Chapter 13. Methadone and Buprenorphine Maintenance Treatment of Opioid-Related Disorders

Abstract

In this chapter we review the use of methadone and buprenorphine for the treatment of opioid-related disorders. Both of these medications are effective and safe and are widely used throughout the world. Methadone has been in use since the 1960s. In the early years of its use, methadone demonstrated that opioid use disorder, previously seen as having a poor prognosis, could be effectively treated. In the United States as well as other parts of the world, methadone treatment is often delivered through a special clinic system. While for many years methadone clinics existed on the fringes of the health care system, recent years have seen these clinics and the clinic system become more integrated into mainstream medical care. Today, standards of treatment for opioid use disorder follow approaches used in other health care settings. Buprenorphine likewise has made a substantial impact on the treatment of patients with opioid use disorder. Buprenorphine has been used for this indication for more than 20 years, and in the United States it can be prescribed in office-based practices, providing improved access to treatment for patients who do not have methadone clinics (now called opioid treatment programs in the United States) located near them. Methadone and buprenorphine are effective, but the complexities of treating patients with opioid use disorder often require nonpharmacological treatments as well, such as counseling and contingency management strategies. While not the focus of this chapter, those treatments combined with these medications can exert powerful positive impacts on patients. Through integrated medication and nonmedication treatments, patients can be assisted in addressing the direct and indirect consequences of their use of opioids, and grow and thrive in their lives.

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