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The short answer
Three FDA-approved medicines treat opioid use disorder: buprenorphine, methadone and naltrexone. Buprenorphine and methadone are associated with lower overdose risk and better staying power in treatment, and naltrexone is an option for people who are fully off opioids. The best choice depends on your history, health, preferences and access. Medication works best with counseling and support.
Why medication matters
Opioids are involved in most overdose deaths. CDC data show that in 2023, about three-quarters of overdose deaths involved an opioid, and most involved illegally made fentanyl. Medication lowers cravings and withdrawal and protects against overdose, while detox alone often leads to relapse and a higher overdose risk after tolerance drops. (See [What Is the Difference Between Detox and Rehab?].)
The three medications compared
| Buprenorphine | Methadone | Naltrexone | |
|---|---|---|---|
| How it works | Partly activates opioid receptors, easing cravings and withdrawal | Fully activates opioid receptors, easing cravings and withdrawal | Blocks opioid receptors so opioids have no effect |
| Is it an opioid? | Yes, partial | Yes, full | No |
| How it is taken | Daily dissolving tablet or film, or a monthly or longer-acting injection | Daily liquid or tablet, dispensed at a certified opioid treatment program | Monthly injection (also daily tablets, which are less used) |
| Where you get it | Doctors’ offices, clinics, telehealth, some ERs | Certified opioid treatment programs | Doctors’ offices and clinics |
| Starting | Timed so withdrawal is managed | Started carefully, with gradual adjustment | You need to be opioid-free first |
| Overdose protection | Lower overdose risk than full opioids | Strong evidence for lower mortality | No tolerance, so overdose risk after stopping is high if opioids are used |
| Good for | Many people, including in primary care | People who need more structure or stronger effect | People motivated to stay opioid-free, often after detox or incarceration |
| Keep in mind | Needs good timing at the start | Daily visits early on, drug interactions | Hard to start without a period off opioids |
Details differ by person, so a prescriber decides. (See [Medication-Assisted Treatment (MAT): How It Works and Who It’s For].)
How to choose
Think about:
- Your history: what you use, how long, and what has worked before.
- Your schedule: daily clinic visits versus a prescription.
- Your health: pregnancy, liver or heart conditions, other medications.
- Access: which clinics and programs are near you.
- Your goals and preferences.
If one option does not work, you can switch. Many people try more than one.
What treatment looks like
- Assessment of your use and health
- Starting medication, with timing chosen to avoid severe withdrawal
- Regular visits to adjust the dose and monitor your health
- Counseling and peer support
- A plan for as long as it helps. There is no set time limit, and stopping should be a decision with your doctor.
Safety points
- Do not mix with alcohol, sedatives or other opioids unless directed by a doctor.
- Keep naloxone at home. (See [How to Get Naloxone (Narcan): Where to Find It Free and When to Use It].)
- Tolerance drops after a break, so returning to a previous amount can cause an overdose.
- Tell every doctor and pharmacist which medication you take.
- Report side effects rather than stopping on your own.
Pregnancy
Buprenorphine or methadone is often recommended for opioid use disorder in pregnancy, with medical care. Tell a doctor right away. (See [Addiction Treatment During Pregnancy: Safe Options and Legal Protections].)
Cost and access
Medicaid, Medicare and many private plans cover these medicines, though rules vary. (See [Does Insurance Cover Rehab? How to Check Your Benefits Step by Step] and [Free and Low-Cost Rehab Options Without Insurance].) Telehealth can help with buprenorphine. (See [Is Telehealth Addiction Treatment Effective? Pros, Cons and Costs].)
If you are a family member
Support the treatment plan, including medication, and learn how to use naloxone. (See [How to Talk to a Loved One About Addiction Without Pushing Them Away].)
Frequently asked questions
Which is best: buprenorphine, methadone or naltrexone?
There is no single best. Buprenorphine and methadone have the strongest evidence for lower overdose risk, and the right one depends on you.
Is methadone or buprenorphine just swapping one drug for another?
No. They are prescribed at stable doses under supervision and help people stop the cycle of cravings and withdrawal.
Can I get buprenorphine by telehealth?
Often yes, though rules and availability vary.
How long do I stay on medication?
As long as it helps, which may be months or years. Decide with your doctor.
Sources
- SAMHSA. Medications for Opioid Use Disorder (TIP 63). samhsa.gov
- National Institute on Drug Abuse. Medications to Treat Opioid Use Disorder. nida.nih.gov
- American Society of Addiction Medicine. National Practice Guideline for the Treatment of Opioid Use Disorder. asam.org
This article is for general information only and is not medical advice. A prescriber must decide which medication is right for you.