Talk with your doctor before starting any medication. This Recovery Tool will help you consider some of risks, side effects, or medication interactions associated with Medication Assisted Treatment (MAT).

For more information on medications, visit: Medline Plus.

FDA approved package inserts are available at DailyMed.

To learn more about medication interactions, visit: Avoiding Drug Interactions.

    Who it works for?

  • Methadone

    1. Able to get to an approved program
    2. Pregnant and post-partum women
    3. Have severe or chronic pain
    4. People being treated for HIV/AIDS
    5. People who do best with structured programs
    Learn more
  • Buprenorphine

    1. Are best treated in doctors' offices
    2. Pregnant and postpartum women
    3. People being treated for HIV/AIDS
    4. Able to follow a treatment plan
    5. Motivated to try buprenorphine for MAT
    Learn more
  • Naltrexone

    1. Able to stop using for 7–10 days
    2. Mandated by court or employer
    3. People with alcohol problems
    4. Motivated to eliminate all opioids now
    5. Re-entering from prison or jail
    Learn more

    Side effects

  • Methadone

    Most people have some side effects.
    Talk to your doctor if they are severe or do not go away.


    Examples of side effects reported by people taking methadone:

    1. Sweating
    2. Headache
    3. Constipation
    4. Drowsiness
    5. Nausea/vomiting
    6. Loss of appetite
    7. Decreased sexual desire/ability
    8. Weight gain
    9. Memory and concentration problems

    Serious side effects are not very common. Call your doctor immediately if you experience any.

    Examples of serious methadone side effects:

    1. Seizures
    2. Itching
    3. Hives
    4. Rash
    5. Racing or irregular heartbeat
    6. Impaired driving
    Learn more
  • Buprenorphine

    Most people have some side effects.
    Talk to your doctor if they are severe or do not go away.


    Some examples of side effects reported by people taking buprenorphine are listed below. This is not a complete list of all possible side effects. See product labeling for more information:

    1. Headache
    2. Stomach or back pain
    3. Constipation
    4. Nausea or Vomiting
    5. Difficulty falling asleep or staying asleep
    6. Sweating
    7. Mouth numbness, redness, or sores
    8. Tongue pain, swelling, or burning
    9. Excess fluid and swelling of feet or legs
    10. Blurred vision
    11. Intoxication (feeling lightheaded or drunk)
    12. Disturbance in attention
    13. Irregular heart beat (palpitations)
    14. Fainting
    15. Dizziness
    16. Sleepiness

    Serious side effects are not as common. Contact medical help if you have:

    1. Hives or Skin rash
    2. Itching
    3. Difficulty breathing or swallowing
    4. Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
    5. Upset stomach, nausea
    6. Extreme tiredness
    7. Blurred vision
    8. Slurred speech
    9. Confusion or cannot think clearly
    10. Unusual bleeding or bruising
    11. Lack of energy or coordination
    12. Loss of appetite
    13. Pain in the upper right part of the stomach
    14. Yellowing of the skin or eyes
    15. Dark-colored stools
    16. Light-colored stools
    17. Have slowed reflexes and breathing
    18. Diziness when changing positions
    Learn more
  • Naltrexone

    Most people have some side effects. Talk to your doctor if they are severe or do not go away.


    Some examples of side effects reported by people taking naltrexone are listed below. This is not a complete list of all possible side effects. See product labeling for more information:

    1. Nausea or vomiting
    2. Diarrhea
    3. Stomach pain
    4. Decreased appetite
    5. Dry mouth
    6. Headache
    7. Difficulty falling asleep or staying asleep
    8. Diziness
    9. Tiredness
    10. Anxiety
    11. Joint pain or stiffness
    12. Muscle cramps
    13. Weakness
    14. Tenderness, redness, bruising, or itching at the injection site
    15. Constipation
    16. Irritability
    17. Tearfullness
    18. Increased or decreased energy
    19. Rash

    Serious side effects are not as common. Contact medical help if you have:

    1. Pain, hardness, swelling, lumps, blisters, open wounds, or a dark scab at the injection site
    2. Coughing
    3. Wheezing
    4. Shortness of breath
    5. Hives
    6. Rash
    7. Swelling of the eyes, face, mouth, lips, tongue, or throat
    8. Hoarseness
    9. Difficulty swallowing
    10. Chest pain
    11. Confusion
    12. Hallucinations (seeing things or hearing voices that do not exist
    13. Blurred vision
    14. Severe vomiting and/or diarrhea
    15. Nausea
    16. Stomach pain
    17. Drowsiness
    18. Diziness
    Learn more

    Accessibility

  • Methadone

    Common forms

    1. Liquid
    2. Other forms may be available

    How do I take it?

    1. Taken once a day
    2. Daily dosing offered at approved programs
    3. Some take home dosing permitted
    4. More frequent if doing well in long-term treatment

    Cost

    1. $
    2. Cost varies depending on state, insurance, and other factors. Talk to provider about payment options.
    Learn more
  • Buprenorphine

    Common forms

    1. Film or pill
    2. Other forms; seldom used for treating addiction

    How do I take it?

    1. Usually taken daily; must dissolve under the tongue or in mouth.
    2. Offered in various treatment programs
    3. Trained physicians provide it for office-based treatment
    4. Patients may get a prescription to take at home.
    5. Can be filled at any pharmacy

    Cost

    1. $$
    2. Cost varies depending on state, insurance, and other factors. Talk to provider about payment options.
    Learn more
  • Naltrexone

    Common forms

    1. Long-acting injection or pill

    How do I take it?

    1. Qualified medical professionals can prescribe the tablets or give injections
    2. Tablets are taken daily; long-acting injections are given monthly
    3. Outpatient programs may offer injectable naltrexone

    Cost

    1. $$$
    2. Cost varies depending on state, insurance, and other factors. Talk to provider about payment options.
    Learn more

    Health concerns

  • Methadone

    Pregnancy and breastfeeding

    1. Safe to use during pregnancy and breastfeeding; very small amounts in breast milk
    2. Risk of withdrawal symptoms in infants born to mothers treated with methadone during pregnancy

    HIV

    1. May be used during treatment for HIV; watch for drug interactions that require dosage adjustments; talk with your doctors

    Hepatitis

    1. Has been used safely by people with hepatitis and by people being treated with interferon for Hepatitis C. Check with your doctors.

    Chronic pain

    1. Usually safe to use methadone with other opioid medications prescribed for pain; dosage watched carefully due to overdose risk
    Learn more
  • Buprenorphine

    Pregnancy and breastfeeding

    1. Studies show buprenorphine safe during pregnancy and breastfeeding
    2. The form of buprenorphine that that does not contain naloxone is recommended during pregnancy and breast-feeding.
    3. Risk of withdrawal symptoms in infants born to mothers treated with buprenorphine during pregnancy

    HIV

    1. May be used during HIV treatment. Smaller risk of drug interactions; talk with your doctors

    Hepatitis

    1. The form of buprenorphine that contains naloxone should not be used if patients have severe liver impairment.
    2. Has been used safely by people with hepatitis. Liver damage reported mostly in people who already had liver conditions. Check with your doctor. Liver function tests recommended.

    Chronic pain

    1. At high doses, buprenorphine can cancel out pain relieving effects of other opioid pain medications.
    2. Buprenorphine dosing for pain should be monitored carefully for overdose risk
    Learn more
  • Naltrexone

    Pregnancy and breastfeeding

    1. Not recommended; no research on safety of use during pregnancy or breastfeeding

    HIV

    1. Safe to use with HIV medications; low potential for HIV drug interactions

    Hepatitis

    1. Liver damage is possible at very high doses. Most studies report no liver damage at recommended doses. Work closely with your doctor before starting.

    Chronic pain

    1. May block effects of opioid medications taken for pain. Can cause withdrawal in people physically dependent on opioid pain medication, unless they stop all opioids 7-10 days before taking it.
    2. Non-opioid pain medication safe with naltrexone at all times. Talk with your doctor about naltrexone and pain.
    Learn more

    Starting/Stopping

  • Methadone

    When can I start?

    1. Immediately

    How long do I take it?

    1. Most effective when used for longer periods of time, at least one year
    2. Safe for long term use as maintenance therapy
    3. Periodic assessment of ongoing treatment needs based on what is right for you

    What happens if I stop?

    1. Methadone withdrawal symptoms
    2. Dose can be gradually reduced instead

    What if I use opioid drugs on this medication?

    1. High risk of overdose
    2. May not have euphoric effect
    Learn more
  • Buprenorphine

    When can I start?

    1. 12–24 hours after last use

    How long do I take it?

    1. Most effective when used for 9 months or longer
    2. Considered safe for long-term use
    3. Periodic assessment of ongoing treatment needs based on what is right for you

    What happens if I stop?

    1. Withdrawal, less intense, but unpleasant
    2. Withdrawal cannot be entirely “avoided” by gradually decreasing the buprenorphine dose.
    3. It is advisable to work with your doctor to gradually decrease your dose.

    What if I use opioid drugs on this medication?

    1. Moderate risk of overdose
    2. May cancel out pain relieving effects of other opioids
    Learn more
  • Naltrexone

    When can I start?

    1. After detox or 7–10 days after last use

    How long do I take it?

    1. Long-acting injectable form stays in effect for 30 days
    2. The length of treatment should be individualized and determined in consultation with your doctor.
    3. Most studies have been over a 5 month period or longer
    4. Approved for treating alcohol dependency

    What happens if I stop?

    1. A person who interrupts treatment with naltrexone and uses opioids sufficiently to become physically dependent again can experience withdrawal when naltrexone is re-introduced.
    2. High risk of overdose if opioid use is resumed – due to lowered tolerance.

    What if I use opioid drugs on this medication?

    1. May block effects of opioids
    2. Taking large amounts to override blocking effect has resulted in fatalities
    3. Naltrexone blocks the effects of an opioid and attempts to override the blocking can result in an opioid overdose.
    Learn more

    Warnings

  • Methadone

    Overdose

    1. Highest risk of methadone overdose during the initial weeks of treatment
    2. High risk of methadone overdose when combined with benzodiazepines
    3. High risk of methadone overdose when combined with alcohol and/or other drugs due to a toxic build up that occurs because methadone stays in the system so long

    Other health risks

    1. Serious heart problems
    2. High dosages may stop a person’s breathing

    Risks to others

    1. Dosages used in MAT may be harmful if shared or given to others
    2. Can be fatal if taken by children, pets, or others with no tolerance
    3. Must be stored safely in locked cabinet
    4. Risk of impaired driving when starting or adjusting medication

    Driving

    1. Do not drive during dosage adjustments due to impairment risk
    2. May affect ability to get a commercial driver’s license (CDL) in some states
    Learn more
  • Buprenorphine

    Overdose

    1. Moderate to high risk when combined with alcohol and/or other substances
    2. High risk when combined with benzodiazepines

    Other health risks

    1. High dosages may stop a person’s breathing

    Risks to others

    1. Dosages used in MAT may be harmful if shared or given to others
    2. Can be fatal if taken by children, pets, or others with no tolerance
    3. Must be stored safely in locked cabinet
    4. Risk of impaired driving when starting or adjusting medication

    Driving

    1. Do not drive during dosage adjustments due to impairment risk
    2. May affect ability to get a commercial driver’s license (CDL) in some states
    Learn more
  • Naltrexone

    Overdose

    1. High risk of opioid overdose during relapse due to lowered tolerance
    2. Attempts to override blocking effect can result in opioid overdose

    Other health risks

    1. Risk of causing severe withdrawal if taken by opioid dependent people unless they have stopped using opioids for 7-10 days prior to starting naltrexone.

    Risks to others

    1. May be harmful if taken by children, pets, or shared with others
    2. Must be stored safely in locked cabinet
    3. No risk of impaired driving; not a controlled substance

    Driving

    1. Not a controlled substance. Does not affect driving or ability to get a commercial driver’s license (CDL)
    Learn more