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Table 1 Comparative information for patients to make a decision

From: Developing a clinical decision support for opioid use disorders: a NIDA center for the clinical trials network working group report

 MethadoneBuprenorphineOral naltrexoneExtended release naltrexone
RouteOral dailySublingual daily or every other dayOral daily or three times per weekIntramuscular injections every 28 days
Constipation++++
Sexual dysfunction+++
Physical dependence++++
Sweating++ (rare)
Starting/StoppingNo lead-in abstinence
Gradual taper
Either lead-in abstinence or no lead-in abstinence if in opioid withdrawal at time of induction
Gradual taper
Lead-in abstinence (2–10 days)
No taper
Lead-in abstinence (2–10 days)
No taper
Weight gain
Sedation±±
Bone/joint pain
Dental problems
Opiate effect+++
Interferes with pain management using opiates±++
Drug interactionsHIV medications
Phenytoin
Rifampin
Carbamazepine
Benzodiazepines
Alcohol
Atazanavir
Benzodiazepines
Alcohol
Opioid analgesicsOpioid analgesics-
Risk of overdose+± (with benzodiazepines)