Opioid use disorder and opioid agonist treatment
Diagnosing opioid use disorder, choosing between methadone, sublingual and depot buprenorphine, safe induction including low-dose starts with fentanyl, interactions and QTc, the PBS opioid dependence program, pregnancy, and leaving treatment.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Opioid use disorder is a chronic relapsing condition. Opioid agonist treatment (OAT) with methadone or buprenorphine is the most effective treatment and cuts mortality: all-cause death rates are about a third of those out of treatment (Sordo, BMJ 2017).
- Withdrawal management ("detox") alone has high relapse rates and leaves the patient with lost tolerance, so overdose risk rises.
- Buprenorphine is safer in overdose; methadone retains more patients and suits those who need a full agonist.
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Sources
- National Guidelines for Medication-Assisted Treatment of Opioid Dependence (Gowing L et al.)AU/NZAustralian Government Department of Health, 2014
- NSW Clinical Guidelines: Treatment of Opioid DependenceAU/NZNSW Health, 2018
- High potency synthetic opioids: consensus guidance. Managing opioid withdrawal and opioid dependence treatmentAU/NZNSW Health, current as at October 2026
- Sublocade (buprenorphine) Australian Product Information, section 4.2 (standard, rapid induction and maintenance dosing)AU/NZmedsinfo.com.au (sponsor Product Information), January 2026
- SUBLOCADE (buprenorphine extended-release) injection: US prescribing information (labelling change SUPPL-31, 21 February 2025)US Food and Drug Administration, 2025
- SUBOXONE (buprenorphine and naloxone) sublingual film: US prescribing information, sections 5.12 and 8.6 (hepatic impairment)US National Library of Medicine (DailyMed), accessed November 2026
- Krantz MJ, Martin J, Stimmel B et al. QTc interval screening in methadone treatment. Ann Intern Med 2009;150:387-95Annals of Internal Medicine, 2009
- Opioid Dependence Treatment Program: frequently asked questions (Section 100, from 1 July 2023)AU/NZAustralian Government Department of Health, Disability and Ageing (PBS), 2026
- Sordo L et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ 2017;357:j1550BMJ, 2017
- Jones HE et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure (MOTHER). N Engl J Med 2010;363:2320-31New England Journal of Medicine, 2010
- The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused UpdateAmerican Society of Addiction Medicine, 2020
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback