Medication for opioid addiction: how it works and how to get it
Three medicines are approved to treat opioid use disorder: buprenorphine, methadone and naltrexone. People treated with methadone or buprenorphine are less likely to overdose or die than people who get no treatment. Yet fewer than 1 in 5 people with opioid use disorder get these medicines.1
Since December 2022, any prescriber whose DEA registration covers Schedule III drugs can prescribe buprenorphine if state law allows, with no special waiver. Methadone for opioid use disorder comes only from a certified opioid treatment program. Medicaid must cover all of these medicines, and that rule is now permanent.5312
Updated October 2026. Rules differ by state, so call your office before you go. Questions? We're here: call or text 888-860-RISE.
Leaving jail or prison? Ask about medication now
People who get methadone or buprenorphine in jail or prison are more likely to stay in treatment after release, and less likely to overdose or be locked up again.1
The Department of Justice says a jail with a blanket rule against continuing medication you were prescribed before you came in would violate the Americans with Disabilities Act.14
Your tolerance drops while you're not using. SAMHSA lists people recently released from incarceration among those who should have overdose-reversal medicine on hand.9
Your steps, in order
- 1
Know your three options
Buprenorphine is a partial opioid agonist. It eases withdrawal and cravings with weaker opioid effects than methadone or heroin, which makes it safer in an overdose and less likely to be misused. Some products add naloxone to discourage misuse.2
It comes as tablets or film under the tongue, film for the cheek, extended-release injections, and implants.1
Methadone is a long-acting full opioid agonist taken daily as a liquid, powder or diskette. It reduces cravings and withdrawal and blunts or blocks the effects of other opioids.3
Naltrexone isn't an opioid and isn't addictive. It blocks opioids from working and reduces cravings. For opioid use disorder, only the shot given every four weeks is FDA approved.4
Methadone and buprenorphine can work equally well to cut opioid use. Methadone may help some people stay in treatment longer.1
- 2
Getting buprenorphine
Many doctors, nurse practitioners and physician assistants can prescribe it, including your regular doctor. You don't need a special clinic.15
You can start it by phone or video. Under a federal rule, a prescriber who has never seen you in person can start buprenorphine and prescribe up to a total 6-month supply that way. After that, you'll need an in-person visit or another form of telemedicine federal law allows.6
To start, you usually need to go 12 to 24 hours without opioids and be in early withdrawal. Starting too soon can bring on sudden, strong withdrawal. Your prescriber will tell you when.2
No photo ID for the pharmacy? A pharmacist can accept other proof, such as a letter from homeless shelter staff, a utility bill, a bank statement, a voter card or a pay stub.6
Tip:Ask your prescriber for a letter on their letterhead confirming who you are. SAMHSA suggests this for people without standard ID.6
- 3
Getting methadone
Enroll at a certified opioid treatment program. SAMHSA's Opioid Treatment Program Directory lets you search by state.38
Federal rules changed in October 2024. Adults no longer need a year-long history of opioid addiction to get in. Counseling is offered, but you can't be refused medication if you choose not to take part. Programs can screen you for buprenorphine by phone or video, and for methadone by video, under certain conditions. A program that's full can give you medication right away while it arranges full services. Your state may have its own rules too.7
At first you take your dose at the clinic. Once you're stable, you may take doses home between visits. Your care team decides take-home doses with you, based on your safety and your situation.37
A National Institute on Drug Abuse guide, cited by SAMHSA, says methadone treatment should last at least 12 months, and some people stay on it long term.3
- 4
Getting naltrexone
Any practitioner licensed to prescribe medicine can prescribe naltrexone.4
You must be off opioids before the first shot: at least 7 days after short-acting opioids and 10 to 14 days after long-acting ones. Starting sooner causes withdrawal.4
Important: if you stop naltrexone or miss shots, your body is more sensitive to opioids. Using the amount you used before, or even less, can kill you.4
- 5
Pay for it
Medicaid must cover every FDA-approved drug for opioid use disorder, including methadone, plus the counseling that goes with it. Congress made this permanent in 2024; it had been set to end September 30, 2025.12
Medicare covers methadone, buprenorphine and naltrexone. At a Medicare-enrolled opioid treatment program you pay no copays, but the Part B deductible applies. If you have both Medicare and Medicaid, you pay nothing for services you get through Medicaid.13
Private plans that cover addiction treatment must cover it on terms comparable to medical care.10
No insurance? Call SAMHSA's National Helpline at 1-800-662-4357. It refers you to state-funded programs and places that charge on a sliding fee scale.11
- 6
Stay safe on your medication
Don't mix it with alcohol, sedatives, tranquilizers or other drugs that slow breathing. Large amounts can lead to overdose or death.23
Never take an extra dose of methadone if you miss one or feel it isn't working. Keep it out of reach of children and pets, and never share it.3
Keep naloxone at home. SAMHSA says prescribers should consider prescribing it to people taking methadone or buprenorphine.9
Methadone and buprenorphine cause physical dependence, so stopping suddenly brings withdrawal. If you want to stop, lower the dose slowly with your prescriber.13
What it costs
| Coverage | What it pays for |
|---|---|
| Medicaid (every state) | All FDA-approved opioid use disorder drugs, including methadone, plus related counseling |
| Medicare, opioid treatment program | No copays; Part B deductible applies |
| Medicare, doctor's office | Copays and the Part B deductible |
| Medicare Part D drug plan | May cover buprenorphine and naltrexone; ask your plan |
| No insurance | State-funded programs or sliding fees, through the National Helpline |
If this is you
Situations that change where you go or what you're owed.
You're pregnant
Methadone and buprenorphine are the treatments of choice for opioid use disorder during pregnancy and breastfeeding. Withdrawal during pregnancy can raise the risk of miscarriage or early birth, so don't stop on your own.23
Your job drug tests
The Americans with Disabilities Act generally protects people taking prescribed medication for opioid use disorder under a health professional's care. An employer can't refuse to hire you or fire you for that legal use unless you can't do the job safely or another federal law disqualifies you.14
A program or nursing home turns you away
The Department of Justice says a facility that refuses all patients who take prescribed medication for opioid use disorder would violate the ADA. Your past treatment is protected too.14
You have Medicare and Medicaid
You pay nothing for opioid use disorder services you get through your state Medicaid program.13
Stuck on a step? You don't have to do this alone.
Call or text, and we'll help you find the right office and what to bring. Someone on our team can step in whenever youwhat to bring, with a real person on our team whenever you need one.apos;d like. Or become a RISING MEMBER: a mentor who's been there helps you build a plan, step by step. You do the work; we walk with you.
Questions people ask
Isn't medication just trading one drug for another?
No. Taken as prescribed, methadone and buprenorphine stop cravings and withdrawal without the high that other opioids cause. They do cause physical dependence, like many medicines, so stopping suddenly brings withdrawal. Naltrexone isn't an opioid at all.
Can I get buprenorphine by phone or online?
Yes. A federal rule lets a prescriber start buprenorphine through a phone or video visit and prescribe up to a total 6-month supply before you need an in-person visit.
Do I have to go to counseling to get methadone?
Counseling is offered and recommended, but under the federal rules in effect since October 2024, an opioid treatment program can't refuse you medication if you choose not to take part.
How long will I need to stay on it?
It depends on you. Federal research guidance says methadone should last at least 12 months, and some people stay on it, or on buprenorphine, long term. Stopping should be planned with your prescriber.
Does Medicaid pay for methadone and buprenorphine?
Yes. Every state's Medicaid program must cover all FDA-approved medicines for opioid use disorder, including methadone, and the counseling that goes with them. Congress made this permanent in 2024.
Keep going: more first-step guides
Sources
Official pages, read in October 2026. Rules change. If something here looks out of date, please let us know at hello@riseaid.org and we'll fix it.
- 1.National Institute on Drug Abuse. Medications for opioid use disorder
- 2.Substance Abuse and Mental Health Services Administration. Buprenorphine
- 3.Substance Abuse and Mental Health Services Administration. Methadone
- 4.Substance Abuse and Mental Health Services Administration. Naltrexone
- 5.Substance Abuse and Mental Health Services Administration. Waiver elimination (MAT Act)
- 6.Substance Abuse and Mental Health Services Administration. Buprenorphine telemedicine prescribing: questions and answers
- 7.Substance Abuse and Mental Health Services Administration. 42 CFR Part 8 final rule: expanding access and flexibility for patients
- 8.Substance Abuse and Mental Health Services Administration. Opioid Treatment Program Directory
- 9.Substance Abuse and Mental Health Services Administration. Opioid overdose reversal medications
- 10.Substance Abuse and Mental Health Services Administration. What does health insurance cover?
- 11.Substance Abuse and Mental Health Services Administration. SAMHSA's National Helpline
- 12.Centers for Medicare & Medicaid Services. State Medicaid Director Letter SMD# 24-004: extension of Medicaid coverage of substance use disorder treatment (November 19, 2024)
- 13.Medicare.gov. Opioid use disorder treatment services
- 14.U.S. Department of Justice, Civil Rights Division. The ADA and opioid use disorder: combating discrimination against people in treatment or recovery (April 2022)
- 15.Utah Department of Health and Human Services, Office of Substance Use and Mental Health. Substance use disorder: find publicly funded services in your county
- 16.Utah Department of Health and Human Services, Office of Substance Use and Mental Health. Local authority location map