Opioid use disorder<unk>  patches in the pouch with packaging: A removed patch is shown on the left. In Britain,<unk>  patches are named Butec 5, Butec 10, and so on.<unk>  is used to treat people with opioid use disorder. In the U.S., the combination formulation of<unk> /naloxone is generally prescribed to deter injection, since naloxone, an opioid antagonist, causes acute withdrawal if the formulation is crushed and injected. Before starting<unk> , individuals are generally advised to wait long enough after their last dose of opioid until they have some withdrawal symptoms to allow for the medication to bind the receptors,since if taken too soon,<unk>  can displace other opioids bound to the receptors and precipitate an acute withdrawal. The dose of<unk>  is then adjusted until symptoms improve, and individuals remain on a maintenance dose of 8–16 mg. Because withdrawal is uncomfortable and a deterrent for many patients, many have begun to call for different means of treatment initiation. Some providers have begun to use the Bernese method, also known as microdosing, in which very small doses of<unk>  are given while patients are still using street opioids, and without precipitating withdrawal, with medicine levels slowly titrated upward.<unk>  versus methadone Both<unk>  and methadone are medications used for detoxification and opioid replacement therapy, and appear to have similar effectiveness based on limited data. Both are safe for pregnant women with opioid use disorder, although preliminary evidence suggests that methadone is more likely to cause neonatal abstinence syndrome. In the US and European Union, only designated clinics can prescribe methadone for opioid use disorder, requiring patients to travel to the clinic daily. If patients are drug free for a period they may be permitted to receive "take home doses," reducing their visits to as little as once a week. Alternatively, up to a month's supply of<unk>  has been able to be prescribed by clinicians in the US or Europe who have completed a basic training (8–24 hours in the US and received a waiver/licence allowing prescription of the medicine. In France,<unk>  prescription for opioid use disorder has been permitted without any special training or restrictions since 1995, resulting in treatment of apprxoimately ten times more patients per year with<unk>  than with methadone in the following decade. In 2021, seeking to address record levels of opioid overdose, the United States also removed the requirement for a special waiver for prescribing physicians. Whether this change will be sufficient to impact prescription is unclear, since even before the change as many as half of physicians with a waiver permitting them to prescribe<unk>  did not so, and one third of non-waivered physicians reported that nothing would induce them to prescripe<unk>  for opioid use disorder. Chronic pain A transdermal patch is available for the treatment of chronic pain. These patches are not indicated for use in acute pain, pain that is expected to last only for a short period of time, or pain after surgery, nor are they recommended for opioid addiction. Potency With respect to equianalgesic dosing, when used sublingually, the potency of<unk>  is about 40 to 70 times that of morphine. When used as a transdermal patch, the potency of<unk>  may be 100 to 115 times that of morphine. Veterinary Uses Veterinarians frequently administer<unk>  for perioperative pain, particularly in cats, where its effects are similar to morphine. The drug's legal status and lower potential for human abuse makes it an attractive alternative to other opioids.
Buprenorphine
Methadone
Isomethadone
Naltrexone
Normethadone
Tapentadol
Morphine
Acetylmethadol