Quick answer
Opioid addiction treatment works best when it includes medication. Methadone, buprenorphine and naltrexone are FDA-approved for opioid use disorder and lower the risk of overdose and relapse. These medications are usually combined with counseling in a detox, inpatient or outpatient program. Keeping naloxone on hand can reverse an opioid overdose.
What are the signs of opioid use disorder?
Opioids include prescription pain relievers such as oxycodone, hydrocodone and morphine, as well as heroin and illegally made fentanyl. Doctors call opioid addiction opioid use disorder (OUD). It is a chronic but treatable medical condition.
Clinicians diagnose OUD using 11 criteria from the DSM-5. Summarized, they ask whether in the past year you have:
- Used more opioids, or for longer, than intended
- Tried to cut down or stop without success
- Spent a lot of time getting, using or recovering from opioids
- Had strong cravings
- Missed duties at work, school or home
- Kept using despite relationship problems
- Given up important activities
- Used in physically risky situations
- Kept using despite physical or mental health problems
- Needed more to get the same effect (tolerance)
- Had withdrawal symptoms when you stopped
Two to three signs suggest mild OUD, four to five moderate, and six or more severe. Tolerance and withdrawal alone don’t count if you take opioids exactly as prescribed under medical care.
Other warning signs loved ones may notice include pinpoint pupils, nodding off, mood swings, money problems, “doctor shopping,” or running out of prescriptions early.
Not sure where to start? Call (877) 847-2855 to talk through treatment options and check your insurance benefits. It’s free and confidential.
What does opioid withdrawal feel like?
When someone who is physically dependent on opioids stops or cuts back, withdrawal can feel like a severe flu. Common symptoms include:
- Muscle and bone aches
- Restlessness, anxiety and trouble sleeping
- Runny nose, watery eyes and yawning
- Sweating, chills and goosebumps
- Nausea, vomiting, diarrhea and stomach cramps
- Strong cravings
Opioid withdrawal is rarely deadly by itself, but vomiting and diarrhea can lead to dehydration. The biggest danger comes after withdrawal: tolerance drops quickly, so using the same amount as before can cause a fatal overdose. That’s why detox alone, without ongoing treatment, is not recommended.
Opioid withdrawal timeline
| Phase | Short-acting opioids (heroin, oxycodone) | Long-acting opioids (methadone) |
|---|---|---|
| Symptoms begin | About 8–24 hours after last use | About 1–3 days after last use |
| Symptoms peak | About days 1–3 | Several days in |
| Acute symptoms ease | About 4–10 days | Can last 2 weeks or longer |
| Lingering effects | Cravings, poor sleep and low mood for weeks or more | Similar, sometimes longer |
Medically supervised detox can ease symptoms with medications such as buprenorphine, methadone or lofexidine, and it’s a chance to start long-term medication right away.
What is the most effective treatment for opioid addiction?
Medications for opioid use disorder
According to NIDA and SAMHSA, medication is the most effective approach for OUD. Combining medication with counseling is often called medication-assisted treatment (MAT). The three FDA-approved options are:
| Medication | How it works | Where you get it |
|---|---|---|
| Methadone | Full opioid agonist that prevents withdrawal and reduces cravings | Certified opioid treatment programs, often called methadone clinics |
| Buprenorphine | Partial agonist that eases cravings with a lower risk of misuse; also comes as a monthly injection | Doctor’s offices, clinics and telehealth providers |
| Naltrexone | Blocks opioid effects; given as a monthly injection | Any prescriber; you must be opioid-free for several days first |
Since 2023, any clinician with a standard DEA registration that covers controlled substances can prescribe buprenorphine for OUD, which has made it easier to find. Learn more about medication-assisted treatment.
Counseling and support
Medication works best with behavioral support, such as:
- Cognitive behavioral therapy (CBT) to manage triggers and cravings
- Contingency management, which rewards progress such as negative drug tests
- Family therapy to rebuild trust and support
- Peer support groups and recovery coaching
Many people with OUD also have depression, anxiety, PTSD or chronic pain. Dual diagnosis treatment addresses both conditions together.
Which level of care should you consider?
Clinicians often use the ASAM Criteria, guidelines from the American Society of Addiction Medicine, to recommend a level of care based on your needs.
- Detox: a safe, monitored start, ideally leading straight into ongoing medication.
- Inpatient or residential rehab: 24/7 support if you have frequent relapses, an unsafe home or serious health needs.
- Partial hospitalization (PHP): a full day of treatment while living at home.
- Intensive outpatient (IOP): several sessions a week so you can keep working.
- Outpatient and office-based treatment: regular medication and counseling visits.
- Telehealth: some providers can start or continue buprenorphine through virtual visits, depending on state and federal rules.
Ask any program whether it offers or supports MAT. Programs that require you to stop medication may not follow current best practice.
How do you prevent an opioid overdose?
Signs of an opioid overdose include pinpoint pupils, slow or stopped breathing, blue or gray lips, limp body, gurgling sounds and being unable to wake up. If you see these signs:
- Call 911.
- Give naloxone (Narcan) if you have it. Naloxone is a medicine that can quickly reverse an opioid overdose.
- Try to keep the person awake and breathing, and lay them on their side.
- Stay with them until help arrives. A second dose may be needed.
Naloxone is safe to give even if you’re not sure opioids are involved. The FDA approved Narcan nasal spray for over-the-counter sale in 2023. Many states also have Good Samaritan laws that offer some legal protection to people who call for help during an overdose.
Because the illegal drug supply often contains fentanyl, anyone who uses opioids, or lives with someone who does, should keep naloxone nearby. Read our fentanyl addiction page for more.
How do you pay for opioid addiction treatment?
Costs vary widely by setting, length of care and insurance. Most health plans must cover substance use treatment as an essential health benefit under the Affordable Care Act, and federal parity law limits stricter rules for addiction care. Coverage still depends on medical necessity, prior authorization, network status, deductibles and your plan type. Federal law requires state Medicaid programs to cover FDA-approved medications for OUD. See does insurance cover rehab? for details.
How do you get help?
You don’t need to hit “rock bottom” to start treatment. Talk to a doctor, ask about medication, and look for programs that offer it. You can also browse rehab centers by state. If you or someone you love is in crisis or thinking about suicide, call or text 988.
Opioid use disorder is treatable, and medication saves lives. To find a program that offers MAT and accepts your insurance, call our admissions helpline at (877) 847-2855. It’s free and confidential.
Frequently asked questions
What is the most effective treatment for opioid addiction?
Medications for opioid use disorder, such as methadone and buprenorphine, are considered the most effective treatment by NIDA and SAMHSA. They reduce cravings and withdrawal and lower the risk of overdose. They work best with counseling and support.
Isn't taking methadone or buprenorphine just trading one drug for another?
No. When taken as prescribed, these medications stabilize brain chemistry without producing the highs and lows of opioid misuse. They let people work, parent and take part in therapy. Addiction experts consider them a standard of care.
How long does opioid withdrawal last?
For short-acting opioids such as heroin or oxycodone, symptoms often start within 8 to 24 hours and last about 4 to 10 days. Withdrawal from long-acting opioids like methadone may start later and last longer. Cravings and low mood can persist for weeks.
Is opioid withdrawal dangerous?
Opioid withdrawal is rarely life-threatening on its own, but vomiting and diarrhea can cause dangerous dehydration. The bigger danger is relapse after withdrawal, when tolerance is lower and overdose risk is much higher.
Can I get naloxone without a prescription?
Yes. The FDA approved Narcan nasal spray for over-the-counter sale in 2023, so you can buy it at many pharmacies and stores. Many health departments and community programs also give it out for free.
How long do people stay on buprenorphine or methadone?
There is no set time limit. Many people stay on medication for months or years. Research shows that stopping too early raises the risk of relapse, so decisions about tapering should be made with a doctor.
