. 2019 Jan 31;28(2):55–62. doi: 10.1111/ajad.12862

Table 3.

Overview of considerations in OUD treatment

Patient type	OUD characteristics	Treatment goals ^a
Opioid analgesic misusers/abusers ○ Short‐acting ○ Long‐acting Heroin/illicit opioid users Post‐opioid overdose (naloxone treated) Users of opioid‐based maintenance therapy for OUD Patients with chronic pain With opioid tolerance or hyperalgesia No longer requiring opioid analgesia	Physical dependence only ^b Mild OUD Moderate/severe OUD	Maintenance therapy ○ Opioid agonist (buprenorphine, methadone) ○ Opioid antagonist (naltrexone) Transition from opioid‐based maintenance to opioid‐free Opioid dose reduction/taper ○ With transition to opioid‐free ○ With maintenance of reduced dose Opioid‐free ○ Residential program ○ Psychosocial counseling ○ Self‐help and 12‐step programs Transition to opioid‐free analgesia or no analgesia

Patient type

OUD characteristics

Treatment goals ^a

Opioid analgesic misusers/abusers ○ Short‐acting ○ Long‐acting

Heroin/illicit opioid users
Post‐opioid overdose (naloxone treated)
Users of opioid‐based maintenance therapy for OUD
Patients with chronic pain
With opioid tolerance or hyperalgesia
No longer requiring opioid analgesia

Physical dependence only ^b
Mild OUD
Moderate/severe OUD

Maintenance therapy ○ Opioid agonist (buprenorphine, methadone) ○ Opioid antagonist (naltrexone)

Transition from opioid‐based maintenance to opioid‐free
Opioid dose reduction/taper ○ With transition to opioid‐free ○ With maintenance of reduced dose

Opioid‐free ○ Residential program ○ Psychosocial counseling ○ Self‐help and 12‐step programs

Transition to opioid‐free analgesia or no analgesia

OUD, opioid use disorder.

^{^a}

Psychosocial counseling and self‐help programs also are recommended in addition to other treatments (eg, maintenance therapy, dose reduction) in patients with OUD.

^{^b}

Physical dependence only (does not meet criteria for OUD but may lead to OUD).