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. Author manuscript; available in PMC: 2022 Nov 15.
Published in final edited form as: AIDS. 2021 Nov 15;35(14):2237–2247. doi: 10.1097/QAD.0000000000003051

Table 2.

FDA Approved Medications for OUD, Adolescent Criteria, and HIV Outcomes

Medication Mechanism Benefits Adverse Effects Use in Adolescents Effect on HIV
Outcomes
Buprenorphine Partial μ-receptor agonist often co-formulated with naloxone Decreased risk of overdose and diversion (when combined with naloxone)

  • Can precipitate withdraw if patient has other opioids in their system

  • Potential for abuse or diversion but less than methadone

 Recommended by the AAP for all patients ≥16 y/o with severe OUD

  • Increase retention in HIV care [1]

  • Decreased heroin use[2]

  • Decreased HIV risk behaviors[3, 4]
Methadone Full μ-receptor agonist Will not precipitate withdraw

  • QTc prolongation

  • Significant interactions with other medications, specifically ART including zidovudine, nevirapine, efavirenz, ritonavir, lopinavir/ritonavir and darunavir/ritonavir.

  • Potential for abuse or diversion

 Use in patients <18 is restricted

  • Decreased HIV risk behaviors[2]

  • Increased HIV testing[5]

  • Increased ART therapy and virologic suppression[5]
Extended-release naltrexone Full μ-receptor antagonist Has decreased overdoses compared to oral naltrexone [6]

  • Risk for mortality if patient relapses[7]

  • Will precipitate withdraw

 FDA approved for 18 years and older. Can be used in patients younger than 18 in certain circumstances

  • Decreased illicit opioid use[8, 9]