Methadone and Buprenorphine: The Place of Opiate Replacement Therapies

Pharmacotherapy is the mainstay and standard of care for treatment of opioid use disorder with behavioral interventions serving as essential adjunctive treatment. Managing patients with opioid use disorder without medications typically fails with 80–90 % relapse rates described (Ball and Ross. The effectiveness of methadone maintenance treatment: clients, programs, services, and outcome. New York: Springer; 1991; Weiss et al. Arch Gen Psychiatry. 2011;68(12):1238–46). Methadone, a full μ-opioid agonist, and buprenorphine, a μ-opioid partial agonist and κ-opioid antagonist, are two FDA-approved medications for the treatment of opioid use disorder. In this chapter, we will discuss the role of these medications in the treatment of opioid use disorder while describing what data exist on the role of these medications in treatment of patients with co-occurring chronic pain and opioid use disorder.