Quick Summary
Medication for opioid use disorder, often called MAT or MOUD, has some of the strongest evidence in addiction treatment. The clearest findings are about staying alive: in large studies, people taking methadone or buprenorphine had much lower rates of overdose death than people not taking medication. “Doubles your chances” is shorthand, though, and the real numbers depend on the medication, the group studied and what was measured. This guide walks through what the research actually shows, how the three FDA-approved medications differ, common myths, and a checklist for talking with a prescriber.
Key Takeaways
- A review of cohort studies found overdose death rates were several times lower while people were taking methadone than after they stopped.
- In a study of people who survived an overdose, methadone was linked to 59% fewer opioid overdose deaths and buprenorphine to 38% fewer over the next year, compared with no medication.
- The weeks right after stopping medication carry higher risk, so decisions about tapering are best made slowly with a prescriber.
- Methadone, buprenorphine and naltrexone work differently. Naltrexone is harder to start, but once started, it did about as well as buprenorphine in one major trial.
- These are associations from specific groups of people. They show strong benefit, not a guaranteed outcome for any one person.
What the Research Actually Measures
When people say MAT “doubles your chances,” they are summarizing a lot of studies that measured different things, such as overdose death, staying in treatment, or opioid use. The most solid findings are about overdose death. Here is what two of the best-known studies found, and who they looked at.
Overdose death in and out of treatment. A 2017 review of cohort studies in the BMJ by Sordo and colleagues compared death rates while people were taking methadone or buprenorphine with death rates after they stopped. For methadone, the overdose death rate was 2.6 per 1,000 person-years in treatment versus 12.7 out of treatment. For buprenorphine, it was 1.4 versus 4.6, based on a single study. All-cause death followed the same pattern.
After a nonfatal overdose. An NIH-funded study of 17,568 Massachusetts adults who survived an opioid overdose found that over the next 12 months, opioid overdose deaths were 59% lower for people receiving methadone and 38% lower for people receiving buprenorphine, compared with people not receiving medication. The study could not draw conclusions about naltrexone because too few people received it.
Two cautions. These are observational studies, so they show strong associations, not proof for every individual. And each medication was compared with no medication, not with each other, so the numbers do not show that one is better than another.
How the Three Medications Differ
The FDA has approved three medications for opioid use disorder:
| Medication | How it works | Forms and access |
|---|---|---|
| Methadone | Full opioid agonist. Activates opioid receptors steadily to prevent withdrawal and reduce cravings. | Oral liquid or tablets, dispensed for opioid use disorder through certified opioid treatment programs. |
| Buprenorphine | Partial agonist. Reduces withdrawal and cravings with a ceiling on some effects. | Films or tablets under the tongue or in the cheek, often combined with naloxone, and long-acting injections on product-specific schedules. |
| Naltrexone | Antagonist. Blocks opioid effects and does not activate the receptors. | Monthly extended-release injection. Requires an opioid-free period and a clinical check before starting, because starting too soon can trigger severe withdrawal. |
Naltrexone’s biggest hurdle is getting started. In the X:BOT trial, 72% of people assigned to extended-release naltrexone started it, compared with 94% assigned to buprenorphine-naloxone, and that gap drove higher relapse in the naltrexone group overall. Among people who did start, relapse rates over 24 weeks were similar. Our guides on Suboxone vs methadone and the Vivitrol shot go deeper on each option.
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How Long People Stay on Medication
There is no set end date. Some people take medication for months, many for years, and some indefinitely. The Sordo review found that the first four weeks after stopping methadone or buprenorphine carried a death rate about two to three times higher than later on. That higher risk is one reason to plan any taper carefully with a prescriber, as an individual decision, with a support plan and naloxone on hand.
Medication Plus Other Support
Medication is a core part of treatment, and many people also benefit from counseling, peer support, treatment for mental health conditions and help with practical needs. Those supports should make it easier to stay on medication, not harder. Counseling is often offered alongside medication, but it should not become a barrier to getting a prescription when someone needs one. If mental health is part of the picture, our page on co-occurring mental health conditions explains how that is handled.
Common Myths
“It is just swapping one drug for another.” Methadone and buprenorphine are prescribed at steady, monitored doses to treat a medical condition. That is very different from the cycle of using, crashing and withdrawal.
“You have to come off it to be in real recovery.” Many people are in long-term recovery while taking medication. The goal is stability and safety, not a deadline.
“Naltrexone is the same as the others.” It works the opposite way. It blocks opioids instead of activating receptors, and you have to be off opioids before starting.
“Medication alone is never enough.” In the studies above, methadone and buprenorphine were associated with lower overdose death. Other support can add to that, but clinically indicated medication should not be delayed just because counseling or other services are not set up yet. Talk through the plan with a qualified prescriber.
Questions to Bring to a Prescriber
- Which medication fits my history, health and goals, and why?
- How do I start it, and what will the first few weeks feel like?
- How often will I need visits or pickups, and how do refills work?
- What if I miss doses or use while on it?
- How does it interact with my other medications, including anything for mental health?
- Is it covered by my insurance, and is prior authorization needed?
- If I want to taper someday, how would we decide when and how?
- Where can I get naloxone?
When to Reach Out for Help
If someone may be having an opioid overdose, such as being hard to wake, breathing slowly or not at all, or having blue lips, call 911 and give naloxone if you have it. Stay with them until help arrives. If you are having thoughts of suicide, call or text 988. If you may act soon or cannot stay safe, call 911 or go to an emergency room. If you are thinking about stopping a medication for opioid use disorder, talk to your prescriber first.
Talking With a Professional
If you or someone you love is considering medication for opioid use disorder, a conversation with a qualified clinician is the next step. They can assess what fits, explain each option, and help line up support around it. Our page on opioid addiction treatment gives general information about care options. The admissions team at Discovery Point Retreat can walk you through what an assessment involves, which services are available, and where medication treatment is provided.
FAQ
Does MAT really double your chances of recovery?
The strongest evidence is about survival: large studies link methadone and buprenorphine with substantially lower overdose death. Exact numbers depend on the medication, the group studied and the outcome measured, so “doubles” is a rough summary, not a promise.
Which medication is best?
There is no single best one. Methadone, buprenorphine and naltrexone each have trade-offs, and the right fit depends on the person. Studies comparing each to no medication do not rank them against each other.
Is naltrexone as effective as buprenorphine?
In the X:BOT trial, once people successfully started it, extended-release naltrexone performed about as well as buprenorphine-naloxone. Fewer people managed to start naltrexone, because it requires being off opioids first.
How long will I need to take it?
It varies. Many people stay on medication for years. Stopping carries higher risk in the following weeks, so any change should be planned with a prescriber.
Do I have to do counseling to get medication?
Counseling and other support help many people, but they should not stand in the way of getting medication when it is needed. Ask the program how it handles this.
References
- Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ, 2017. Accessed October 2026. pmc.ncbi.nlm.nih.gov
- National Institutes of Health. Methadone and buprenorphine reduce risk of death after opioid overdose. Accessed October 2026. nih.gov
- Lee JD, Nunes EV, Novo P, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT). Lancet, 2018. Accessed October 2026. pubmed.ncbi.nlm.nih.gov
- U.S. Food and Drug Administration. Information about Medications for Opioid Use Disorder (MOUD). Accessed October 2026. fda.gov
- National Institute on Drug Abuse. Medications for Opioid Use Disorder. Accessed October 2026. nida.nih.gov
Related Reading
Resources
- 988 Suicide and Crisis Lifeline. Call or text 988, or chat at 988lifeline.org. Free, confidential support 24/7.
- SAMHSA National Helpline. Call 1-800-662-HELP (4357) or visit the SAMHSA National Helpline page for free, confidential referrals to local treatment.
- 911. For any medical emergency, including a suspected overdose, call 911 immediately.
This article is general education and is not medical advice.
If you want to talk through treatment options for opioid use, call Discovery Point Retreat at (855) 245-7133 to talk with our admissions team.
