This page has information on:

  • What are opioids
  • What is opioid use disorder
  • Treatment for opioid use disorder

What are opioids?

Opioids are a class of drugs that act on the endorphin system, which helps manage pain and pleasure.

Opioids include medications, like hydrocodone and oxycodone, and non-prescription drugs like heroin and illicit fentanyl products. For more examples of opioids check out NIDA’s page on opioids.

Opioids can cause:

  • Tolerance: over time you to need more to have the same effect.
  • Physical dependence: when you stop using you go into withdrawal. Opioid withdrawal can feel like a very bad flu and can include nausea, chills, diarrhea, vomiting, and anxiety.
  • Overdose: more opioids than the body can handle, breathing slows or stops.
  • Opioid use disorder (OUD): also called addiction, this is physical dependence along with thinking/psychological and social problems.

Learn more about opioids from the CDC.

Susan's Brain, the science of addiction

Susan’s Brain: The Science of Addiction, a video from Harvard and National Geographic describes what happens in the brain when someone takes opioids.


What is opioid use disorder?

Opioid use disorder (OUD) is a medical condition. If you have OUD it means you are physically dependent on opioids and have brain changes that affect your thinking, priorities and relationships.

Opioid use disorder is:

  • Biological: physical dependence, tolerance, and withdrawal.
  • Psychological: compulsive use, always thinking about opioids, most important thing in life.
  • Social: opioids get in the way of responsibilities, relationships, work, school, etc.

Opioid use disorder is a medical condition that can be long-term, like diabetes, high blood pressure, or depression. Like those health conditions, medications can improve your health.

OUD can come back if not treated properly. You may need to try more than one type of treatment to find what works best for you

Signs and symptoms

People with opioid use disorder:

  • Keep using opioids even though they know it is hurting them,
  • Can’t quit even when they try repeatedly,
  • Spend lots of time using opioids, or recovering from using,
  • Use opioids in dangerous situations,
  • The formal diagnosis of OUD involves these behaviors.

Read more about the official diagnosis of OUD.

Why do people get opioid use disorder?

Most people who try opioids will not develop opioid use disorder. About one in four people who try heroin develop opioid use disorder; this proportion is probably similar for people who try other types of opioids in the social context and with the mindset of trying “to get high.”

Whether or not someone who tries opioids develops opioid use disorder can be influenced by their genetics, personality, physical/emotional trauma, life history, social environment, and other factors.

For some people, the first time they try opioids, they feel really good; others feel sleepy or nauseated. Over time their body gets used to opioids, and when a person does not have external opioids in their system, they will have symptoms of withdrawal and feel really bad. People will continue to use opioids just to feel normal.

Medications like methadone and buprenorphine can help people stabilize and avoid withdrawal by binding to opioid receptors where they have a full or partial opioid effect.

Health and opioid use disorder

If you have untreated opioid use disorder you are at higher risk for dying, including being at high risk from an opioid overdose. You are also more likely to get serious infections like hepatitis C and HIV. If you think you might have opioid use disorder, talk to your health care provider. They can help you stay healthy even if you’re not ready for treatment.


Treatment for opioid use disorder

Medications are proven to work the best at treating opioid use disorder. They help:

  • Manage craving and withdrawal,
  • Reduce illicit opioid use,
  • Decrease the risk of having an overdose.

Medications can provide stability, allowing you to address other things in your life.

You can be in recovery and be on medications at the same time.

You may also want counseling or other recovery supports. Learn more about those here.

Download the Medications for Opioid Use Disorder brochure in English or Spanish.

What medications are used to treat OUD?

Methadone

How does this medication work?

  • Methadone is a full opioid medication.
  • The more you take the more you will feel its effects. (Finding the proper dose is important.)
  • It manages cravings and withdrawal by binding to opioid receptors.

Does it lower my risk of dying? Based on research that tracked outcomes in the real world.

  • Methadone lowers risk of death by about 50%.

How long does it last, and how do I take it?

  • It lasts about 24 hours and is taken by mouth.

Where can I get it, and how often do I need to go?

  • Methadone is dispensed only at opioid treatment programs.
  • You will need to visit the OTP 6 days a week to start, but this can decrease over time.

Will I need to go to counseling?

  • Methadone treatment requires regular urine drug testing and counseling.
Buprenorphine

How does this medication work?

  • Buprenorphine is a partial opioid medication.
  • It has a ceiling effect, so above a certain dose you stop feeling its effects.
  • It manages cravings and withdrawal by binding to opioid receptors. (Finding the proper dose is important.)

Does it lower my risk of dying? Based on research that tracked outcomes in the real world.

  • Buprenorphine lowers risk of death by about 50%.

How long does it last, and how do I take it?

  • It lasts about 24 hours and is usually taken by mouth (implant or injection possible and beginning to be used more often).

Where can I get it, and how often do I need to go?

  • Buprenorphine can be prescribed by a medical provider and picked up at a pharmacy or dispensed at some opioid treatment programs.
  • Visits vary from daily to monthly.

Will I need to go to counseling?

  • Most providers require urine drug testing and some require counseling.
Naltrexone

How does this medication work?

  • Naltrexone is an opioid blocker.
  • It is not an opioid, so you won’t feel an opioid effect.
  • It helps manage cravings for some people.

Does it lower my risk of dying?

  • Naltrexone has not been shown to lower the risk of death, based on research that tracked outcomes in the real world. It reduces chances of dying while the medication is being taken and active in the body, but the majority of people only take it for a short period of time.

How long does it last, and how do I take it?

  • Naltrexone for opioid use disorder is typically given in the form of an injection that lasts for 28 days. You can’t use any opioids for 7-10 days before taking naltrexone.
  • A daily, oral form of naltrexone is available but not recommended for ongoing treatment of opioid use disorder.

Where can I get it, and how often do I need to go?

  • Naltrexone is prescribed and given by a medical provider or provided at an opioid treatment program.
  • Visits vary from weekly to monthly.

Will I need to go to counseling?

  • Some providers require urine drug testing and counseling.

Treatment settings

There are three places where you can get medications for opioid use disorder:

Opioid treatment program (OTP), historically known as a methadone clinic
  • Methadone, buprenorphine, or naltrexone may be available.
  • Highly structured: counseling and supervised dosing may be required.

At an OTP, you do not receive a prescription and fill it at a pharmacy, instead you go to the program to take your medication and to pick up take-home doses. OTPs are licensed and regulated by the state and federal government.

If you take methadone at an OTP, you are required to take part in counseling and have supervised dosing to start. You may be able to take medication home once you have been in the program for a while.

Medical office/Primary care
  • Buprenorphine or naltrexone may be available.
  • Familiar medical office setting.
  • Less structure (often weekly or monthly visits, some don’t require counseling).
  • Appointment usually needed.
  • Similar to seeing a prescriber or nurse for other health issues.

Buprenorphine is prescribed by the provider and you pick up the prescription at a pharmacy. Naltrexone is usually an injection and can be given at the provider’s office.  

Healthcare providers who prescribe buprenorphine to treat OUD have taken additional training in treating OUD and received a special DEA waiver. Any healthcare provider can prescribe naltrexone, no waiver required.  

Community program
  • Buprenorphine or naltrexone may be available.
  • Other services may be offered, such as syringe exchange or housing supports.

Washington State has worked to set up treatment programs that are easy to access. These programs are in places like syringe services programs, community health centers, and non-profits that serve the homeless.

What makes these programs different?

  • Treatment offered in a trusted setting where clients may already receive services.
  • Drop-in visits available.
  • Short time to start medications.
  • Offers, but does not require counseling.

 

WA Recovery Help Line logo

If you’re ready for treatment and/or recovery supports, or just want to learn more, connect with the Washington Recovery Help Line: 1-866-789-1511 (toll free, WA only) 206-461-3219 (TTY). 24-hour referrals to WA state.