with OUD.
Click to download PDF version of this table.
Source
Medications for Opioid Use Disorder, Opioid Withdrawal, and Opioid Overdose: A Review. JAMA. 2026 Feb 11. doi: 10.1001/jama.2025.26348. Epub ahead of print. PMID: 41671014.
