Medications for Opioid Use Disorder (MOUD)

Opioid Use Disorder (OUD) is a medical condition for which there are several effective treatments, collectively known as Medications for Opioid Use Disorder (MOUD). 

The most effective MOUDs ease withdrawal symptoms, reduce cravings, and support recovery by empowering people to engage in work and family life without the constant disruption of untreated withdrawal or cravings. 

MOUD is the gold standard of care for OUD, and it significantly improves the success of long-term recovery.

FDA-approved MOUDs

FDA-approved MOUDs include methadone, buprenorphine, and naltrexone, with the strongest evidence supporting buprenorphine and methadone.

Methadone

• Fully activates opioid receptors at a controlled, stable level to prevent withdrawal symptoms and reduce cravings (full opioid agonist).
• Can only be provided through federally certified Opioid Treatment Programs (OTPs, also known as methadone clinics).
  • Often requires daily in-person visits at the beginning of treatment until take-home doses are permitted.
• Daily (oral) formulations are available to treat OUD. 

Buprenorphine

• Partially activates opioid receptors to prevent withdrawal symptoms and reduce cravings (partial opioid agonist).
• Can be prescribed in any clinical setting by any clinician with a standard DEA Schedule III registration.
• Daily (oral) and weekly or monthly (injectable) formulations are available.

Naltrexone

• Completely blocks opioid receptors to prevent opioids from activating them (opioid antagonist).
  • Does not relieve withdrawal symptoms or cravings but prevents the effects of opioids if they are used.
• Can be prescribed by any clinician with a license to prescribe medications.
  • Requires a period of complete opioid abstinence before starting treatment.
• Daily (oral) and monthly (injectable) formulations are available.

How MOUD works

When opioids like fentanyl enter the brain, they bind to receptors that activate the body’s reward system, slowing down internal organs and providing euphoric effects.

Repeatedly using opioids can result in the development of opioid tolerance. This means more opioids are needed each time to reach the expected effect and prevent the body’s survival system from triggering painful withdrawal symptoms, like nausea, fever, and extreme body aches, that can make it impossible to function in daily life.

For most people with OUD, abstinence alone is not effective because the changes in the brain make withdrawal and cravings extremely difficult to overcome without medication support. MOUD stabilizes these brain receptors, reduces cravings and withdrawal, and allows people to return to daily life while significantly lowering the risk of overdose.

Normal dopamine levels in the brain vary throughout the day. Opioid use raises these levels significantly, until withdrawal symptoms throw this cycle out of balance. With MOUD, patients can get their dopamine levels back into the normal range and focus on recovery. 

Buprenorphine works by attaching to the brain’s opioid receptors and partially activating them. This stabilizes these receptors just enough to relieve withdrawal symptoms and reduce cravings, without producing the intoxicating effects associated with full opioids. By providing this steady, controlled activation, buprenorphine helps people feel well enough to focus on recovery and succeed in daily life. 

Low barrier MOUD access

Medications for opioid use disorder (MOUD) are highly effective, but many Minnesotans continue to face barriers to accessing this treatment. Low-barrier approaches remove unnecessary obstacles and make it easier for people to start and continue medication when they need it.

Principles of Low-Barrier MOUD:

• Same-day access: Offer medication on the first visit whenever possible.
• Flexible delivery: Provide care in healthcare settings, community locations, and through telehealth.
• Person-centered: Respect patient goals without requiring abstinence from other substances.
• Trauma-informed: Prioritize dignity, trust, and culturally responsive treatment.
• Engagement and retention: Focus on keeping patients connected to care rather than enforcing rigid requirements.

MDH-funded MOUD programs

• Emergency Medical Services (EMS): EMS is uniquely positioned to deliver rapid access to evidence-based care and linkage to ongoing treatment directly in the community. More information on EMS-initiated buprenorphine is available from MN Bridge.
• Primary Care Clinics: Tackling Overdose with Networks (TOWN) is a state-funded clinic-based program that works directly with primary care providers to build prevention programs in their communities.
• Emergency Departments: With federal funding, MDH helped launch a network of five emergency departments to increase MOUD access and expand the implementation of patient navigators in emergency departments. 
  • As of October 2025, Minnesota Health Care Programs (MHCP) will cover G2213 as an add-on code to support reimbursement for the initiation of medication for opioid use disorder (MOUD) in emergency departments.

Resources for providers

Clinical Training and Implementation Tools

• AHRQ MOUD Playbook provides guidance for implementing MOUD in outpatient settings. 
• MNBridge.org is an EMS-led website designed to support providers in initiating MOUD in the field by offering protocols, training materials, clinical guidance, and implementation tools.
• On-Shift - Bridge to Treatment: Buprenorphine protocols from California Bridge. 
• ASAM Implementation Guide: Guide for hospital and emergency department substance use disorder care from the American Society of Addiction Medicine.
  • Additional ASAM Resource Guides
• Providers Clinical Support System (PCSS): Training materials and MOUD resources. 

7-OH and Kratom Clinical Resources

• Prepare for Patients Using Concentrated 7‑OH Products (PDF): This document contains important information about Kratom and 7-OH withdrawal treatment in clinical settings. 
• Minnesota Medical Association (MMA): 7-OH, Kratom Clinical Guidance

Online trainings and continuing education

Minnesota Project ECHOs: 

ECHO participants engage in a virtual community with their peers where they share support, guidance and feedback. As a result, collective understanding of how to disseminate and implement best practices across diverse disciplines continuously improves and expands.

• CORE Center for Opioid Resources and Education - Stratis Health
• Project ECHO - Hennepin Healthcare
• Stratis Health Opioid Addiction in Rural (SOAR) Project ECHO - Stratis Health
• Midwest Tribal Echo — NACC
• Essentia Health Upper Midwest Rural Interdisciplinary SUD/OUD ECHO
• Essentia Health Substance Use & Addiction Care ECHO 

Additional Training and Resources:

• Locate certified practitioners who treat substance use disorder using SAMSHA’s Substance Use Treatment Locator.
• NO PAIN MN seeks to help patients experiencing chronic pain find alternatives to opioids and narcotics for pain management. NO PAIN MN is a useful tool for patients and providers in locating treatment methods that are safe, reliable, and effective for managing and healing pain.
• CDC’s Addiction Medicine Toolkit provides an overview of substance use disorders and the field of addiction medicine, including diagnosis and treatment of substance use disorders, linkage to care, methods to reduce stigma, and communication strategies that foster trust and help to build a collaborative patient relationship. Free continuing education (CE) credit is available.
• CDC Clinical Practice Guidelines for Prescribing Opioids for Pain: These guidelines focus on prescribing opioids for treating chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
• The California Bridge On Demand Training: The California Bridge Program, which works to provide access to MOUD in emergency departments, offers a host of evidence-based on demand trainings for providers and clinicians. Topic areas include clinical treatment, navigation to care, and harm reduction. MDs, DOs, PAs, and NPs can earn Continuing Medical Education (CME) credits through the Bridge Academy, which can be applied to the one-time DEA license renewal requirements. Nurses can use the Bridge Academy to watch trainings and earn CE Contact Hours.
• CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain: This CDC training highlights recommendations on MOUD implementation and provides example patient scenarios. Continuing education credits are available.

X-Waiver Removal

There is no longer a federal requirement for practitioners to submit a waiver to prescribe buprenorphine to treat OUD. Prescriptions for OUD, like all prescriptions, now only require a standard Drug Enforcement Agency (DEA) registration number. For more information visit SAMHSA’s Waiver Elimination webpage.