- Reduce craving in OUD patients
- High affinity partial μ-opioid receptor agonist  
- Associated with a ceiling effect with respect to the risk of respiratory depression 
- Effects from additional illicit opioid use during maintenance treatment can be blocked
- Impact on craving is dose-dependent
- Must be carefully up-titrated to achieve the optimal dose for
each patient to adequately suppress craving
- Therapeutic impact on dysphoria, potentially leading
to improvements in quality of life

Buprenorphine for OUD

- Can treat substance use disorders
- However, cannot treat OUD because it can increase negative affect and craving
- There is no clinically proven  therapeutic impact of this drug on craving 

Naltrexone for OUD

- Reduce cravings in OUD patients 
- Long term maintenance  improved mood and reduce cue-induced craving
- First pharmacotherapy approved in OUD
- Impact on craving is dose-dependent
- Must be carefully up-titrated to achieve the optimal dose for
each patient to adequately suppress craving

Methadone for OUD

- Methadone and Buprenorphine are medication treatments used for OUD
- Other treatment options include intravenous diamorphine, oral L-methadone, and slow-release oral morphine but have limited availability in most countries

Rutgers University

- Substance use disorder
- Chronic and complex neurobiological disease 
- Associated with frequent relapse of taking drugs
- Major public health issue 
- Craving is a main component of OUD and other substance use
disorders

Opioid Use Disorder (OUD)

Kakko J, Alho H, Baldacchino A, Molina R, Nava FA and Shaya G
 2019) Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice.Front. Psychiatry 10:592. doi: 10.3389/fpsyt.2019.00592

Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice

- Overwhelmingly strong desire or need to use a drug because of the memory of a pleasant rewarding effect in place of a negative emotional state 
- Strongly associated with patients having opioid misuse 
- Important treatment target to reduce the risk of relapse and
improve patients’ quality of life
- Essential component of dependence syndromes 

Craving

OUD Pharmacological Treatment 

Patients may benefit from cognitive-behavioral therapy (CBT), motivational interventions, "mindfulness" and contingency management .

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