Approach to medication treatment for opioid use disorder*^¶

LAI: long-acting injectable.

* This algorithm assumes the individual is not pregnant or breastfeeding. Refer to other UpToDate content for information on treatment of opioid use disorder in pregnant or breastfeeding individuals.

¶ In addition to pharmacotherapy, we treat all patients with opioid use disorder with psychosocial intervention if the patient agrees to it. Refer to other UpToDate content in determining psychosocial treatment for opioid use disorder.

Δ Supervised daily oral naltrexone is a reasonable alternative to LAI naltrexone in highly motivated patients who refuse injection and are adherent to medications.

◊ The preferred goal for individuals with opioid use disorder is abstinence from use of all opioids. However, other responses may include lower frequency of use, diminished craving, or harm reduction.

§ We treat opioid use disorder as a chronic disorder in all individuals. We continue to treat indefinitely.