Decisions in Recovery: 

Treatment for Opioid Use Disorder

Handbook
This decision support tool was developed with funding from the federal 

Substance Abuse and Mental Health Services Administration (SAMHSA). 

It was prepared by the Center for Social Innovation with Advocates 

for Human Potential, Inc. under Bringing Recovery Supports to Scale 

Technical Assistance Center Strategy (BRSS TACS); contract number 

HHSS280201100002C, SAMHSA, U.S. Department of Health and Human 

Services (HHS). Cathy Nugent, Marsha Baker, and Deepa Avula served 

as the Contract Officer Representatives. 

Disclaimer 

The views, opinions, and content of this decision support tool are those of 

the authors and do not necessarily reflect the views, opinions, or policies 

of SAMHSA. 

Public Domain Notice 

All material in this decision support tool is in the public domain and may 

be reproduced or copied without permission from SAMHSA. Citation of 

the source is appreciated. However, this material may not be reproduced 

or distributed for a fee without the specific written authorization of the 

Office of Communications, SAMHSA, HHS. 

Electronic Access and Copies of the Material 

This decision support tool and the accompanying handbook can be 

accessed electronically on the World Wide Web at 

http://www.samhsa.gov/brss-tacs/shared-decision-making

Recommended Citation 

Substance Abuse and Mental Health Services Administration. (2016). 

Decisions in Recovery: Medications for Opioid Use Disorder. [Electroni

Decision Support Tool] (HHS Pub No. SMA-16-4993), 2016. Available 

from http://www.samhsa.gov/brss-tacs/shared-decision-making 

c 

 

Originating Office

Division of Pharmacologic Therapies, Center for Substance Abuse 

Treatment (CSAT) and the Center for Mental Health Services (CMHS), 

SAMHSA, 1 Choke Cherry Road, Room 2-1007, Rockville, MD 20850. 

Phone: 1-877-SAMHSA-7 (726-4727). Website: www.dpt.samhsa.gov. 

Contributors 

The following organizations and individuals participated in the 

development, review, and evaluation of this decision support tool. 

Prime Contractor 

Center for Social Innovation, Inc. (C4) 

200 Reservoir St., Suite 202 

Needham, MA 02494 

http://center4si.com 

BRSS TACS Project Director: Livia Davis 

Project Director/Developer: Dr. Wayne A. Centrone 

Subcontracted Project Co-Director/Developer: Laurie Curtis, AHP 

Content Expert, Lead Writer, Editor: Niki Miller, AHP 

Subcontractor 

Advocates for Human Potential, Inc. (AHP) 

41 State Street, Suite 500 

Albany, NY 12207 

http://www.ahpnet.com 

Center for Social Innovation Development Team 

Nick Garza, Megan Grandin, Corey Grant, Baldwin Martinez, George 

Payne, Alex Shulman, Erika Simon, Monica Terry, Lisa Carlucci Thomas, 

Michael Torocsik, Alan Zaitchik 

Video Production Writer, Producer, Videographer, Editor: Alexander 

Steacy, Erika Simon, 

Graphics, Photographer, Colorist: Kristen Nichols 

Cast: Tarah Johnson 

Music: M. R. Miller 

Consultant 

Lisa Mistler, M.D. 

Assistant Professor of Psychiatry 

Geisel School of Medicine; Dartmouth University 

lisa.a.mistler@dartmouth.edu 

References/Sources 

Sources of information used to create this handbook are listed online at 

http://www.samhsa.gov/brss-tacs/shared-decision-making, under “About 

This Tool.” 

Special thanks to the following organizations for their support and 

contributions: 

• AIDS Resource Center of Wisconsin, Milwaukee, Wisconsin

• American Association for the Treatment of Opioid Dependence

(AATOD) 2012 National Conference, Las Vegas, Nevada

• Harm Reduction Coalition, Oakland, California

• Casa Segura–The HIV Education and Prevention Project, Alameda

County, California

• Medication Assisted Recovery Services (MARS) Project, New York,

New York

• National Alliance for Medication Assisted Recovery (NAMA), New York,

New York

• Office-Based Buprenorphine Induction Clinic (OBIC) San Francisco

General Hospital, San Francisco, California

• Opioid Treatment Outpatient Program, San Francisco General

Hospital, San Francisco, California

• Outside In Medical Clinic, Portland, Oregon

• Tom Waddell Health Center, San Francisco, California

• West End Clinic, Massachusetts General Hospital, Boston,

Massachusetts

The following individuals also contributed significantly to the 

development and content of this decision support tool: 

• Gavin Bart, Hennepin County Medical Center, Division of Addiction

Medicine, Minneapolis, Minnesota

• Thomas Freese, Pacific Southwest Addiction Technology Transfer

Center (ATTC), Los Angeles, California

• Walter Ginter, Medication Assisted Recovery Support (MARS) Project,

New York, New York

• Kurt Kemmling, National Alliance for Medication Assisted Recovery,

Norwalk, Connecticut

• Robert Lambert, Connecticut Counseling Centers, Norwalk,

Connecticut

• Alan Mathis, Liberation Programs, Bridgeport/Norwalk, Connecticut

• Scott Stokes, Director of Prevention Services, AIDS Resource Center

of Wisconsin, Milwaukee, Wisconsin

• Matt Tierney, Office-Based Buprenorphine Induction Clinic (OBIC),

San Francisco, California

• Nalan Ward, West End Clinic, Massachusetts General Hospital,

Boston, Massachusetts

• William White, Senior Research Consultant, Chestnut Health Systems,

Bloomington, Illinois

Finally, special appreciation must go out to people in recovery from opioid 

addiction from across the United States who were willing to share their 

hope, strength, and experience. Thank you. 
2

Important Information from SAMHSA

This handbook is for informational purposes only. The information provided is not intended to 

diagnose, treat, cure, or prevent any disease or condition, including opioid use disorder. The 

Substance Abuse and Mental Health Services Administration (SAMHSA) does not approve or 

endorse any specific treatment. If you have a health condition or concern, contact a health care 

provider.

Decisions about treatment of opioid use disorder are the sole responsibility of you and your 

treatment providers. Not all the options presented may be appropriate for your situation. Talk with 

your treatment providers about your situation and the role of medication in your recovery from 

opioid use disorder.

Every effort has been made to ensure the information in this handbook, and on the decision support 

tool website for which it was developed, is accurate and up-to-date. However, medical information 

is continually changing and can become quickly outdated. Talk with your providers about the most 

recent research findings as they relate to your situation.

SAMHSA recognizes that widespread use of various medications to support addiction recovery 

is a new and rapidly changing practice. SAMHSA respects the diverse opinions of the recovery 

community on its use.

SAMHSA acknowledges that this handbook and decision support website do not explore all 

effective treatment approaches, alternative treatments, or recovery pathways for opioid use 

disorder. These tools are intended to help make objective, research-based information accessible 

to individuals and families facing specific decisions about medication for opioid use disorder, 

rather than to promote any single treatment option.

SAMHSA emphasizes that evidence supports that medications are best used in combination with 

recovery support, lifestyle changes, and professional treatment. 
3

This handbook is a companion to a website for the electronic decision support tool: Decisions in Recovery: 

Medications for Opioid Use Disorder. Visit http://www.samhsa.gov/brss-tacs/shared-decision-making for 

more information, videos of people talking about their experience with medication-assisted treatment, 

and links to resources.

Table of Contents

Introduction ��������������������������������� 4

Whether Medication Can Support My Recovery����������������� 5

Thinking About Making a Change? ��������������������������� 5

Tool: My Reasons for Stopping ���������������������������� 7

What Is Medication-Assisted Treatment (MAT)? ��������������������� 9

Tool: Concerns About Treatment �������������������������� 11

Concerns about pregnancy ����������������������������� 13

Tool: Weighing My Gains and Losses ������������������������ 14

Learn More...About the Topics Covered in This Section ���������������� 15

Which Medication Can Support My Recovery? �������������� 22

About Methadone......................................................................................................... 22

About Buprenorphine................................................................................................... 27

About Naltrexone......................................................................................................... 31

Tool: Comparing medications for opioid use disorder ���������������� 35

How Can Medication Support My Recovery?......................................................... 40

Talking with Doctors and Treatment Providers��������������������� 40

Tool: Talking With a Provider ��������������������������� 42

What to Expect ����������������������������������� 43

Recovery Support���������������������������������� 44

Tool: Who’s In My Corner? ���������������������������� 45

Planning for Success �������������������������������� 46

Tool: Next Steps ��������������������������������� 47

Learn More... About the Topics Covered in This Section ���������������� 48

Appendix ����������������������������������� 57

About This Decision Support Tool �������������������������� 57

Glossary�������������������������������������� 58

Resources ������������������������������������� 63
4

Introduction

Are you finding it difficult to stop using? If you’ve thought about cutting 

down or cutting out narcotics, prescription pain medications, heroin, 

or other opioid drugs, this tool can help. You can also link to videos 

of real people talking about their lived experiences with many of the 

topics covered. 

Is this decision support tool for you? This handbook is 

for anyone looking for help or information, and for people 

who care about them, who may be

 Misusing prescription pain medications, using narcotics, heroin, or other opioid drugs; thinking 

about seeking help for an opioid problem; or

 Considering medications that help with recovery from opioid use disorder.

If any of the statements below apply, you are probably in the right place.

 I have been told medications may help me stop using opioids. 

 I just want information.

 I don’t want to stop using now, but maybe someday I will. 

 I have tried to stop or cut down several times.

 I am reluctant to use medications because I want to be able to do this on my own. 

 I want a medication to help me through withdrawal.

 I want to stop using with the help of medication, but I am not sure which one. 

 I am under pressure to stop using.

 I have chronic pain, and opioids have become a problem. 

 I am pregnant and want to stop using opioids.

 I am pregnant, and my doctor has recommended I start medication for opioid use disorder. 

 I care about someone who has a problem with opioids.

The choice to include medication as part of your recovery is a personal, medical decision. This 

handbook gives you information about medication options so you can talk through your concerns 

with a treatment provider and make informed decisions.

WARNING: Everyone needs to be aware of the increasing risk of overdose, especially for people 

taking opioid pain medications, and the steps that can reduce the risk of harm. 

Learn more at the end of this section: “Overdose prevention” on page 15

intro
5

Whether Medication Can Support My Recovery

Thinking About Making a Change?

If you have thought about cutting down or stopping your use of 

narcotics, prescription painkillers, heroin, or any other opioid drug, 

this tool has information about some of your treatment options and 

ways to locate a provider who can help. It also has links to online 

videos of people who have been where you are. They found a way to 

succeed in recovery and reclaim their lives. So can you.

Whether it is your first try at stopping or reducing opioid use, or a fresh 

start after many attempts, give yourself credit for having the courage to 

change. Although no single pathway to recovery is right for everyone, research 

has shown people seeking recovery from opioid problems are more successful when they combine 

a prescribed medication used to treat addiction with professional counseling and a strong support 

system. 

Watch videos about making a change: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfTGp5CW6NTaljlGUeXGCpxk

Why is it so hard to stop?

Opioids are synthetic or natural drugs that have certain unique effects on the brain and body. 

Opioids relieve pain and give a people a sense of well-being or euphoria by changing the body 

and brain chemistry. The first change many people notice is tolerance, or the need for more of a 

drug to get the desired effect. 

Learn more at the end of this section: Opioids and pain “Opioids and pain” on page 15

Over time, the need for the drug becomes a powerful motivator to keep using, even when there is a 

strong desire to stop. When people need the drug to function normally, they are no longer using to 

feel good, but rather to avoid withdrawal symptoms and to stop feeling sick.

Videos about BRSS TACS Decisions in Recovery: Planning for Success: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfS3zQA5XEvDT66vLM_gytdS

How do people stop?

Recovery begins when you start to think your life might be better without opioids. It is normal to 

want to stop using one day and then feel unsure or unable to do so the next. Quitting is tough, and 

change does not happen overnight. Most people need support to become ready, willing, and able 

to quit.

Do I 

start?
6

However, even people who are certain they no longer want the daily grind of getting drugs, using 

drugs, and watching drugs damage their lives and health usually can’t just walk away. They need 

a plan of action and support. Research shows that when people include a medication prescribed 

to treat opioid use disorder as part of their recovery plan, their chances of success increase. This 

doesn’t mean medication is right for everyone. Many people also recover from opioid use disorder 

without medication. But, it is important information for anyone looking at treatment options. 

Learn more at the end of this section: “How do people stop?” on page 16
7

Tool: My Reasons for Stopping

People stop using opioids or cut down for very good reasons. This worksheet lists some of them.

Directions: For each statement, select the choice that best describes how much it matters to you. 

Skip any statements that do not apply. Then make note of your three most important reasons for 

quitting. Use the space at the bottom to add any other reasons.

 Share this worksheet with people in your support network when you talk over treatment options 

and what matters most to you.

 Make a copy for yourself to remember the reasons you decided to get help.

 Refer to it when you are tempted to use.

For myself

This matters to me:

a lot some a little

1. I am worried about my health. • • •

2. I do not want to go to jail/prison. • • •

3. I want the law off my back. • • •

4. I want to keep or get a job. • • •

5. I do not want to feel sick all the time. • • •

6. I want to go to or stay in school. • • •

7. I cannot afford my drug use. • • •

8. I am tired of the hassle. • • •

9. I do not like being around other users. • • •

10. Getting and using drugs takes all my time. • • •
8

For the people I love

This matters to me:

a lot some a little

11. I am or want to get pregnant. • • •

12. I want to set a better example for my children. • • •

13. I want to see my children more. • • •

14. I want better relationships with my family/partner. • • •

For my quality of life

This matters to me:

a lot some a little

15. I want to feel more in control of my life. • • •

16. I want to do other things with my life. • • •

17. I can do better than this. • • •

18. Things seem to be getting worse. • • •

19. I want to respect myself. • • •

20. I want to live like other people. • • •

Note any other reasons:
9

What Is Medication-Assisted Treatment (MAT)?

Medication-assisted treatment (MAT) for opioid use disorder combines counseling and other 

recovery supports with prescribed medications. These medications help reduce cravings and 

withdrawal symptoms that come from stopping opioid use. The medications approved for MAT are 

methadone, buprenorphine, and naltrexone. 

Watch videos that describe MAT: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfTYEmi25ZxGlJ1It_r20B9X

More about medication-assisted treatment

There are two key ways medications work to help reduce opioid use:

1. Methadone and buprenorphine are long-acting medications that reduce craving and control 

withdrawal symptoms by satisfying areas of the brain affected by opioid use disorder. This 

allows people to continue to work and function normally.

2. Naltrexone blocks the pain-relieving effects of opioids and their ability to induce euphoria. 

These rewarding aspects of opioid use lead to the desire for more. Research shows the 

extended release injectable form of naltrexone reduces cravings, helps people remain in 

treatment longer, and helps them abstain from opioid use.

Three medications are currently approved for treating opioid problems:

Methadone is a long-acting opioid medication that reduces cravings and withdrawal symptoms. 

It is usually taken by mouth in liquid form. It is dispensed to addiction treatment clients daily in 

single doses and only at certified opioid treatment programs. Methadone is highly effective for 

treating opioid use disorder, especially in people with extensive histories of drug use. Side effects 

of methadone include constipation, sexual problems, swelling, and sweating. It can also can cause 

heart problems or make them worse.

Buprenorphine is usually taken daily and must be dissolved under the tongue or in the mouth. It 

comes in tablet form and as a film. Doctors who complete a training and certification process can 

prescribe buprenorphine for office-based treatment or at treatment programs. Patients making 

satisfactory progress may receive a prescription for buprenorphine to take at home. It has 

proven to be very effective, although not more effective than methadone. For some people it may 

offer advantages. Risk of overdose is lower and withdrawal from buprenorphine may be milder. 

Buprenorphine is widely available in a formula that contains added naloxone, which discourages 

abusing or injecting it. Access to buprenorphine has helped many individuals seek treatment who 

otherwise might not have. Some common side effects are headache, nausea, and constipation.

Naltrexone blocks the ability of opioids to eliminate pain and induce euphoria. This removes the 

rewarding aspects of opioid use that result in a desire for more. Reduced cravings make it easier 
10

for people not to use. Naltrexone does not help with withdrawal symptoms, and cannot be started 

until seven to ten days after the last opioid use. It is available in an extended release injectable 

form that lasts 30 days. Overdose risk is high for people who use large amounts of opioids while 

taking naltrexone and for those who return to opioid use after a period of taking naltrexone, due to 

a decrease in tolerance. 

How can medications help?

People use medications to help manage many health problems, such as diabetes, cigarette 

smoking, or high cholesterol. Medications can help people get started while they make the lifestyle 

changes necessary for long-term recovery. Medications for opioid use disorder can decrease 

cravings or withdrawal symptoms and reduce the stress of extreme highs and lows. Some people 

recover from opioid use disorder without medications. Others find that medications help them to 

make the changes needed to build a life in recovery.

Watch videos about personal recovery stories: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfQttCYox9Kw3nh4rTy1f8DG

Things to consider

Research shows MAT can increase the chances of successful recovery, but medication alone is 

usually not enough. Recovery support is essential and may include help from family or friends, 

connections to other recovering people, and periods of professional treatment. The longer 

people stay in treatment and make use of recovery supports, the better they do at abstaining from 

compulsive drug use. 

Learn more at the end of this section: “Risks and benefits” on page 18

Is it right for me? 

Because MAT involves prescribed medications, it is not for everyone. Some medications are unsafe 

for people with certain health conditions or for women who are pregnant. Some work well for some 

people and do not work for others. The more you talk over your health concerns about MAT with 

your doctor or treatment provider, the more help they can offer.

Before you make a decision about whether MAT is right for you, it is important to discuss your 

concerns with professionals experienced in MAT. They will let you know about the risks, treatment 

options in your area, and requirements for successfully completing treatment. Think of your 

provider as an expert on what has worked for others. You are the expert on what is best for you and 

your situation.

Is MAT right for you? Only you can make that decision, but you do not have to make it alone.

Watch videos about how people decide if MAT was right for them: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfS-WtvaGoynVDt036fhavdx
11

Tool: Concerns About Treatment

Most people decide to try MAT because they hope it will help. But, they also have concerns. Here 

are some common ones. Use this tool to help you think about your concerns before you talk them 

over with a counselor or others. They may be able to help by giving you practical information.

Directions: For each statement select the choice that best describes how much it worries you. Skip 

any statement that does not apply. Use the space at the bottom to add any other concerns.

Can I do it?

This matters to me: a lot some a little

1. I have not done well with treatment programs. • • •

2. I tried medication, and I hated the side effects. • • •

3. I don’t want to give up my friends that use. • • •

4. I cave in and use when I have a strong 

craving. • • •

5. I am embarrassed to get help. • • •

Getting started

This matters to me: a lot some a little

6. I do not know how or where to get help. • • •

7. I cannot deal with going through withdrawal. • • •

8. I cannot go away to treatment and leave my 

kids. • • •

9. I cannot take time off from work. • • •
12

Practical concerns

This matters to me: a lot some a little

10. I do not know if I can pay for treatment. • • •

11. I have a hard time getting to appointments. • • •

12. I have a lot of health problems that worry me. • • •

13. I don’t know how to tell my partner. • • •

14. I cannot go get meds every day. • • •

15. I am on probation, and they drug test me. • • •

Attitudes and beliefs

This matters to me: a lot some a little

16. People may look down on me for getting help. • • •

17. My family or friends do not think I need 

treatment. • • •

18. I think I should be able to do this without 

meds. • • •

List any other worries or concerns:
13

Concerns about pregnancy

Many women who become pregnant while using opioids make immediate plans to quit. This is 

a good instinct. Studies find that women who use substances during pregnancy have more early 

births, deliver babies with lower birth weights, and have more problems during labor and delivery. 

Yet, going off of opioids too quickly during pregnancy is risky. When a pregnant woman uses 

opioids, they cross over into the bloodstream of the developing fetus and affect it. If the pregnant 

woman suddenly quits cold turkey, the fetus also experiences withdrawal. This can result in sudden 

abortion, early birth, and other dangerous complications. It is very important for women who 

become pregnant while using opioids to have immediate and regular prenatal care from a qualified 

medical provider and to seek care and consultation regarding their opioid use from their doctor.

It is also important to note that none of the medications used to treat opioid use disorder are 

approved by the FDA for use during pregnancy. However, in some situations, under close medical 

supervision, they have been used during pregnancy for the treatment of opioid problems and can 

help decrease some of the potential harm to the fetus and reduce certain maternal health risks. For 

example, methadone may help control withdrawal symptoms and to help stabilize heart rate, blood 

pressure, and other maternal and fetal functions.

Decisions about the right course of treatment are best made by each woman, with the help of 

doctors and providers that specialize in treating pregnant women. Some women have strong 

feelings about treatment with medications during pregnancy, and may wish to withdraw from 

opioids. It is important that they find a doctor or program that specializes in working with 

recovering women during pregnancy. Experienced providers can supervise a safe withdrawal and 

make recommendations that will protect the health of pregnant women and fetuses.

Although none of the medications used to treat opioid use disorder are approved by the FDA for 

use during pregnancy, methadone has been used safely for a number of years and has been widely 

researched. As with any treatment, there are some risks, but they are weighed against the risks 

pregnant women with untreated opioid use disorder may face. Infants born to mothers treated with 

methadone during pregnancy are at risk for withdrawal symptoms, sometimes severe enough to 

require medication and delay discharge from the hospital. These symptoms can be monitored and 

managed in most hospitals. Women receiving medications are usually encouraged to breastfeed, 

although trace amounts of methadone may be found in breast milk. 

Since buprenorphine was approved for MAT only a few years ago, in comparison to methadone, 

there are fewer long-term studies of safety and effectiveness. So far the research suggests that 

long-term treatment with buprenorphine is safe and very effective when combined with counseling 

and recovery support and may have advantages over methadone in some cases. Pregnant women 

treated with buprenorphine should only receive the single drug formula, without added naloxone, 

which has not been tested on pregnant women and is not recommended.

Learn more at the end of this section: “More about pregnancy” on page 20
14

Tool: Weighing My Gains and Losses

Use this page to help you think about what you might gain or lose if you start MAT, and if you do not 

start MAT. Share it with your provider or others when discussing your options.

Directions: In the top two sections of the page, list what you could gain and what you could lose if 

you decide to try MAT. In the bottom two sections, list what you could gain and lose by deciding not 

to try MAT. Consider your gains and losses. How do they compare to your priorities?

Starting Medication-Assisted Treatment: Potential Gains and Losses

 What I might gain if I start MAT: 

 What I might lose if I start MAT:

Not Starting Medication-Assisted Treatment: Potential Gains and Losses

What I might lose if I do not start MAT:

What I might gain if I do not start MAT: 
15

Learn More...About the Topics Covered in This Section

Overdose prevention

The Centers for Disease Control and Prevention (CDC) reports overdose is now the leading cause 

of accidental death in the U.S., exceeding motor vehicle fatalities. The rates of death due to opioid 

analgesics have nearly doubled over the last decade. Prolonged opioid use leads to physiological 

tolerance and to larger and more frequent doses to achieve an effect. Tolerance may be reversed 

after a period of abstinence, and dosages that once were tolerated may become dangerous. Some 

populations are at particularly high risk for overdose. For example, studies in Washington State 

indicate a prison inmate’s risk of death from drug overdose in the first two weeks post-release is 

between 40 and 129 times higher than the rate of the general population. The Substance Abuse 

and Mental Health Services Administration has developed the Opioid Overdose Prevention Toolkit

(http://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit-Updated-2016/SMA16-4742), which 

offers information on policies and practices that can reduce opioid-related fatalities. The toolkit 

encourages providers, persons at high risk, family members, and others to learn how to prevent 

and manage opioid overdose. The CDC also offers consumer information, safety tips, fact sheets, 

and instructions for safe storage of prescribed medications. National Prescription Drug TakeBack Day, which encourages safe disposal of leftover prescribed medications, has been a very 

successful annual event resulting in collection and destruction of many tons of medications from 

more than 5,000 collection sites nationwide. The U.S. Department of Justice has more information on 

National Prescription Drug Take-Back Day (http://www.deadiversion.usdoj.gov/drug_disposal/index.html). 

Opioids and pain

Some people who are addicted to opioid drugs are also dealing with chronic pain. When this is 

the case, it is important to get adequate treatment for both conditions from a specialist trained and 

experienced in addiction and pain.

Doctors should work with you on other ways to relieve pain before they prescribe an opioid 

medication. Talk with your doctor about whether cognitive behavioral therapy, physical therapy, or 

other treatments such as massage or chiropractic might help with your pain. If you and your doctor 

decide you need opioid drugs to manage your pain, then this may influence your choice of MAT 

options.

Naltrexone and pain medications

People who are physically dependent on opioids need to stop all opioid drugs for at least seven to 

ten days before taking naltrexone to avoid bringing on withdrawal. Non-opioid pain medications 

can be taken with naltrexone at all times. If you need to take opioid medication for medical reasons 

while you are being treated with naltrexone, your prescriber can help you with the following: 
16

 Inform medical providers that you take naltrexone.

 If possible, postpone use of pain medications until you are no longer experiencing the effects 

of naltrexone.

 Stop naltrexone before you start taking a prescribed opioid medication.

 Wait at least seven days after the last dose of opioid medication before starting naltrexone 

again.

WARNING: There is a high risk of overdose if people start using again after a period of treatment with 

naltrexone. Their tolerance lowers while they are free of all opioids. If they go back to taking amounts 

they were taking before treatment, it can be fatal. There is a high risk of overdose when people try to 

“override” naltrexone’s blocking effect by taking larger doses of opioids. 

Why do people start using?

People try opioids for many reasons. Sometimes when doctors prescribe opioid medications for 

pain, for one reason or another, some people may start taking more than is prescribed. Others are 

curious about the opioid high. When given a chance to try it, often through a friend or acquaintance, 

they do. But not everyone who experiments with opioids becomes addicted. It is not clear why 

some people become addicted and others do not. Research shows that addiction has a strong 

hereditary component. Other factors can increase a person’s chance of becoming addicted. People 

are more likely to start taking drugs if they are easily available or if family members, friends, or 

neighbors are also experimenting with drugs. Nearly all people with serious drug and alcohol 

problems start to use in their teens or early twenties. People who begin using before age 18 have 

an increased risk of addiction. 

Research also links addictions such as alcoholism or injection drug with a history of physical, sexual, 

and emotional trauma or abuse, especially during childhood. About two thirds of adults in public 

treatment centers report a history of physical or sexual abuse. 

How do people stop?

Reducing or stopping compulsive alcohol and drug use is a key part of addiction recovery. 

Medication provides one of the most effective ways to help people stop opioid use and break the 

cycle of addiction. For some, achieving abstinence marks the beginning of their recovery. For 

others, recovery is a process. There are many different pathways to recovery and what works for 

one person may not work for another. Each person finds their individual path. 

Recovery: One definition of recovery is “a process of change through which people improve their 

health and wellness, live self-directed lives, and strive to reach their full potential.” Input from more 

than 2,000 people helped to identify four key things that support a life in recovery: health, home, 

purpose, and community.
17

Counseling: Counseling for addiction often begins by talking with a helping professional about 

drug use, the problems it has caused, and ways to overcome those problems. It helps to find a 

counselor with whom you feel comfortable. Research shows that people do better when they have 

a good relationship with their counselor. Counselors have different ways of working. For example, 

counseling can be individual or group settings. Counselors can encourage and support people as 

they deal with day-to-day stress and setbacks, providing them with the tools they need to build a 

life in recovery. Most counseling for addiction includes some or all of the following:

 Education about addiction and its effects

 Support and guidance to reduce or eliminate substance use

 Help to identify and cope with stressful life issues

 HIV risk reduction counseling, access to confidential testing, and hepatitis screening

 Help to develop ways to prevent and manage setbacks

 Referral to resources in the community, such as peer support groups, housing, and faith-based 

groups.

Individual counseling may include setting goals, talking about setbacks, and celebrating progress. It 

may also include discussing legal concerns and family problems. 

Group counseling can help people feel that they are not alone with their issues. In groups, you can 

hear about the difficulties and successes of others dealing with the same challenges. This helps 

people learn strategies to deal with situations they may encounter.

Family counseling includes parents, partners or spouses, children, siblings, or others who are close 

to you. It is up to you to decide if family members should be involved in treatment and who should 

participate. When there is a history of violence in the family, counseling should not include anyone 

with whom you do not feel safe.

Treatment: Treatment programs are structured, often intensive, time-limited services for dealing 

with addiction. Programs may be outpatient, daily, weekly, residential, or even hospital-based. 

Most programs help you learn about addiction and find new ways to deal with life. Some programs 

include detoxification and follow-up counseling or support. But, detoxification alone is not 

considered treatment.

Treatment usually includes an assessment that allows the staff to understand how severe your 

problem is and to help create an effective personal treatment plan with you. Treatment helps 

identify thought patterns and belief systems that cause problems. It also helps you to recognize 

high-risk situations and practice new ways of thinking and acting. Treatment programs may 

specialize in different kinds of addictions such as marijuana, opioids, alcohol, or gambling. There 

are programs for just men, women, adolescents, and other groups. Some treatment programs last 

for a few weeks; others last for many months.
18

Outpatient programs have the benefit of offering treatment services in the community. They may 

offer MAT, as well as counseling and other support services. Residential programs combine 

housing and treatment services in a living situation where peers support each other to stay in 

recovery. Hospital-based programs may offer both inpatient and outpatient programs that combine 

health care and addiction treatment services for people with medical problems.

Medications: Prescribed medications can help control cravings and manage withdrawal. They 

can also help people manage recovery from opioid use disorder over the long haul. The decision 

of how long to take medication is a personal choice that you make with your support team (doctor, 

peer support, family, friends, or counselor). 

Research shows that generally, the longer people remain involved with treatment and continuing 

care, the more likely they are to benefit. People in medication-assisted treatment who continue 

with long-term treatment have better results. Stopping medication too early increases the risk of 

returning to opioid use. People in long-term maintenance treatment for opioid use disorder should 

be periodically assessed for their individual ongoing medication needs. 

WARNING: Given the high risk of overdose with a return to opioid use, decisions about stopping 

medication should be made carefully and in consultation with your doctor or treatment provider. 

Support: Recovery supports are the people, places, and things that help people stop using 

drugs and alcohol and begin a life in recovery. Different people find different things supportive. 

Successful recovery depends on finding and using the supports that work best for you. Recovery 

support can include transitional housing, employment services, medical care, mental health 

treatment, childcare, transportation, and other types of services and resources that allow people to 

move forward in recovery. Sometimes, recovery support includes finding a faith-based group that 

inspires you, getting involved sports and leisure activities, or even giving back to the community.

Recovery community: A growing number of organizations, led by people in recovery, support 

all pathways to recovery, even when medication is a part of the journey. Some groups, such as 

Methadone Anonymous, are specifically geared toward people in medication-assisted recovery. 

Recovery Community Centers offer peer support and opportunities to socialize with others in 

recovery. For more information about these groups and other recovery options visit the National 

Alliance for Medication Assisted Recovery http://www.methadone.org.

Risks and benefits

All medications have risks and benefits. Individuals must weigh the pros and cons in light of their 

own unique circumstances and decide if the potential benefits outweigh the possible risks. FDA 

approved package inserts contain a complete listing of medication risks, side effects, and warnings, 

including cautionary information for individuals with certain health conditions. You can find this 

information at https://dailymed.nlm.nih.gov/dailymed.
19

Options: MAT includes several treatment approaches. What is right for you will depend on your 

situation, your needs, and what is important to you.

Detoxification (or “detox”) is medically supervised gradually reduced doses of medication to 

ease withdrawal symptoms and cravings. The goal is to reduce the dosage slowly and discontinue 

medication by discharge. It is short-term, usually lasting no more than 21 days. Research shows 

that without further support or treatment, medication-assisted detoxification is not likely to result in 

long-term recovery. 

Maintenance is long-term MAT, usually for at least a year, with periodic reassessment of the need 

for ongoing treatment. Maintenance therapy can help control cravings and stabilize functions 

over the long haul, which allows time to focus on building a life in recovery. Research shows that 

maintenance therapy is more effective than detoxification. 

Health conditions: Your provider needs to know about all your health conditions and the drugs 

you use. All medications involve some degree of risk, but sharing this information can help avoid 

harmful drug interactions and minimize other health risks. You and your primary care provider can 

go over the risks and benefits in light of your situation. 

Using medications safely: MAT involves taking powerful prescription drugs, storing them 

properly, following instructions carefully, and working with your provider to get the dose right. 

All medications should be stored in a locked cabinet out of reach of children or pets. Medications 

should only be taken by the person for whom they were intended. Doses tolerated in some 

individuals can cause serious harm to others, or even fatality to children or pets. Excess medication 

should be disposed of properly. 

MAT for people with HIV/AIDS or chronic hepatitis: People with liver disease should check with 

their doctors before deciding to use naltrexone or buprenorphine. Very large doses of naltrexone 

can cause liver damage, but studies show the recommended dose has been used safely, even 

with people being treated for Hepatitis C (HCV). Liver function tests are recommended before 

beginning buprenorphine, since there is a possibility it could contribute to liver damage, especially 

in people with liver disease. But, many people with HCV have been safely treated with medications 

for opioid use disorder, even while they were taking interferon and other medications. People with 

HIV/AIDS have also been treated safely with medications for opioid use disorder and sometimes 

benefit from the additional structure and support they receive in opioid treatment programs. They 

also should check with their medical providers. Medication interactions may occur and sometimes 

require dosage adjustments for people taking a combination of anti-viral medications as part of 

their HIV treatment regime. 

Availability: Access is an important issue for people thinking about starting MAT. Methadone is 

only available at state- and federally-regulated opioid treatment programs that require daily visits 

for dosing. Some people do not live close enough or cannot realistically arrange transportation 

nearly every day. Private physicians trained and certified to prescribe buprenorphine can offer 
20

office-based treatment for opioid use disorder. Patients usually need to see their doctor frequently 

during the initial weeks of treatment with buprenorphine, but if they make good progress, their 

doctor can prescribe a take home supply of buprenorphine, often for up to a month. Any qualified 

medical professional can administer an extended release long-acting naltrexone injection once a 

month or prescribe it in pill form to take daily. This includes a nurse practitioner or a physician’s 

assistant. 

More about pregnancy

If you are using opioids and think you may be pregnant, you can take steps to increase your baby’s 

chances of getting a healthy start:

 Avoid other substances, including alcohol and cigarettes.

 Get good prenatal care as early in the pregnancy as possible.

 Begin treatment for opioid use disorder.

Frequently, pregnant women who are using do not have the social support they need. They are 

often judged harshly and subjected to discrimination. Many pregnant women who try to stop using 

relapse again and again. They may try to get off opioids in an effort to do the best thing for their 

baby, but are not able to stick with it. This cycle can be very dangerous for the baby.

Abrupt withdrawal from opioids during pregnancy can be risky and MAT is recommended. Most 

states have facilities that specialize in treating pregnant women and families. If you call your state 

substance abuse service agency, they can tell you where to get help.

Pregnant women are granted priority admission to treatment by federal mandate. Most programs 

for women offer family-based treatment so they can bring their children with them. Learn more 

about what women should know about pregnancy, substance use, and MAT.

Here are some links to help get you started:

 Research on the advantages of buprenorphine during pregnancy, presented to the American 

College of Obstetricians and Gynecologists at 

https://www.nih.gov/news-events/news-releases/buprenorphine-treatment-pregnancy-less-distress-babies

 Methadone Treatment for Pregnant Women at 

http://store.samhsa.gov/product/Methadone-Treatment-for-Pregnant-Women/SMA14-4124

 The National Institutes of Health information page on Neonatal Abstinence Syndrome (NAS) at 

https://www.nlm.nih.gov/medlineplus/ency/article/007313.htm

 State-by-state listing of Women’s Substance Abuse Service Coordinators to help you find 

providers to help with both pregnancy and opioid dependence at 

http://www.cffutures.org/files/webinar-handouts/SSA-WSN-CFSR%20Coordinator%20Directory.pdf
21

Research: Studies show that the longer people stay in treatment and remain involved with recovery 

support programs, the better they do at maintaining recovery. Studies measure success a number 

of ways:

 How long people stay in treatment and whether they complete treatment.

 Whether they remain free from or reduce their drug use.

 If they reduce risk behaviors for contracting HIV and HCV infections.

 If they reduce criminal justice involvement.

 If they maintain stable housing.

 If they maintain stable employment.

 Whether they report fewer problems with mental health.

 Lower death rates.

Overall, the evidence shows that MAT helps people overcome opioid use disorder and sustains 

recovery. MAT helps decrease drug relapse rates, overdose deaths, and criminal justice 

involvement. Maintenance therapy helps reduce the spread of HIV and HCV. None of the 

medications actually protect against HIV. However, people in MAT are more likely to reduce their 

high-risk behaviors.
22

Which Medication Can Support My Recovery? 

Three medications are approved in the United States for treating opioid 

use disorder: methadone, buprenorphine, and naltrexone. They are 

dispensed differently and have different side effects. Some work 

better than others in certain situations. The information that follows is 

not intended as advice. The following sections are intended to make 

it easier to compare medications for opioid use disorder, to consider 

the side effects, and to understand the risks and benefits of each. 

These comparisons can help you prepare to talk with a qualified 

professional about what is best for you. The following does not cover 

every side effect or all the risks and warnings. Medications may interact 

with alcohol, illicit drugs, other prescribed medications, over-the-counter 

medicines, vitamins, herbs, and supplements.

Everyone needs to be aware of the increasing overdose rates, especially for people taking 

opioid pain medications, and steps that reduce the risk of harm. Talk with your doctor before 

starting any medication. Make sure you are familiar with the overdose prevention tools listed in the 

resource section of this handbook, which also provides Internet sites with more information.

Visit Medline Plus at https://www.nlm.nih.gov/medlineplus to learn more about each medication. For 

FDA approved product labeling, package inserts, warnings, and patient counseling information, 

visit DailyMed at https://dailymed.nlm.nih.gov/dailymed. You can learn more about what medications 

are not safe to take together on the FDA’s page about Avoiding Drug Interactions at 

http://www.fda.gov/forconsumers/consumerupdates/ucm096386.htm.

About Methadone

What it is

Methadone is a long-acting opioid medication that reduces cravings and withdrawal symptoms. 

It is usually taken by mouth in liquid form. It is dispensed to addiction treatment clients daily in 

single doses, but only at certified opioid treatment programs. Limited take-home dosing may be 

permitted and can become more frequent over time. But, in order to begin methadone treatment, 

you should be able to get to an opioid treatment program daily.

What it does

Methadone satisfies the areas of the brain that opioids act on, calms withdrawal symptoms, and 

reduces drug cravings. It can block the intense euphoric effects of heroin and other short-acting 

opioids. Methadone can have a “leveling effect,” with fewer highs and lows. People taking a 

prescribed dose of methadone that is right for them feel normal, can continue to work, and can 

Which 

do I 

start?
23

usually perform tasks like driving. Because it controls withdrawal symptoms and blocks cravings, 

people who are addicted to opioids tend to stick with it. This allows them to rebuild a life in 

recovery and avoid the health hazards and problems that come with illegal drug use.

Where you get it

Methadone is usually given daily and only at licensed, federally regulated opioid treatment 

programs. Limited take-home dosing may be permitted and can become more frequent for those 

doing well in long-term treatment. The provider can explain the guidelines about “take-home 

medication.”

Cost

Methadone is typically the least expensive of the three MAT options. However, the real cost to an 

individual varies depending on the state where the person lives, health insurance coverage, and 

other factors. The provider will have information about real cost and payment options.

Who it works for

Methadone can work for people who have made other unsuccessful attempts to stop. It is a 

recommended treatment for opioid use disorder during pregnancy. Methadone has been effective 

for people who are undergoing treatment for HIV/AIDS. It may be a good choice for those who also 

have chronic pain. People who are starting methadone have to be able to get to an opioid treatment 

program every day.

Research outcomes

Methadone has been in use for many years. It is the best-studied approach to MAT for opioid use 

disorder. Research shows that methadone treatment can be highly effective when combined with 

counseling and recovery support.

Starting methadone

Methadone can be started at any time. There is no need to wait after the last use for withdrawal 

symptoms to begin. However, providers will not begin methadone treatment with anyone who 

seems to have just used or appears intoxicated.

After the first dose of methadone, people typically stay at the treatment center for a few hours. The 

doctor or nurse usually checks on them regularly to watch their reaction. If withdrawal symptoms 

are a problem, two to four hours after the first dose, another small dose may be given. 
24

The goal is to find the dose that controls withdrawal symptoms with the fewest side effects by 

beginning low and increasing slowly.

Side effects

Most people have some side effects from methadone such as constipation, sleepiness, and sweating. 

The package insert product information has a complete list of side effects and includes a warning 

about the risk of serious heart problems. Sexual side effects have been reported by people taking 

methadone for long-term maintenance treatment.

Warnings

Some warnings are listed below. For complete information, visit the websites listed at the end of 

this section.

 High dosages may stop a person’s breathing

 Highest risk of methadone overdose at start of treatment

 High risk of methadone overdose when combined with benzodiazepines (Valium, Ativan, 

Xanax)

 High risk of methadone overdose when combined with other substances, including alcohol, 

due to a toxic build up that occurs because methadone stays in the system so long

 Risk of driving impairment at the start of treatment and during dosage adjustments

 Increased risk of serious heart problems and sudden cardiac death

 To reduce the risk of heart problems, experts recommend that

 you know about the heart risks;

 you are screened for heart health and history;

 you possibly get heart tests as part of your treatment program; and

 if a problem is found, the methadone dose is lowered or stopped.

All medications should be stored in a locked cabinet out of reach of children or pets.

Doses tolerated by some individuals can cause serious harm, even death, to others. Only the person 

they were intended for should take medications. Dispose of excess medication properly.

How long you need to take it

The decision about how long to take methadone is an individual choice people discuss with 

their doctor or treatment provider. Methadone treatment for less than 90 days usually has little 

effect. People who stick with treatment and take the medication for a year or more have the best 
25

success rates. Some people take methadone for many years. Others decide to taper off gradually 

under medical supervision. Some research shows that many people return to drug use when 

they stop taking methadone. This is one reason some people stay on methadone maintenance for 

long periods. It is best to periodically assess the need for ongoing treatment with your doctor or 

treatment provider. Withdrawal from methadone can be difficult, especially when it is stopped 

quickly. Working with your doctor or treatment provider to cut down the dosage very slowly over 

several months can reduce withdrawal symptoms. This is the last phase of MAT, known as tapering 

or medically supervised withdrawal.

WARNING: Overdose fatality risk is high for people who return to opioid use after a period of 

MAT. Decisions about stopping medication should be made carefully and in consultation with 

your doctor or treatment provider.

Pregnancy

Although none of the medications used to treat opioid use disorder are approved by the FDA for 

use during pregnancy, methadone has been used safely for a number of years and has been widely 

researched. As with any treatment, there are some risks, but they are weighed against the risks 

pregnant women with untreated opioid use disorder may face. Infants born to mothers treated with 

methadone during pregnancy are at risk for withdrawal symptoms, sometimes severe enough to 

require medication and delay discharge from the hospital. These symptoms can be monitored and 

managed in most hospitals. Women receiving medications are usually encouraged to breastfeed, 

although trace amounts of methadone may be found in breast milk.

HIV/AIDS

Structured methadone programs may be beneficial for people who are being treated with HIV 

medications. Methadone can interact with some of the medications used to treat HIV/ AIDS, and 

dosages of one or both medications may need to be adjusted.

Hepatitis and liver disease

Methadone is usually safe for people with hepatitis unless the liver is functioning poorly. People 

being treated for Hepatitis C have safely used methadone in combination with interferon. Talk with 

your doctors about your situation.

Pain

Methadone for maintenance therapy is only taken once a day, which is not enough to control pain. 

Methadone can be used with other opioid medications prescribed for pain, but dosage must be 

watched carefully due to the overdose risk. People who use methadone for MAT may have a high 
26

tolerance for opioid pain medications and may not get relief 

from pain at typical dosages. They can benefit from working 

with a doctor experienced with managing pain in people with 

histories of opioid use disorder.

Legal issues

 Methadone treatment does not keep people from getting 

a driver’s license as long as they are not using illegal 

drugs or abusing prescription medications.

 Methadone may affect eligibility for a commercial 

driver’s license (CDL) in some states.

 Confidentiality and anti-discrimination laws protect 

people receiving methadone treatment as long as they 

are not using illegal drugs or misusing prescription 

medications.

 Methadone may show up on a drug screen.

 An employer cannot legally fire you for being treated with methadone as long as you can 

document that it is prescribed as part of your medical treatment.

 People involved with the criminal justice system often have a difficult time getting methadone 

while in jail or prison or while under court supervision.

Watch videos about the experiences of people treated with methadone: 

https://www.youtube.com/watch?v=BosqnvlI4IM&list=PLBXgZMI_zqfQUr3GJWtCtu5HLws5mxm1H

For more information

More Information on Methadone: 

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682134.html

FDA Approved Package Inserts and Product Labeling: 

https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=METHADONE

How to Use Methadone Safely: 

http://store.samhsa.gov/product/Follow-Directions-How-to-Use-Methadone-Safely/SMA09-4409

Methadone Treatment for Pregnant Women: 

http://store.samhsa.gov/product/Methadone-Treatment-for-Pregnant-Women/SMA14-4124

Know Your Rights: Rights for People on MAT: 

http://store.samhsa.gov/product/Rights-for-Individuals-on-Medication-Assisted-Treatment/SMA09-4449
27

About Buprenorphine

What it is

Buprenorphine is usually taken daily and dissolved under the tongue or in the mouth. It comes in 

pill form and as a film. Doctors who have completed the required training and certification process 

can prescribe buprenorphine for opioid use disorder in their office or at treatment programs. 

Patients seen at a doctor’s office are referred to counseling services and monitored to ensure 

they are making satisfactory progress. If they are making good progress, they may receive a 

prescription for a supply of buprenorphine to take at home.

Buprenorphine has proven very effective. Although it has not been more effective than methadone, 

it may offer advantages for some people. Office-based treatment with prescribed buprenorphine 

can allow patients a great deal more flexibility. Risk of overdose is lower and withdrawal from 

buprenorphine may be milder. It is widely available in a formula that contains added naloxone, 

which discourages abusing or injecting it. Buprenorphine is also made in a single drug formula 

without added naloxone, which is sometimes used for MAT during pregnancy. Access to 

buprenorphine has helped many individuals seek treatment who otherwise might not have. Some 

common side effects are headache, nausea, and constipation.

What it does

Buprenorphine helps control withdrawal symptoms and blocks cravings. People taking a 

prescribed dose of buprenorphine that is right for them should feel normal, can continue to work, 

and can usually perform tasks like driving.

Where you get it

Once doctors complete the training and certification process, they can prescribe buprenorphine for 

opioid use disorder to patients they see in their office or for clients in treatment programs. At the 

beginning of treatment, patients seen at a doctor’s office usually have frequent appointments, are 

referred to counseling services, and are monitored to ensure they are making satisfactory progress. 

Then they may receive a prescription for a supply of buprenorphine to take at home. They can fill it 

at any public pharmacy.

Cost

Buprenorphine is typically more expensive than Methadone, but less expensive than Naltrexone. 

However, the real cost to an individual varies depending on the state where the person lives, health 

insurance coverage, and other factors. The provider will have information about real cost and 

payment options.
28

Who it works for

Access to buprenorphine has helped many individuals seek treatment who otherwise might not 

have. It can also work for people who want to switch from methadone. It offers a safe and effective 

alternative for those unable to get to an opioid treatment program on a regular basis, and has been 

used safely by pregnant women seeking treatment. It works best for people who are able to adhere 

to treatment plan and take the medication as directed.

Research outcomes

Since buprenorphine was approved for MAT only a few years ago, in comparison to methadone, 

there are fewer long-term studies of safety and effectiveness. So far, the research suggests that 

long-term treatment with buprenorphine is safe and very effective when combined with counseling 

and recovery support. 

Starting buprenorphine

It is necessary to wait 12 to 24 hours after the last opioid use before starting buprenorphine to 

avoid uncomfortable symptoms. After the first dose, people typically stay at the doctor’s office or 

treatment center for a few hours while the doctor or nurse checks on them regularly to watch their 

reaction. If withdrawal symptoms are a problem, dosages can be adjusted.

Side effects

Most people have some side effects from buprenorphine such as headache, nausea, and 

constipation. Some people using buprenorphine for long-term maintenance treatment MAT have 

reported sexual side effects or liver problems. 

Warnings

Some warnings are listed below. For complete information, see the websites listed at the end of this 

section.

 High dosages may stop a person’s breathing

 Moderate to high risk of overdose when combined with other substances, including alcohol

 High risk of overdose when combined with benzodiazepines (Valium, Ativan, Xanax) 

 Risk of driving impairment at the start of treatment or during dosage adjustments 

 Possible risk of liver damage

All medications should be stored in a locked cabinet out of reach of children or pets.
29

Doses tolerated by some individuals can cause serious harm, even death, to others. Only the person 

they were intended for should take medications. Dispose of excess medication properly.

How long you need to take it

The decision of how long to take buprenorphine is an individual choice people make with their 

doctor or treatment provider. It is safe to stay on buprenorphine for a long time, and generally 

outcomes are better with long-term treatment. When they are ready, most people work with their 

doctor or treatment provider to slowly reduce the dose of buprenorphine. Withdrawal tends to be 

milder for some people than it is with methadone.

Pregnancy

Although there are fewer long-term studies on buprenorphine treatment during pregnancy and 

while nursing, a substantial amount of research has shown it can be used safely. Infants born to 

mothers treated with buprenorphine are at risk for experiencing withdrawal; however, current 

medical guidelines consider buprenorphine an option for pregnant women who prefer it or are 

already taking it. Buprenorphine only, in the single drug formula, is used to treat pregnant women. 

Formulations containing naloxone are not recommended, since its effects during pregnancy are 

unknown.

HIV/AIDS

People with HIV/AIDS may use buprenorphine. There are fewer interactions with HIV drugs than 

with methadone. It is possible that it may still interact with some HIV medications and require an 

adjusted dose. Talk with your doctors about your situation.

Hepatitis and liver disease

People with liver disease should check with their doctors before starting buprenorphine. It is 

possible it may contribute to liver damage, especially in people who already have a liver condition. 

Liver function tests are recommended before beginning buprenorphine. Studies show people with 

Hepatitis C can be safely treated with buprenorphine and can use it with interferon. Talk with your 

doctors about your situation. Combination products containing naloxone should not be used if there 

is severe liver impairment.

Pain

People who use buprenorphine for MAT often have a high tolerance to the opioid medications 

used for pain. They may have difficulty getting relief with the typical dosage. Buprenorphine can 

also decrease the effectiveness of other opioids used to manage pain. If you have chronic pain 
30

and are considering buprenorphine for MAT, talk with a treatment provider or physician who has 

experience managing pain in people with histories of opioid problems.

Legal issues

 Buprenorphine treatment does not keep people from getting a driver’s license as long as they 

are not using illegal drugs or abusing prescription medications.

 Buprenorphine may affect eligibility for a commercial driver’s license (CDL) in some states.

 Confidentiality and anti-discrimination laws protect people taking buprenorphine for MAT as 

long as they are not using illegal drugs or misusing prescription medication.

 Buprenorphine may show up on a drug screen.

 An employer cannot legally fire you for being treated with buprenorphine as long as you can 

document that it is prescribed as part of your medical treatment.

 People involved with the criminal justice system may have difficulty getting buprenorphine 

while in jail or prison or while under court supervision.

Watch videos about the experiences of people treated with buprenorphine: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfSDgnmKgqsKfyRflW2sYWcf

For more information

More Information About Buprenorphine:

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a605002.html

FDA Approved Package Inserts and Product Labeling: 

https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=BUPRENORPHINE

The Facts About Buprenorphine:

http://store.samhsa.gov/shin/content/SMA09-4442/SMA09-4442.pdf

Know Your Rights: Rights for People on MAT:

http://store.samhsa.gov/product/Rights-for-Individuals-on-Medication-Assisted-Treatment/SMA09-4449

The Advantages of Buprenorphine During Pregnancy:

https://www.nih.gov/news-events/news-releases/buprenorphine-treatment-pregnancy-less-distress-babies
31

About Naltrexone

What it is

Naltrexone blocks opioids from acting on the brain to induce euphoria and relieve pain. This 

removes the rewarding aspects of opioid use that create a desire for more. Reduced cravings can 

help people stop using. Naltrexone does not help with withdrawal and cannot be started until seven 

to ten days after the last opioid use, when withdrawal symptoms have passed. It is available in 

extended-release injectable form, administered every 30 days, and in tablet form, taken daily by 

mouth.

The injectable form has been the most effective form of naltrexone for addiction treatment. It can 

help people stay in treatment, reduce cravings, and prevent relapse when combined with recovery 

supports.

Risk of overdose is high when people use large amounts of opioids while taking naltrexone to try to 

override its blocking effect. There is an increased risk of overdose if people skip dosages, are at 

the end of a dosage cycle, and use again after a period of taking naltrexone. This is because their 

tolerance goes down while they are free of opioids. Taking amounts that they once tolerated can 

result in overdose fatality.

What it does

Naltrexone is not a controlled substance and has no potential for abuse. People feel completely 

normal while taking it. When tablets were the only form of naltrexone available, people with

a strong impulse to use simply stopped taking their pills, and the blocking effect no longer stood 

in their way. The extended-release injectable form has been much more effective for opioid use 

disorder. Once administered, the blocking effects are active until four weeks have passed.

However, if people addicted to opioids do not stop completely for at least seven to ten days before 

taking naltrexone, they risk bringing on withdrawal symptoms that can be quite severe. Naltrexone 

can also block the effects of opioid pain medication. People who may need to take a prescribed 

opioid medication for chronic pain should keep this in mind when they consider MAT options.

Where you get it

Any doctor, physician’s assistant, or nurse practitioner can administer an injection or write a 

prescription for naltrexone tablets. They do not need special training and can treat people in their 

offices.
32

Cost

The extended release injectable form of naltrexone is typically the most expensive MAT option. 

However, the real cost to an individual varies depending on the state where the person lives, health 

insurance coverage, and other factors. The provider will have information about the real cost and 

payment options.

Who it works for

Naltrexone works for highly motivated people who can get through opioid withdrawal and remain 

opioid-free for at least seven to ten days prior to beginning treatment. It is a good option for those 

who want to eliminate all opioids right away and for people who do not want to deal with withdrawal 

when they stop MAT. The injectable form is helpful for people who have a hard time with daily pills 

or frequent appointments. Since naltrexone is also approved for treating alcohol problems, it may 

be helpful if people also wish to avoid drinking.

Research outcomes

The extended-release injectable form of naltrexone was approved for treating opioid use disorder 

in 2010, so a limited number of long-term studies have been completed. Results so far suggest that 

the extended-release injection, used in combination with counseling and other supports, reduces 

craving and helps prevent relapse. It helps people to maintain abstinence from opioid drugs and to 

stay in treatment longer. It also has been an effective medication for treatment of alcoholism.

Starting naltrexone

Naltrexone cannot be taken until at least seven to ten days after the last opioid use without bringing 

on immediate, severe withdrawal, which may require hospitalization. Treatment providers will 

not administer it to someone showing signs of opioid withdrawal. Treatment providers and 

doctors frequently ask for a urine sample to verify people have been free of opioids. Or they may 

administer a small test amount of another opioid blocker that wears off quickly to make sure there 

is no adverse reaction before administering a full dose by injection. The doctor, nurse, or treatment 

provider should check periodically to make sure the medication is well-tolerated before the patient 

leaves.

Side effects

Most people do not have many side effects from naltrexone, but soreness in the area of the injection 

is very common. Other side effects can include stomach pain or nausea, diarrhea, and difficulty 

sleeping.
33

Warnings

Some warnings are listed below. F or complete information visit the websites listed at the end of 

this section.

 High risk of opioid overdose if people treated with naltrexone use large amounts of opioids to 

try to override blocking effect

 Moderate to high risk of opioid overdose during relapses into opioid use due to lowered 

tolerance

 Risk of causing severe withdrawal symptoms if administered to opioid-dependent patients 

without waiting seven to ten days from last use

 Risk of canceling effects of opioid pain medications given in a medical emergency

 Risk of depression and suicidal thoughts

 Risk of injection site reactions, some severe

All medications should be stored in a locked cabinet out of reach of children or pets.

Doses tolerated by some individuals may cause harm to others. Only the person they were intended 

for should take medications. Dispose of excess medication properly.

How long you need to take it

Deciding how long to take naltrexone is an individual choice people discuss with their doctor 

or treatment provider. Like other medications used for MAT, it is safe to stay on it for long-term 

treatment. There is no withdrawal from naltrexone. It can be stopped at any time. However, when 

an extended-release injection is given, it stays in effect for a 30-day period. Some research has 

shown that many people return to drug use when they stop taking naltrexone, skip doses, or are 

at the end of a dosing cycle. When this takes place, there is a risk of increased sensitivity to the 

effects of opioids and a heightened risk of overdose. In most of the research studies, treatment with 

naltrexone continued for at least five to six months.

Pregnancy

There is no research on safety of use during pregnancy or breastfeeding. It is not recommended to 

use naltrexone during pregnancy until there is more research about its safety.

HIV/AIDS

Naltrexone is safe to use with HIV medications. There is low potential for HIV drug interactions.
34

Hepatitis and liver disease

People with a history of liver disease who are considering naltrexone should talk it over with their 

doctors. They often recommend liver function tests before treatment begins. Very large doses of 

naltrexone can cause liver damage, but studies show it is safe at the recommended dose, even for 

people with Hepatitis C who are taking interferon. Talk with your doctor about your situation.

Pain

Naltrexone can keep opioid pain medications from working. It may bring on severe withdrawal 

symptoms in people physically dependent on opioid pain medication, unless they have stopped all 

opioids for at least seven to ten days beforehand. Non-opioid medications taken for pain relief can 

be used safely with naltrexone at all times. If you have chronic 

pain, and are considering naltrexone for MAT, talk with your 

doctor. If you use naltrexone for MAT and have to take opioid 

pain medication for medical reasons

 inform medical staff that you are using naltrexone;

 stop taking naltrexone before starting to take a prescribed 

opioid pain medication;

 postpone use of pain medications until you are no longer 

experiencing the effects of naltrexone; and

 restart naltrexone seven days after the last dose of pain 

medication.

Legal issues

Naltrexone is not a controlled substance and legal issues are usually not a concern.

For more information

More Information on Naltrexone: 

http://www.nlm.nih.gov/medlineplus/druginfo/meds/ a609007.html

FDA Approved Package Inserts and Product Labeling:

https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=naltrexone

Facts About Naltrexone:

http://store.samhsa.gov/product/The-Facts-about-Naltrexone-for-Treatment-of-Opioid- Addiction/SMA13-4444

Watch videos about the experiences of people treated with naltrexone: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfRkFw-HloKb4fuA1N9tu_lF
35

Tool: Comparing medications for opioid use disorder 

These charts are not intended as advice. They are designed to help you compare the approved 

medications so you are prepared to discuss your options with a qualified health professional.

Methadone

Who it works for 

 People who: Are able to get to an approved program; Benefit from structured programs; Have 

severe or chronic pain issues; Are being treated for HIV/AIDS; Are pregnant or post-partum

Side effects

Most people have some side effects. Talk to your doctor if they are severe or do not go away. This is not 

a complete list of possible side effects. See product labeling for more information. Serious side effects 

are not very common. Call your doctor immediately if you experience any. 

 Examples of side effects reported by people taking methadone: Sweating; Headache; 

Constipation; Sleepiness; Nausea/vomiting; Abdominal pain; Dizziness; Tiredness; Lightheadedness; Loss of appetite; Decreased sexual desire/ability; Weight gain; Memory and 

concentration problems

 Examples of serious methadone side effects: Seizures; Itching; Hives; Rash; Trouble 

breathing; Shortness of breath; Fast heartbeat; Chest pain; Swelling of the face, eyes, tongue 

or throat; Extreme drowsiness; Light-headedness when changing positions; Any symptom of 

overdose

Symptoms of overdose: Small pinpoint pupils; Slow or shallow breathing; Drowsiness; Cool, clammy, or 

blue skin; Loss of consciousness; Limp muscles 

Accessibility

 Cost: Varies depending on insurance coverage and other factors. Talk to provider about 

payment options 

 Common forms: Liquid; Other forms may be available

 How it is taken: Taken daily at approved programs; Some take-home dosing; More frequent if 

doing well in treatment
36

Health concerns 

 Pregnancy and breastfeeding: Safe during pregnancy; Breastfeeding is recommended since 

only trace amounts are found in breast milk; Risk of withdrawal symptoms in infants born to 

mothers treated with methadone during pregnancy

 HIV/AIDS: May be used during treatment for HIV; Watch for drug interactions that require 

dosage adjustments; Talk with your doctors

 Hepatitis: Used safely by people with hepatitis and during treatment with interferon for 

Hepatitis C; Check with your doctors Chronic pain: Usually safe with other opioid medications 

prescribed for pain; Watch dosage carefully due to overdose risk

Starting and stopping 

 When can I start: Immediately; Risk of methadone overdose during the initial weeks of 

treatment

 How long do I take it: Best results when used for long-term treatment; Safe for long-term 

maintenance; Periodic assessment of ongoing treatment based on individual needs

 What happens if I stop: Significant methadone withdrawal symptoms; Dose can be gradually 

reduced to lessen discomfort 

 What if I use opioid drugs on this medication: High risk of opioid overdose because it stays 

in the system so long; May not have euphoric effect; Overdose fatalities also reported when 

combined with benzodiazepines, alcohol, and other drugs

Buprenorphine

Who it works for 

 People who are: Best treated in doctors’ offices; Motivated to try buprenorphine; Able to 

adhere to a treatment plan; Being treated for HIV/AIDS; Pregnant or post partum

Side effects

Most people have some side effects. Talk to your doctor if they are severe or do not go away. This is not 

a complete list of possible side effects. See product labeling for more information. Serious side effects 

are not very common. Call your doctor immediately if you experience any. 

 Examples of side effects reported by people taking buprenorphine: Sweating; Headache; 

Constipation; Nausea/vomiting; Stomach or back pain; Difficulty falling or staying asleep; 

Impaired driving; Mouth numbness, redness, or sores; Tongue pain, swelling, or burning; 

Excess fluid and swelling of feet or legs; Blurred vision; Intoxication; Disturbance in attention; 

Irregular heart beat (palpitations); Fainting; Dizziness; Sleepiness 
37

 Examples of serious buprenorphine side effects: Itching; Hives or skin rash; Difficulty 

breathing or swallowing; Light-colored stools; Upset stomach/nausea; Swelling of face, eyes, 

tongue, or throat; Extreme tiredness; Dizziness when changing positions; Slowed reflexes and 

breathing; Dark-colored urine; Yellow skin or eyes; Pain in upper right stomach; Loss of appetite, 

energy, or coordination; Bruising or bleeding; Confusion or inability to clearly; Blurred vision; 

Slowed speech 

Accessibility

 Cost: Varies depending on insurance coverage and other factors; Talk to provider about 

payment options 

 Common forms: Film or pills; Other forms seldom used for addiction treatment

 How it is taken: Taken daily; Must dissolve under tongue or in mouth; Available at approved 

treatment programs and from trained physicians for office-based treatment; A qualified 

physician can prescribe a supply to take at home

Health concerns 

 Pregnancy and breastfeeding: Studies show buprenorphine has been used safely during 

pregnancy and breastfeeding; The form without added naloxone is used during pregnancy; 

Risk of withdrawal symptoms in infants 

 HIV/AIDS: May be used during treatment for HIV; Smaller risk of drug interaction; Talk with 

your doctors

 Hepatitis: Liver function tests recommended; Check with your doctor; Has been used safely 

by people with hepatitis; Liver damage reported mostly in people with pre-existing liver 

conditions; Forms with naloxone should not be used when liver impairment is severe 

 Chronic pain: Use of opioid pain medications during treatment with buprenorphine must be 

monitored carefully to prevent risk of overdose; At high doses, buprenorphine can cancel out 

pain-relieving effects of other opioid pain medications

Starting and stopping 

 When can I start: 12 to 24 hours after last use

 How long do I take it: Best results when used as a part of long-term treatment; Safe for longterm maintenance; Periodic assessment of ongoing treatment based on individual needs

 What happens if I stop: Withdrawal symptoms less intense but unpleasant; Dose gradually 

reduce to lessen discomfort 

 What if I use opioid drugs on this medication: Moderate risk of overdose; May cancel out pain 

relieving effects of other opioids; Overdose fatalities when combined with benzodiazepines: 

Use of alcohol or other drugs increases overdose risk 
38

Naltrexone

Who it works for 

 People who: Are able to stop using for seven to ten days; Are mandated by court or employer; 

Experience alcohol problems; Are motivated to eliminate all opioids now; Are re-entering from 

prison or jail.

Side effects

Most people do not have many side effects. Talk to your doctor if they are severe or do not go away. 

This is not a complete list of possible side effects. See product labeling for more information. Serious 

side effects are not very common. Call your doctor immediately if you experience any. 

 Examples of side effects reported by people taking naltrexone: Nausea or vomiting; Diarrhea; 

Stomach pain; Decreased appetite; Dry mouth; Headache; Difficulty falling asleep or staying 

asleep; Dizziness; Tiredness; Anxiety; Joint pain or stiffness; Muscle cramps; Weakness; 

Tenderness, redness, bruising, or itching at injection site; Constipation; Irritability; Tearfulness; 

Increased or decreased energy; Rash or soreness at injection site

 Examples of serious naltrexone side effects: Pain, hardness, swelling, lumps, blisters, open 

wounds, or a dark scab at injection site; Coughing; Wheezing; Shortness of breath; Hives or 

rash; Swelling of the eyes, face, mouth, lips, tongue, or throat; Hoarseness; Difficulty swallowing; 

Chest pain; Confusion; Hallucinations; Severe vomiting, diarrhea, or both; Nausea; Stomach 

pain; Drowsiness; Dizziness

Accessibility 

 Cost: Extended release injections are costly, but actual costs depend on insurance coverage; 

Talk to your provider for options 

 Common forms: Pills or extended release injectable form

 How it is taken: Qualified medical professionals prescribe daily pills or give an injection 

every 30 days; Outpatient programs may offer injections

Health concerns 

 Pregnancy and breastfeeding: Not recommended; No research on safety of use during 

pregnancy or breastfeeding

 HIV/AIDS: Safe to use with HIV medications; Low potential for HIV drug interactions

 Hepatitis: Liver damage is possible at high doses; Most studies report no damage at 

recommended doses; Work closely with your doctor before starting 
39

 Chronic pain: May block effects of opioids taken for pain; Can cause withdrawal in people 

physically dependent on opioids unless they stop all use seven to ten days before taking 

naltrexone; Non-opioid pain medication safe with naltrexone; Talk with your doctor

Starting and stopping 

 When can I start: After detox or seven to ten days after last use 

 How long do I take it: Long-acting injection in effect for 30 days; Most studies have been 

periods of five months or longer; Best results when used for long-term treatment; Safe for longterm maintenance; Periodic assessment of ongoing treatment needs

 What happens if I stop: No withdrawal symptoms 

 What if I use opioid drugs on this medication: High risk of overdose if opioid use is 

resumed; Taking large amounts to override blocking effect has resulted in overdose fatalities; 

May cancel out pain relieving effects of other opioids; If taken while physical addiction to 

opioids is present, without waiting seven to ten days, withdrawal can result 
40

How Can Medication Support My Recovery?

Talking with Doctors and Treatment Providers

Overcoming opioid use disorder can seem overwhelming. Finding 

experienced providers that can help and building a network of support that 

you can count on makes it more manageable.

Watch videos of personal recovery stories of overcoming opioid 

use disorder: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfQttCYox9Kw3nh4rTy1f8DG

There are a number of people who can help with your decisions about MAT. Who is the best person 

to talk with? The one you feel most comfortable with! Here are some places to start.

 If you know people who stopped using opioids through MAT, you can ask them about their 

treatment experience.

 If you have a counselor, case manager, or doctor you trust, you can ask them about treatment 

options in your area.

 National treatment locators can help you find treatment programs and prescribers in every 

state. You can find links to online treatment locators in the Resources section of this handbook, 

by visiting the National Treatment Locator web page at http://www.samhsa.gov/find-help, or by 

checking the online tools at the companion web site for this handbook: 

http://www.samhsa.gov/brss-tacs/shared-decision-making

When you seek the services of a provider who is experienced in treating opioid use disorder, you 

begin with an exchange of information. The provider tells you about treatment options and you tell 

the provider about your situation. Then, together, you arrive at a treatment approach that will meet 

your individual needs. Competent providers make clients aware of all treatment options, including 

medications. They will work with you on all decisions about your treatment. 

Learn more at the end of this section: page 48

Finding a provider

Naltrexone is available through any qualified medical provider. Methadone and buprenorphine are 

only available from approved opioid use disorder treatment programs and from specially trained 

doctors. They must follow all federal and state regulations, codes of ethics, and practice guidelines 

for prescribing and dispensing MAT. Methadone is dispensed daily in single doses at approved 

opioid treatment programs. After you have been doing consistently well in treatment for a period 

of time, you may be able to take home a limited number of doses. Over time, the number of takehome doses permitted may increase. Doctors who complete the required training and certification 

How 

do I 

start?
41

process to prescribe buprenorphine can treat you in their offices and link you to other treatment 

and support services. They also may prescribe buprenorphine at various treatment programs. 

Patients making satisfactory progress may receive a prescription to take at home. Here are some 

examples of places you can go for treatment for an opioid problem:

 Approved methadone treatment programs. Some also offer other medications

 Private offices with doctors who can prescribe buprenorphine

 Addiction treatment centers that offer counseling, structured programs, and residential care 

may also offer one or more types of MAT

 Some community health centers

 Some mental health centers

What to look for

Look for providers who take the time to give you all the information and make sure that you 

fully understand your options. You want to be able to ask questions, talk comfortably about your 

concerns, and feel confident about your decision. 

Learn more at the end of this section: page 48

Here are some tips to help you choose a MAT provider:

 Find providers who specialize in treating opioid use disorder. They may be able to connect you 

with support and resources that are just for people who want to stop using opioids.

 Ask about their approach. Do they offer outpatient counseling or residential treatment? What 

type of groups and other supports do they offer? How often do they meet? What are their 

connections to peer support?

 Ask if they have special services for your unique needs. For example, do they help coordinate 

treatment for people with HIV/AIDS? Are there staff members who are experts in treating 

pregnant women? Do they offer childcare?

 Ask if there is a waiting list and how long will it take to be seen. Do they have a sliding fee scale 

or payment plans?

 Consider what is doable given your current situation.

Watch videos where MAT providers speak out: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfSqdsrsxPufCnSuTmuxECaX
42

Tool: Talking With a Provider

Directions: Fill out this page and take it with you to your appointment to help you talk with your 

provider about what is important to you.

Prepare: What questions do you have? What information do you need? (Make note of all that apply.)

❏ What treatment options do you offer for opioid use disorder? What medication(s) do you 

offer? How soon can I begin treatment?

❏ How long will I need to be treated?

❏ What are the program hours and requirements?

❏ How flexible is the program? Will I be able to do this with my work schedule? What are the 

costs? How do people pay for treatment?

❏ Are there financial programs that might help me pay for treatment or for medication? Are 

there any research studies on opioid treatment that are recruiting subjects?

❏ What other kinds of help are available? Choose from this list or make note of what else you 

need.

❏ Childcare

❏ Help with transportation

❏ Help with benefits and medical coverage

❏ Counseling

❏ Support groups

❏ Other: ________________________________

Make note of any other questions or concerns you may want to ask about.

Gather Your Information: The provider will want to know about you. The information you will 

need is listed below. You can print this page out and use it to gather the information you will need 

when you go to your appointment.

✔ List all your current health conditions and concerns.

✔ List the medications and supplements you use now.

✔ List the opioid drugs you have been using, how long, and an estimate of how much.

✔ List any other legal or illicit drugs you use (For example: marijuana, tobacco, valium, alcohol, 

etc.).

✔ List dates and details of any past or current treatment for opioid use disorder (For example: 

where, when, and how it worked out).

REMEMBER: Bring any paperwork and any relevant medical records or test results you have to 

your appointment.
43

What to Expect

Addiction treatment clients have the right to confidentiality, respect, accurate information, and 

decisions about their treatment. 

Learn more at the end of this section: “Your rights” on page 49

Providers gather and review information from an assessment of your drug use and from your health 

checkup. They will talk with you about treatment options and goals. Providers will then work with 

you to create a treatment plan to help you achieve your goals. Your concerns and your questions 

need to be part of the discussion and treatment planning. 

Learn more at the end of this section: “What to expect” on page 50

Starting MAT

There are four stages of MAT: induction, stabilization, maintenance, and tapering.

1. Induction is the starting phase. Your doctor will keep a close watch to make sure you adjust to 

the medication safely.

2. Stabilization begins when you are on the right dose and your body and brain have adjusted to 

the new medication.

3. Maintenance is the long-term use of medication while remaining drug free and rebuilding a 

life in recovery.

4. Tapering is medically managed withdrawal from a medication by gradually reduced doses.

Preparing for your first appointment

When you go in for your appointment, it helps to be prepared. You can use the tool Talking With a 

Provider to make sure you have the information you need and to help organize and remember your 

questions.

Here are some tips to help you prepare:

 Have a list of all current prescribed medications.

 Provide details of any substances you use or take so drug interactions can be avoided.

 Arrange a ride home from your first few MAT appointments. You will not be able to drive until 

the side effects of methadone or buprenorphine are stable.

 Have a long-term plan for reliable transportation if you have to get to an opioid treatment 

program daily.
44

 Expect daily appointments at the doctor’s office when you start buprenorphine. They gradually 

become less frequent.

 Often, urine samples for drug screenings are taken throughout treatment.

Watch videos about talking with providers about MAT: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfQi7D-za9SebGXm21EQ5K8D

Recovery Support

There are many ways people can support your recovery. They can listen, share information, and 

help with practical things like rides and childcare. Support can come from family, close friends, 

and from connections with others who have “been there.” Peer support groups are great ways to 

connect with people who do not use and can help.

Whether you need an extra boost during difficult times or people you can touch base with daily, the 

more you add to your network of support, the better your chances of staying in recovery. 

Learn more at the end of this section: “Building recovery support” on page 52

Building a support team

Building a recovery support team is a key part of MAT. Your team can get you through the tough 

stuff and help you celebrate your successes.

Professionals play an important role. But your recovery also depends on what happens after you 

leave the doctor’s office or treatment center.

Strong allies may include friends, relatives, recovering people, and others in your community.

Being around people in recovery can help you feel less alone and more hopeful. You do not have 

to become best friends or hang out all the time. But, you may want to get to know some people by 

visiting a recovery community center near you and by attending support groups or meetings. Here 

are some places to start:

 Association of Recovery Community Organizations: 

http://www.facesandvoicesofrecovery.org/who/arco

 Narcotics Anonymous: http://www.na.org

 Methadone Anonymous: http://www.methadonesupport.org

 Heroin Anonymous: http://www.heroinanonymous.org

Watch videos about buidling recovery supports: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfR9SxWROmwu-bfXf_48QRg3
45

Tool: Who’s In My Corner?

This tool helps you map out your support network and think about ways to expand it.

Directions: List the people in your life under the category where they fit best. Put those you are 

closest to first and the people that you are not as close to last.

After you make your lists, look over the names in each category.

 Make note of the ones who are supporters and allies.

 Make note of the ones who might provide practical help.

 Make note of the ones you might be tempted to use with.

Family ____________________________________________________________________________________

____________________________________________________________________________________________

Friends ____________________________________________________________________________________

____________________________________________________________________________________________

Work ______________________________________________________________________________________

___________________________________________________________________________________________

Professionals _______________________________________________________________________________

____________________________________________________________________________________________

Other Recovery Support _____________________________________________________________________

___________________________________________________________________________________________

When you look at your network, what do you have too much of?

What do you have too little of? 

How could you expand the positive support in your network?
46

Talking to people in your life about your recovery

Friends, family, employers, and even other recovering people may not fully understand or accept 

MAT. People who choose MAT often deal with misinformation, stigma, and even discrimination. 

Deciding who to share your plans with and what to say can be tough. The choice of who to tell about 

your treatment is very personal. You have a right to your privacy, but you may also feel a need to let 

some people know.

Before you open up about your decisions, take the time to think about who you want to know, how 

much you want to tell them, and when you want to talk with them. It is important to be sure the 

people you tell will respect your privacy, even if they do not fully understand your decision. It is 

also important not to let shame, pride, or the fear of disappointing your family and others close to 

you hold you back from having support from those who can help you in your recovery.

Sometimes, people have kept their opioid problem secret from family so they are hesitant to 

tell them about treatment and recovery. But, chances are the people who are close to you know 

something is wrong and will likely be happy to know about your decision to get help.

Learn more at the end of this section: “Talking to others” on page 53

Planning for Success

When you head for a new destination, you need a map to show you the roads you can take. A 

treatment plan is a roadmap of the route you and your providers agree upon to treat your opioid use 

disorder.

A recovery plan is like a snapshot of your destination. It is based on your vision of the things you 

want to do and who you want to be once you are free of your opioid use disorder.

Both are helpful for building a track record of success. It is important to look back occasionally and 

acknowledge how far you have come.

Here are some things to consider when making a plan for success:

 What has worked for me in the past? What has not worked?

 What situations have set me back? What has triggered my urge to use?

 What situations might be tough in the future?

 What are the practical things I can do to manage these situations and avoid relapse?

Watch videos about planning for success: 

https://www.youtube.com/playlist?list=PLBXgZMI_zqfS3zQA5XEvDT66vLM_gytdS
47

Tool: Next Steps

What else do you need before you are ready to talk to someone who can help you with MAT?

Directions: Use this page to decide your next steps. Check all that apply. Print the page and use it 

to remind yourself of what you will do. You may cross off items when you have completed them.

I need more information about (check all that apply)

❏ The cost

❏ Time and scheduling

❏ Transportation

❏ Other _______________________________

Where I will go to find this information? _______________________________

I need to talk this over with (check all that apply)

❏ My relationship partner

❏ My parents

❏ My friends

❏ My counselor

❏ My sponsor

❏ Other _______________________________

When I will talk to them?____________________________________________________

I am ready to talk to a provider. My next step is

❏ Search for local providers

❏ Call the numbers of local providers that I have

❏ Make an appointment with _______________________________

❏ Other _______________________________
48

Learn More... About the Topics Covered in This Section

Professionals offer intensive services and support that help people to stop using and move into 

recovery. They know about treatment approaches and how to minimize risks. They provide 

structure and check on your progress over time. 

Doctors

 Can give methadone for addiction treatment only through a registered opioid treatment 

program

 Can prescribe buprenorphine for office-based treatment if they complete special training and 

certification

 Can write prescriptions for a take home supply buprenorphine that can be filled at a public 

pharmacy

 Can administer injections of long acting naltrexone or prescribe the pill form without any 

special training 

Addictions counselors

 Are licensed or certified by each state

 Are required to keep up with new addiction research

 Are trained to encourage and support clients

 Are required by law to keep information about your treatment confidential

 Are trained to help people prepare for situations where they may be tempted to use

Treatment programs

 May offer more than one approach

 May work with doctors who prescribe buprenorphine or naltrexone as part of treatment

State drug and alcohol offices

 Offer information about all available treatment programs in the state

 Have a designated staff member in charge of MAT (for the contact in your state visit 

http://dpt2.samhsa.gov/regulations/smalist.aspx)
49

Advocacy organizations (including RCOs)

 Support people in recovery

 Look out for the interests of people in recovery

 Have websites with helpful information 

Mental health professionals

 May be familiar with MAT

 May help you find treatment

 May help you consider your options 

Recovery support specialists

 Are usually people with personal experience in recovery or family members experienced with 

addiction

 Are usually given specialized training or are certified

 Are not professional counselors

 Are knowledgeable about recovery and support all recovery pathways

 May work in a treatment program or through a recovery community organization

 May be volunteers or paid employees

Your rights

The federal government has recognized that stigma, discrimination, and fear of prosecution can 

keep people from entering drug treatment. There are special laws that protect people in addiction 

treatment. The best way to protect your rights is to know what they are. Here are some of your 

rights in MAT:

 You have the right to fair and respectful treatment. 

 Information about your treatment is confidential. You have a right to know about any exceptions.

 Opioid treatment programs are required to help with medical, counseling, and vocational 

needs.

 You also have the right to be informed before you give your consent for treatment. Information 

should be understandable and in your best language. It should include

 a program’s rules and regulations;

 your rights and responsibilities;

 medication risks and possible drug interactions;
50

 cost and other financial aspects of treatment; and

 other treatment options.

 It is illegal to discriminate against people because they are receiving MAT.

 Child welfare or probation/parole cannot legally require you to stop MAT.

 Government services, student loans, and food stamps cannot be denied because of MAT.

 Employers can drug test. 

 They are allowed to ask for proof that you are in treatment if you test positive for 

methadone or buprenorphine.

 If you are truthful about your treatment and provide proof, they cannot legally fire you for 

it.

If you feel that your rights are violated, you can file a complaint with government agencies that 

deal with discrimination. You do not need a lawyer to do this, but you should do it as soon as you 

can. You can also complain to the head of the program or contact an advocacy group. For more 

information visit Know Your Rights: For Individuals on Medication Assisted Treatment and other 

relevant publications on the rights of individuals in medication-assisted treatment at 

http://lac.org/resources/substance-use-resources/medication-assisted-treatment-resources

What to expect

At the beginning of treatment a lot of information is gathered, often by a treatment providers and 

health professionals. A complete assessment and a health examination are part of this process. 

Assessments: The assessment asks questions about your past and present drug use. There are also 

questions about your family background, living situation, work history, legal problems, and your 

needs and strengths. The assessment is the starting place for finding the best treatment options 

for you. Providers are responsible for making sure you can use MAT safely. They need to know 

everything that could affect your health or put you at risk. This includes the amount and types of 

substances you use and your ability to follow the instructions for taking prescribed medications 

and storing them safely. They also need to know about your medical conditions, mental health 

conditions, other prescribed medications, and any over-the-counter medications or supplements 

you are taking to make sure there are no risky interactions when you start a medication. If you are 

seen at a clinic or treatment center, a licensed professional usually does the assessment before 

you meet with the doctor. If you are seen in a doctor’s office, you may be referred to an addiction 

counselor for assessment. 

Most assessments have questions in several areas:

 Use history Sample question: How much money would you say you spent on drugs in the last 30 

days?
51

 Employment and means of support Sample question: How many days were you paid for 

working in the last 30 days?

 Legal status Sample question: Are you on parole or probation?

 Family and social relationships Sample question: With whom do you spend most of your free 

time?

 Mental status Sample question: Have you ever been prescribed any medication for 

psychological or emotional problems?

Health checkup: The doctor will usually begin by asking about your health history. You will also 

have a number of routine health screenings, including blood and urine tests. You will be offered 

confidential, voluntary screening for HIV and hepatitis. Sometimes people who use opioid drugs 

avoid regular health checkups and medical care. Some people are very anxious before their 

checkup. They may have health conditions that need attention or may be uneasy about hearing the 

results of various tests. Many health problems are treatable and may be easier to treat if diagnosed 

early. Most people in recovery feel that it is better to deal with health issues before beginning 

treatment than to have them come up after they get started.

After the assessment, health checkup, and tests are completed, your doctor or counselor will talk 

with you about the results. You will find out if you can begin MAT safely. This is also the time to 

discuss your concerns and questions, talk about your preferences, and ask about the risks and 

precautions that go along with MAT. The information from the assessment and checkup is used to 

help create a treatment plan. Your individual treatment plan is an agreement between you and your 

providers. It is a roadmap to help you get to where you want to go, tailored to your situation and 

your goals.

Getting started: When you begin a medication, your body will have to adjust to it. After the first 

dose of methadone or buprenorphine you will usually stay at the clinic or doctor’s office for a few 

hours. The doctor or nurse should check on you to see how you react. If withdrawal symptoms are a 

problem two to four hours after taking the first dose, you may be given another small dose. The goal 

is to find the dose that controls withdrawal symptoms with the fewest side effects by starting low 

and increasing slowly.

 There is an increased risk of death during the first two weeks of taking methadone, especially 

in the first four days. The risk is higher if you have a low tolerance to opioids or if you also use 

alcohol or benzodiazepines. The same risks apply to buprenorphine, but they are lower.

 Methadone may be started at any time.

 Buprenorphine may be started 12 to 24 hours after the last opioid use. If you start it earlier, it 

may cause uncomfortable symptoms.

 Naltrexone must be started no sooner than seven to ten days after the last opioid use to avoid 

triggering withdrawal symptoms. With naltrexone you do not usually need to stay at a doctor’s 

office to be observed.
52

For more information about starting MAT read the SAMHSA Treatment Improvement Protocol (TIP) 

43 MAT for Opioid Addiction at http://www.ncbi.nlm.nih.gov/books/NBK64164

Building recovery support

In some communities, recovering people gather and open a center, club, or organization. Some 

operate various types of services for people in or seeking recovery and their families, and may 

offer a range of supports, such as peer recovery coaching, clean and sober social activities, and 

assistance locating appropriate housing and employment. Below are some of the different types of 

recovery support people find helpful.

Recovery community organizations (RCOs): These organizations often host walks, rallies, and 

other events to celebrate recovery. You may be interested in joining one of these if there is one in 

your community. There is not currently a comprehensive listing of RCOs, however the Association 

of Recovery Community Organizations (http://www.facesandvoicesofrecovery.org/who/arco) may be able 

to help you determine if there is one in your community.

Family, friends, and allies: Friends, relatives, and allies can be important sources of emotional 

support and practical help. Research shows recovery is more likely when clients invite the 

important people in their lives to take part in treatment activities. “Family” means people in your 

life that understand and support you. This may include your relatives or others you are close to. 

Who do you like to spend the holidays with? Who do you call when you want to share good news? 

Your friends, family, and other people you are close to can become part of your support team. If 

they would be pleased to see you stop using, then they can become allies in your effort to get in 

and stay in recovery. Research shows that this type of support is a huge advantage in treatment and 

in recovery from opioid use disorder.

It is important not to let shame or the fear of disappointing your family and others close to you hold 

you back from accepting the support of those who love you unconditionally. Sometimes, people 

manage to keep their family from knowing about their opioid problem, so they are hesitant to let 

them know about treatment and recovery. But, chances are the people who are close to you know 

something is wrong and will probably be relieved to know about your decision to get help. 

In other instances, people damage their relationship to family and friends through their addiction. 

When this is the case, family or friends may not always be a source of support, although that 

can sometimes change over time. Regardless of whether or not your family and friends can be 

supportive at this time, other people in recovery, who have had similar experiences to yours are 

always available to provide support through recovery community organizations, mutual aid groups, 

treatment groups, and so forth. 

Community resources: Recovery is the beginning of many things, not just an end to using. There 

are usually resources to help people making a new start. But, many people are not sure what is 

available in their area. Helpful resources can include job training programs, community health 
53

centers, housing programs, and public libraries. Legal aid and advocacy groups may also be 

available. People in recovery need the same things as anyone else. They need a home, health, 

purpose, and community.

Home: It is important to have a place to live where you can feel safe and at ease and are not 

tempted to use. There are some housing resources specifically for people in recovery. You can 

find out about housing by contacting local recovery community centers, state or county housing 

agencies, and treatment providers.

Health: One benefit of treatment can be feeling healthy and energized again. Eating healthy 

meals and getting regular sleep help the body get back to normal. Many people find that 

exercise helps with mood and energy. Most areas have community programs, public health and 

recreation departments, and hospitals that offer wellness programs and health services.

Purpose: People find purpose in their lives in many ways. Some get a job they like or take care 

of a family. Others volunteer or connect with a faith community. Often, people try different things 

before they find out they have something to contribute. A good place to start is with the local 

recovery community.

Community: People are drawn to others when they have something in common. Recovery 

communities are one way people can feel connected with others. Many people in recovery 

also find acceptance and support in the general community. For example, they may become 

members of faith groups, political parties, or sports teams, or they may become involved in 

music and the arts.

Talking to others 

Old friends and new connections: Does recovery mean you have to let go of people you sincerely 

care about just because they use? The idea in recovery is to bring people into your life, not to cut 

them out. It will pay off to invest most of your time in increasing your contact with people who can 

strengthen your recovery. Of course, there may be some people that you have used with that you 

will be happy to avoid. Others may seem impossible to give up. There may be no need to cut them 

out of your life if you can see them in situations where you will not be tempted use. It can be helpful 

to reconnect with friends you knew before you started to use. Some of them will be glad to hear 

from you and happy that you are making changes. Some of them may have reasons to be upset with 

you, but if they are willing to set the past aside, you may be able to rebuild the friendship. If you 

started using while very young, you may not have many friends from before you began using. If 

that’s the case for you, work to build the number of recovering friends you have in your network.

What to share: Deciding who to tell about your treatment is very personal. You have a right to your 

privacy, but you may also feel a need to let some people know. Try not to let shame, pride, or the 

fear of disappointing those close to you hold you back from having support from those who can help 

you in your recovery. As a guide, ask yourself these questions:
54

 Who needs to know?

 How much do they need to know? It is useful to have a brief explanation prepared in advance. 

It can be as simple as “I found a treatment approach that works for me.” You do not have to tell 

your story or go into detailed explanations. You are in control of how much information you 

share.

Your employer: Most people would rather not tell an employer about MAT, especially if the 

information could end up in a personnel file. An exception is when a boss knows you have a drug 

problem and has requested you get help or required you do so if you want to keep your job. In that 

case, it may be important to let the boss know you are in treatment, but ask yourself: Does my boss 

really need to know details about my treatment?

Your sponsor: Some people who choose MAT also attend 12-step meetings and work with a 

sponsor. Some sponsors understand and accept MAT; others do not. If you have a sponsor who is 

not supportive, ask yourself: What do I want from a sponsor?

Dating partners: Honesty is part of healthy relationships. But it has risks, too. When a relationship 

begins to get serious, you may consider saying something about MAT and recovery. Before you do, 

ask yourself: Is the benefit greater than the risk? It is often recommended that one avoid starting 

new romantic relationships or major undertakings during the first year or so of recovery as these 

can distract you from building the support networks and recovery skills you need and can also 

be the source of anger, stress, frustration, or hurt that can put you at risk of relapse. If you have a 

sponsor, counselor, or other mentor, you may wish to discuss this.

Family: Some family members are supportive, but some are not. If you have supportive relatives 

that you think will stand by you, it may be beneficial to talk with them. You may have other family 

members who are likely to criticize and disapprove. Before you tell those family members, ask 

yourself: Do I expect them to change? You may be positively surprised by the reaction of some 

family members. It is also possible that some you thought would be supportive are not. Be prepared 

for that and know who you can turn to for support if you need it in such a time.

Children: Some people in recovery feel they need to tell their children about their drug use, others 

do not feel their children need to know, and some think it could be harmful for them to find out. 

Every family situation is different. Before you talk with your children, ask yourself: Who can I talk 

with about what is best for my children?

Others: Reaching out to other people in your life who could become allies is an excellent strategy 

for building your support network. Addiction touches the lives of many families, and you probably 

know people who can relate to your situation. Ask yourself: Who might become an ally?

When to share: Not only do you want to consider who to talk to, you also want to think about the 

best time to talk to them. Here are some tips for when to talk to others about MAT:
55

Before you start MAT: Talk with people you want to help with your decisions about treatment. 

If you need rides or other practical help, ask people in advance. Asking for help can be difficult, 

but it is an important skill for people in recovery.

During early treatment: After you have started treatment and are feeling better, you may 

decide some people you are close to need to know. If you start with the people who are the 

easiest to tell, you will be in practice by the time you get to the more challenging ones.

Later: It may be best to wait until you are further along in recovery and have some time free from 

using substances before talking to people who may not be supportive. They might see things 

differently if they know you have something that is working for you.

Stages of Medication-assisted Recovery: There are several stages of medication-assisted 

recovery. Each stage has its specific focus.

Stage 1 Stop using. Focus on controlling withdrawal symptoms, getting through detox, and 

reaching stabilization.

Stage 2 Learn recovery skills. Focus on recognizing high-risk situations and taking action to 

avoid relapse.

Stage 3 Stay in recovery. Focus on finding a routine, building a support network, and learning 

to have fun without using.

Stage 4 Live in recovery. Focus on living a full and meaningful life in recovery. This may 

include your job and family, becoming part of your community, and enjoying good 

health.

Avoiding Relapse: If you have tried to stop using before, you have important information. You 

know what situations resulted in a return to drug use.

Relapse prevention groups can be very helpful. You can look at your own relapse triggers and hear 

what others do to avoid pitfalls. Other people in recovery who have successfully overcome opioid 

use disorder are a good source of information on what helps prevent relapse. They can also tell you 

what helped them build a positive and rewarding life in recovery, one of the best ways of avoiding 

relapse.

Your Plan for Success: Here are some things to consider when making your plan for success:

 What do you want to be different in your life? 

 What is your vision of success?

 What are the barriers that stand in your way?

 What resources and supports do you have? 

 What else might you need?

 What you have tried in the past? 
56

 What has been helpful—even a little bit? 

 What has not been helpful?

 What are your strengths and weaknesses? 

 What caused you to relapse in the past? 

 What pitfalls are the most risky for you?

 What do you need the most help with now?

 Who can help you with that?

Finding meaning

When people are addicted to opioids, they often wake up in the morning with the thought: How 

do I get the drugs I need today? They know they will spend much of their time finding or using 

drugs. Part of recovery is finding new reasons to get out of bed and new things to do with your day. 

You will find activities that give your life meaning and purpose. They could include work, family, 

spirituality, creative expression, or volunteering. 

Remember, when you head for a new destination, you need a map to show you the roads you can 

take. A treatment plan is a roadmap of the route you and your providers agree upon to treat your 

opioid use disorder. A recovery plan is like a snapshot of your destination. It is based on your vision 

of the things you want to do and who you want to be once you are clean. It keeps you motivated 

and takes you from vision to action and back again. Both are helpful for building a track record of 

success. It is important to occasionally look back and acknowledge how far you have come. Best of 

luck with your journey in recovery. We hope to see you on the road to happy destiny.
57

Appendix

About This Decision Support Tool

This decision support tool is for people who want information about 

the role of medications in treating opioid use disorder. You can use 

the tool to help you:

 learn about MAT;

 compare your treatment options;

 decide which options are best for you and your recovery; and

 discuss your preferences with a provider.

This decision support tool does not:

 substitute for or replace professional advice; 

 endorse any particular pathway to recovery; 

 direct your treatment choices;

 tell you what to do; or

 have all the answers.

No single approach works for everyone. This decision support tool may help you make informed 

choices about treatment for opioid use disorder and find an approach that is right for you.

appendix
58

Glossary

Abstinence is an intentional choice not to use alcohol or drugs or to abuse medications. It is a 

commitment many people make when they want to overcome an addiction.

Addiction is physical dependence on a drug and compulsive using behavior that causes problems 

in many life areas.

AIDS (acquired immunodeficiency syndrome) is an incurable disease caused by a virus (see HIV). It 

can be passed on through sexual contact or injection drug use. When someone has AIDS, it means 

the virus has affected the body’s ability to fight diseases. It can be fatal. New medications can save 

lives when HIV/AIDS is detected and treated.

Assessment is a standard set of questions that help doctors, counselors, or other providers 

determine how severe a person’s drug problem is. It lets them know what treatment approach is 

best and what other services are needed.

Belief system is a set of ideas and thoughts people hold as true about themselves and the world 

around them. These include beliefs about what is right or wrong. Individuals, groups, communities, 

and cultures can have belief systems that influence the way they see things.

Benzodiazepines are a group of addictive medications used for anxiety. They have sedative and 

relaxing effects. These drugs include Valium, Ativan, and others. They can be fatal when mixed with 

some medications used to treat opioid use disorder.

Cognitive behavioral therapy (CBT) is a type of counseling that works well for people with drug 

problems. The counselor helps the person change the thoughts and feelings that lead to using. Then 

they practice new coping skills.

Cognitive skills are thinking skills. They include the ability to learn, to put ideas together, to 

remember, and to communicate. Cognitive skills are used to solve problems and make decisions.

Cold turkey is a term for quitting opioids with no medical help or preparation. It involves 

abruptly stopping drug use in an effort to quit for good. The term refers to one of the symptoms of 

withdrawal, “goose flesh” (horripilation).

Complementary treatments are helpful things like vitamins, yoga, or exercise. People may do them 

along with their drug treatment and as an ongoing part of their recovery.

Confidentiality in drug treatment is governed by law. It means information about people in drug 

treatment is private and cannot be given out without permission.

Counseling in addiction treatment usually includes working on a treatment plan and checking in on 

progress. It teaches skills that help people stay away from drug use. It also helps people work out 

other problems and connects them to other services as needed.
59

Craving is an urgent, overpowering need to use a substance. Anxious, depressive, or negative 

feelings usually go along with it. The urges are intense because they are related to changes in the 

brain that result from addiction.

Dependence is a physical change that the body goes through when it gets used to having a 

substance. Once it happens, people have withdrawal symptoms when they stop or rapidly decrease 

the drug.

Detox/Detoxification is supervised stopping of drug use. Medications are often used for a short 

period to help and medical supervision is often required.

Drug interaction is when two drugs do not mix well when they are taken together. Drug interactions 

can be very dangerous. A prescription medication can interact with a street drug or two or more 

prescriptions can interact, as can two or more street drugs.

ECG/EKG is an electrocardiogram. It is a test that measures the electrical activity of the heart to see 

if it is functioning normally.

Heart problems include a change in the heartbeat that puts people at risk for abnormal heart 

rhythm and sudden death. Methadone use increases the risk of this kind of problem.

Hepatitis C virus (HCV) is an infectious disease that affects the liver. There is a high rate of HCV 

infection among people who use drugs. It can be passed to others. Some of the ways it gets passed 

include tattooing, sharing razors, and especially sharing needles, spoons, and other things used to 

inject drugs. There is also a small risk of getting it through sexual contact with a person who has it. 

A simple and quick blood test can tell if someone is infected.

Hereditary means something is passed down from parents to children. Each parent gives a set of 

genes to their children. The genes determine eye and hair color and can make children prone to 

the same illnesses as their parents.

Highly motivated describes people who are ready to make a change. They have important reasons 

for doing so and are committed. Motivation can change as people become more certain they want 

to stop using.

HIV (human immunodeficiency virus) is an infection that can lead to AIDS. It is a virus that can be 

passed on to someone through sexual contact or though sharing needles, spoons, and other things 

used to inject drugs. A simple and quick test can tell if someone is infected with HIV. When people 

know they have it, they can get treatment.

Induction is the beginning of MAT when people start the medication and get used to it.

Infectious diseases are also called communicable diseases because they can spread among groups 

of people. Things like bacteria and viruses on shared drug paraphernalia cause them.
60

Inpatient or residential treatment programs are centers where people live for a period of time 

while they get counseling and support. Some programs are long-term and offer housing and other 

services.

Intensive outpatient treatment programs are recovery services people can attend three to five times 

a week for several hours while living at home. They treat severe to moderate substance addiction.

Interferon is a medication used to treat hepatitis C virus (HCV).

Liver function tests are blood tests that check how well the liver is working.

Maintenance is the long-term part of MAT. People in maintenance may stay on medication for a long 

time or they may gradually cut down their dosage under medical supervision.

Mutual aid groups are also known as self-help groups. They are made up of people recovering from 

addiction who help and support each other. Peer support groups such as AA and NA are one type of 

mutual aid group.

Neonatal abstinence syndrome (NAS) is something that happens with babies born to mothers who 

are using opioids. The infant goes through some degree of withdrawal after birth, which can require 

medical care. This also can occur when the mother is receiving MAT. About half of the time medical 

care is required before the infant goes home.

Opiates are a class of drugs that come from the opium poppy, but many people use the word to 

mean all drugs that belong to the same class, including synthetic opioids.

Opioid drugs are synthetic or natural substances that have a very specific action on the brain and 

body. They are often used in medicine to relieve pain. They create a feeling of well-being, have 

sedating effects, and can easily result in physical addiction. Large doses can cause respiratory 

failure and death.

Outpatient treatment services are often scheduled weekly and may include both group and 

individual counseling.

Peer support is when people who are in recovery from addiction give and receive help to others in 

or seeking recovery.

Peer recovery support services are provided by a person in recovery. They can include coaching 

or mentoring, assistance locating housing and employment, and support developing a recovering 

social network. Peer specialists usually offer them through a recovery community organization or 

treatment center.

Prenatal care is working with a doctor and others to take care of pregnant women and the fetus 

during pregnancy.

Prescribed medications are given to you by a doctor to help with a medical problem. For opioid 

use disorder, they include methadone, buprenorphine, and naltrexone.
61

Providers are professionals who give services to people in need of drug and alcohol treatment and 

other health-related services.

One way of defining recovery is as a process of change through which people work to improve 

their health and well-being, live a self-directed life, and strive to achieve their full potential. Many 

people with addiction achieve recovery by abstaining from alcohol and illegal or non-medically 

required drug use.

Recovery community is made up of people and families who are in recovery from drug and 

alcohol problems. They share common interests and activities. They support each other and 

serve as a voice of recovery in the greater community. They sometimes form advocacy or support 

organizations.

Recovery lifestyle begins when people choose to try and overcome a problem with substances and 

live a healthier and more fulfilling life, often by adding new goals, activities, and social connections.

Recovery pathways are individual routes to overcoming addiction. There is no one single pathway 

to recovery and no single definition of recovery that works for everyone. People find their recovery 

pathway by looking at what has worked for others and trying out approaches they think might work 

for them.

Recovery skill building is learning strategies and skills to avoid risky situations and seek help when 

one is having difficulty, experiencing cravings or a desire to use, or both, while learning to cope 

with challenges or without using drugs or alcohol.

Recovery supports are people, places, and things that help with staying clean and sober. Each 

person has different needs such as rides, housing, childcare, job training, or social contacts

Relapse is a setback that people who are trying to stop using drugs sometimes go through. It 

can begin with a lot of stress, on top of triggers that lead to cravings. This is often followed by a 

breakdown in coping skills and isolation from supportive people. Eventually the result is a return to 

substance use.

Screening is a way of identifying people who may have a problem or condition. When people are 

screened, it usually means they have some signs that require a closer look.

Sexual problems can include having less than normal interest in sex. Women may have a hard time 

reaching orgasm and men may have difficulty becoming aroused.

Stabilization is when the person is on the right dose of medication and has adjusted to it.

Stigma is when someone is judged harshly or discriminated against because of their addiction or 

because of their choice of treatment.

Stress is a feeling of anxiety or worry in your life. Stress is often caused by problems with money, 

health, relationships, work, housing, and other pressures.
62

Sudden cardiac death is caused when the electrical system to the heart functions abnormally. The 

heart is not able to keep blood moving through the body.

Support system is the combination of people and things that help a person get in and stay in 

recovery.

Thought patterns are set ways of thinking. Sometimes they center on a set of assumptions that 

may or may not be true. For example: If I can’t get high, I’ll never be able to have fun again. Often 

changing thought patterns is part of changing behavior.

Tolerance is the body’s adaptation to regular use of a drug. As the body gets used to having the 

drug, one or more of the drug’s effects decrease over time. It begins to take larger amounts to get 

the desired effect.

Trauma is an experience that a person finds threatening and frightening, that may have a longlasting effect. Trauma can relate to childhood experiences such as sexual abuse, domestic violence, 

or loss or to later experiences, such as combat, street violence, domestic violence, or sexual assault. 

People who are addicted to substances or have a history of addiction often have traumatic past 

experiences that affect them in the present.

Treatment plan is a written document mapping out the approach the client and the treatment 

provider have agreed to try.

Treatment programs are usually licensed. They provide counseling, groups, medications, and other 

services to people seeking help with drug and alcohol problems.

Urine retention is when people have a hard time urinating (peeing) or emptying their bladders.

Withdrawal is what happens when someone is physically dependent on a drug and stops taking it or 

decreases the amount abruptly. Withdrawal from opioids can be intensely uncomfortable.

Withdrawal symptoms are physical and psychological. They begin shortly after someone stops 

taking a drug they are physically addicted to. Most of the intense withdrawal symptoms improve 

with time.
63

Resources

General Information from the U.S. Department of Health and Human Services

Opioids: The Prescription Drug & Heroin Overdose Epidemic

http://www.hhs.gov/opioids

Treatment Locators

National Treatment Locators:

http://www.samhsa.gov/find-help

Opioid Treatment Program Locator:

http://dpt2.samhsa.gov/treatment/directory.aspx

Buprenorphine Physician and Treatment Locator:

http://buprenorphine.samhsa.gov/bwns_locator

National Alliance of Advocates for Buprenorphine Treatment (NAABT) Physician/Patients Matching System:

http://www.naabt.org

State-by-State Listing for State Opioid Treatment Authority Designees: 

http://dpt2.samhsa.gov/regulations/smalist.aspx

Rights

“Know Your Rights: Rights for People on MAT” and Other Related Publications:

http://lac.org/resources/substance-use-resources/medication-assisted-treatment-resources

Educating the Courts, Other Government Agencies, and Employers About Methadone:

http://www.lac.org/doc_library/lac/publications/Educating_about_Methadone.pdf

About MAT

Medication-Assisted Treatment for Opioid Addiction: Facts for Families and Friends: 

http://store.samhsa.gov/product/Medication-Assisted-Treatment-for-Opioid-Addiction-Facts-for- Families-and-Friends/SMA09-4443

SAMHSA TIP 43 MAT for Opioid Addiction:

http://www.ncbi.nlm.nih.gov/books/NBK64164
64

Topics in Brief: Medication-Assisted Treatment for Opioid use disorder: 

Seeking Drug Abuse Treatment: Know What to Ask: 

http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications

About MAT Medications

Federal Guidelines for Opioid Treatment: 

http://store.samhsa.gov/product/Federal-Guidelines-for-Opioid-Treatment-Programs/PEP15-FEDGUIDEOTP

Drug Information: Methadone

Overview: 

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682134.html

Complete Product Labeling Information: 

https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=METHADONE

Using Methadone Safely:

https://store.samhsa.gov/shin/content/SMA09-4413/SMA09-4413.pdf

Drug Information: Buprenorphine

Overview: 

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a605002.html

Complete Product Labeling Information: 

https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=BUPRENORPHINE

The Facts About Buprenorphine: 

http://store.samhsa.gov/product/The-Facts-about-Buprenorphine-for-Treatment-of-Opioid-Addiction/SMA15-4442

Drug Information: Naltrexone

Overview: 

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a685041.html

Complete Product Labeling Information:

https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=naltrexone

The Facts About Naltrexone: 

http://store.samhsa.gov/product/The-Facts-about-Naltrexone- for-Treatment-of-Opioid-Addiction/SMA13-4444
65

Medication Interactions

Drug Interactions: What You Should Know. U.S. Food and Drug Administration:

http://www.fda.gov/drugs/resourcesforyou/ucm163354.htm

Methadone Interaction Checker. Medscape:

http://reference.medscape.com/drug/methadose-dolophine-methadone-343317#3

Buprenorphine Interaction Checker. Medscape: 

http://reference.medscape.com/drug/subutex-buprenorphine-343326#3

Naltrexone Interaction Checker. Medscape:

http://reference.medscape.com/drug/vivitrol-revia-naltrexone-343333#3

HIV/AIDS Medication Interactions. U.S. Health and Human Services:

http://www.aidsinfo.nih.gov/Guidelines/HTML/1/adult-and-adolescent-treatment-guidelines/22

Overdose Prevention

Opioid Overdose Prevention Toolkit. Substance Abuse and Mental Health Services Administration:

http://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit-Updated-2016/SMA16-4742

Naloxone Auto-injector Information. U.S. Food and Drug Administration: 

http://www.fda.gov/Drugs/DrugSafety/ PostmarketDrugSafetyInformationforPatientsandProviders/ucm391449.htm

When the Seconds Count—Opioid Overdose Resuscitation Card. American Society of Anesthesiologists 

and the Office of National Drug Control Policy: 

http://www.asahq.org/WhenSecondsCount/resources

Vital Signs: Prescription Painkiller Overdose Information Page. Centers for Disease Control and Prevention: 

http://www.cdc.gov/vitalsigns/PrescriptionPainkillerOverdoses/index.html

Harm Reduction Coalition. Online Training Institute:

http://harmreduction.org/our-work/training-capacity-build/online-training-institute

Recovery Support Organizations

Narcotics Anonymous (NA):

http://www.na.org

Narcotics Anonymous (NA) Meeting Locator:

http://www.na.org/MeetingSearch

Methadone Anonymous:

http://marsmethadone.com/methadone-anonymous
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Heroin Anonymous:

http://www.heroinanonymous.org

Cocaine Anonymous:

http://www.ca.org

SmartRecovery:

http://www.smartrecovery.org

Dual Recovery Anonymous:

http://draonline.org

Alcoholics Anonymous (AA):

http://www.aa.org

Double Trouble in Recovery:

http://www.bhevolution.org/public/doubletroubleinrecovery.page

Recovery Advocacy Organizations

American Association for the Treatment of Opioid Dependence (AATOD):

http://www.aatod.org

National Alliance for Medication Assisted Recovery:

http://www.methadone.org

National Alliance of Advocates for Buprenorphine Treatment (NAABT):

http://www.naabt.org

Association of Recovery Community Organizations

http://www.facesandvoicesofrecovery.org/who/arco

Living in Recovery

SAMHSA Working Definition of Recovery: 10 Guiding Principles:

http://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF

Tips to Maintain Recovery and Prevent Relapse: 

http://store.samhsa.gov/product/Maintaining-Resiliency-and-Sustaining-Recovery-Ensuring- That-Recovery-Lasts-a-Lifetime/SMA10-4490

Chronic Pain

SAMHSA TIP 54 Managing Chronic Pain in Adults With or in Recovery:

http://store.samhsa.gov/shin/content//SMA12-4671/TIP54.pdf
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Pregnancy

Methadone Treatment for Pregnant Women:

http://store.samhsa.gov/product/Methadone-Treatment-for-Pregnant-Women/SMA09-4124

The National Institute of Health Information Page on Neonatal Abstinence Syndrome:

http://www.nlm.nih.gov/medlineplus/ency/article/007313.htm

State-by-State Listing of Women’s Substance Abuse Service Coordinators Who Can Help Pregnant Women 

with Opioid Addiction Get Services:

http://www.cffutures.org/files/webinar-handouts/SSA-WSN-CFSR%20Coordinator%20Directory.pdf

Research on the Advantages of Buprenorphine During Pregnancy: 

https://www.nih.gov/news-events/news-releases/buprenorphine-treatment-pregnancy-less-distress-babies