This review helps pharmacists compare buprenorphine-naloxone and naltrexone outcomes, prepare for expanded methadone access, and use stimulant co-use as a risk-stratification signal during opioid treatment.
Bottom Line
All three FDA-approved medications for opioid use disorder are effective, but buprenorphine-naloxone offers a modest edge in overdose prevention, and treatment continuity plus harm reduction matter more than agent choice alone.
2.3 pp
lower nonfatal overdose, bup-naloxone
1.4%
24-week mortality, both agents
aOR 2.97
stimulant use, concurrent heroin use
71.7%
pharmacists willing, weekly methadone
State of Play
Medications for opioid use disorder (MOUD), namely buprenorphine-naloxone, extended-release (XR) naltrexone, and methadone, remain the standard of care, with all three considered efficacious under current federal guidance. The practical questions have shifted from whether to treat toward which agent, how to protect continuity, and how to layer harm reduction onto ongoing polysubstance risk.
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Full Analysis: Subscribers Only
The complete evidence synthesis, practice recommendations, and open questions.
What Changed
How It Fits the Guidelines
Effect chart & evidence comparison
Evidence at a Glance
Practice Considerations
Open Questions
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Not medical advice. PharmD Signal provides educational synthesis of published pharmacy and medical literature for practicing pharmacists. It is not a treatment recommendation for any individual patient; clinical decisions remain the responsibility of the treating clinician exercising independent professional judgment.