Approved medications for opioid use disorder : current update.

Abstract

Introduction: Opioid use disorder (OUD) is recognized as a chronic, relapsing disorder with a high mortality and psychiatric and somatic comorbidity.

Areas covered: Existing guidelines and meta-analyses on pharmacotherapy of opioid use disorder were reviewed. Opioid maintenance treatment (OMT) is the generally accepted first line treatment in OUD with oral methadone and buprenorphine being the gold standard. In recent years a number of novel opioids have been introduced into clinical practice including depot formulations of buprenorphine, retarded morphine and heroin (diacetylmorphine). The review refers to the different drugs available and gives an overview on clinical use, side effects, and efficacy in certain subgroups.

Expert opinion: OMT is a success story with emerging new pharmacological options available. While oral methadone or buprenorphine still are the most suitable medications for many patients, depot formulations of buprenorphine may improve adherence and facilitate clinical management of many patients. Diacetylmorphine and retarded morphine are second line medications for treatment refractory patients. Future research may focus on responder characteristics for certain medications and efficacy in special subgroups as well as interaction of psychosocial and pharmacological treatments.