Myths and Misconceptions: Medications for Opioid Use Disorder (MOUD)

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People with opioid use disorder (OUD) and their families often believe many myths and inaccuracies about MOUD, overshadowing the evidence in support of MOUD’s benefits.[1] Many of the negative attitudes towards MOUD among patients, their doctors, and their peers may come from misunderstandings of how these treatments work. Common myths and inaccuracies about methadone treatment may prevent patients and their families from recognizing the evidence in support of methadone’s benefits.

Myth #1: MOUD replaces one addiction with another.

Sometimes patients and their families or friends wonder why doctors use drugs like buprenorphine or methadone to treat opioid addiction, since these medicines are in the same family as heroin and prescription opioid pain medication. However, physician-prescribed buprenorphine and methadone are not just “substituting” one addiction for another.

Addiction treatment uses longer-acting and safer medications to help overcome more dangerous opioid use and addiction. Many studies have shown that maintenance treatment with long-acting opioids like methadone or buprenorphine helps keep patients healthier, reduces criminal activity, and helps prevent drug-related diseases like HIV/AIDS and hepatitis C.

Patients who strongly object to using maintenance opioids for any reason may choose a different type of MOUD. For example, naltrexone is not an opioid drug, and actually works by blocking the effects of opioids in the brain for up to one month. For more information, see the Community Resources section of

Myth #2: MOUD is a bad moral choice. It is inferior to recovery without medication
Some of the negative stigma of MOUD comes from different ways of understanding addiction.

Some people with OUD and their communities view addiction as a moral and spiritual failing, rather than as a medical disease. In this view, medical treatment with methadone may seem like a “crutch,” or a weak moral choice because a patient is continuing to use an opioid on a daily basis. Medication-free abstinence is the most common treatment plan in this view of addiction. MOUD’s ability to make addiction recovery easier and less painful may not be seen as a benefit, but may suggest that a patient “isn’t as serious” about quitting. MOUD patients do not meet some 12-step programs’ definitions of abstinence because of their use of opioid medications, and they may be excluded and shunned from these groups. Individuals attending 12-step groups may be criticized as having “traded one drug for another” if they reveal that they are seeking treatment with buprenorphine or methadone. This is not always the case, and some AA and NA members understand the role of MOUD in recovery.

Addiction as a medical disease: Instead of understanding addiction as only a moral or spiritual failing, many medical professionals have begun to view OUD as a medical disease. The disease of addiction can be caused by repeated exposure to a drug, coupled with genetic or environmental risk factors, leading to physical changes in the brain’s opioid receptors. In this view, addiction can be treated and managed with medication, much like other chronic medical conditions.

Myth #3: MOUD is not effective because it does not immediately end drug dependence.

OUD is not “cured” by the use of MOUD. Addiction is a “chronic” (long-lasting) disease. Medical treatment for addiction can be compared to medical treatment for other common chronic conditions like diabetes or high blood pressure. Just as diabetes is not “cured” by the use of insulin, and people with high blood pressure often continue taking medications for many years, so people with OUD are not “cured” but instead well-managed by MOUD.

Misconception #4: “I’ve known a few people who could stop using opioids without help from any kind of medication. MOUD is only for the weak.”

Though opioid abuse may begin with a series of poor judgments or risky decisions, addiction involves real, physical changes in the brain. While some people are eventually able to quit using opioids on their own, the majority of patients go though many dangerous cycles of relapse and recovery. MOUD can make the recovery process much safer, and has saved many lives by preventing death from overdose or dangerous behaviors associated with “street” or black market and unregulated drug use.

[1]Frank, D. (2011.) The trouble with morality: the effects of 12-step discourse on addicts’ decision-making. J Psychoactive Drugs 43(3), 245-256.

Kenneth Stoller, MD, 2018 Steering Committee Meeting

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