Opioid Addiction Treatment: Understanding Your Options and Finding Help

Opioid use disorder is a treatable medical condition, and it has the strongest evidence base of any substance use disorder. That matters, because the most damaging belief about opioid treatment is that medication is somehow cheating.

Start with an assessment

Before treatment decisions, a clinician should look at what you are using, how much, for how long, your physical and mental health, and whether you are pregnant. Fentanyl has made the picture more urgent: it is highly potent, and it now appears in counterfeit pills and in supplies sold as other drugs.

An assessment is not an admission. You can be assessed, discuss options, and decide later.

Medications for opioid use disorder

Three medications are used most often.

Buprenorphine is a partial opioid agonist, which means it reduces cravings and withdrawal without producing the same full effects. It is usually prescribed by a clinician and taken daily at home, sometimes as a combination product with naloxone. It has a ceiling effect that makes overdose on buprenorphine alone less likely than with full agonists.

Methadone is dispensed through a licensed opioid treatment program. It has been used for decades and is well studied. Initially, dosing is supervised at the clinic; take-home doses are possible over time as requirements are met.

Naltrexone blocks opioid effects rather than replacing them. It requires you to be fully through withdrawal before starting, which can be difficult for some people, but it suits others well.

Research consistently associates these medications with reduced overdose deaths, better retention in care, and less illegal opioid use. The choice between them is a clinical decision based on your history and what is available near you.

If a program tells you that medication is not real recovery, that is a red flag. Ask for a referral somewhere that offers it, or contact the SAMHSA National Helpline at 1-800-662-4357 and ask specifically for medication treatment options.

Counseling and behavioral support

Medication can do a lot, and so can support around it. Counseling options include individual therapy, group treatment, and contingency management, which uses small incentives for verified progress and has strong evidence in stimulant and opioid use.

You do not have to choose between medication and counseling. Combining them helps many people, and peer support can run alongside both.

Overdose risk after a break in use

Tolerance to opioids drops quickly, and it drops fastest after any break: time in jail, a hospital stay, a detox program, or a period of abstinence. Returning to a familiar dose after that break is how many fatal overdoses happen.

If you are coming back from a break, assume your tolerance is lower than you remember. This is a reason to have naloxone on hand and to avoid using alone. It is also a strong reason to get back in touch with a treatment provider, who can adjust a medication plan rather than leaving you to guess.

Naloxone and what it can and cannot do

Naloxone is a medication that reverses an opioid overdose. It is available in many pharmacies, often through standing orders, and from community harm reduction programs. Our harm reduction resources explain how to get it and who to ask.

What naloxone does: it can restore breathing during an opioid overdose, and it buys time.

What naloxone does not do: it is not a substitute for emergency care. After naloxone, call 911. Someone who has been revived can go back into overdose as the naloxone wears off, and the underlying emergency has not been resolved.

Signs of an opioid overdose include very slow or stopped breathing, blue or grey lips and fingertips, limpness, and unresponsiveness. If you see those signs, call 911, give naloxone if you have it, and stay with the person.

How to find a provider

• FindTreatment.gov lets you filter for facilities offering medication for opioid use disorder, and by payment option.
• SAMHSA's National Helpline, 1-800-662-4357, can search for medication providers with you, free and confidentially, 24 hours a day.
• Community health centers, found through the HRSA health center finder (opens in a new tab), often prescribe buprenorphine and serve people regardless of insurance status.
• Your state Medicaid program, if you qualify, covers treatment and medication in most states.

A final word

You are allowed to start treatment without being certain you will never use again. You are allowed to stay on medication for as long as it helps. You are allowed to have tried before and be trying again. None of that means you are doing it wrong.

If you are in immediate danger, call 911. If you are thinking about suicide, call or text 988. For help finding treatment, our national resource directory is a good next stop.