Opioid use disorder is compulsive opioid use despite harm, with cravings, tolerance and withdrawal. The most effective treatment is medication: buprenorphine (Suboxone) or extended-release naltrexone (Vivitrol), which reduce overdose death by roughly half, combined with therapy and treatment of co-occurring mental health conditions. Buprenorphine can begin within a day of your first visit, including by telehealth.
Stedfast Psychiatry provides office-based and telehealth treatment with buprenorphine and extended-release naltrexone, the medications that cut the risk of death by half or more, along with psychiatric care for the depression, anxiety, PTSD and ADHD that so often accompany opioid use. Treatment is confidential, starts quickly, and is built around keeping you alive and functioning while recovery takes hold.
Symptoms of OUD
- Taking opioids in larger amounts or for longer than intended
- Repeated unsuccessful efforts to cut down or stop
- Strong cravings for opioids
- Needing higher doses to get the same effect
- Withdrawal when stopping: muscle aches, sweating, nausea, diarrhea, anxiety, insomnia, yawning, dilated pupils
- Spending much of the day obtaining, using or recovering from opioids
- Failing to meet obligations at work, school or home
- Continued use despite relationship, legal, financial or health consequences
- Using in dangerous situations, such as driving or alone without naloxone available
Causes and risk factors
Opioid use disorder develops when repeated opioid exposure reshapes the brain's reward, stress and decision-making systems. Opioids produce intense relief and pleasure by acting on mu-opioid receptors; with regular use the brain adapts, tolerance develops, and stopping produces a withdrawal state of pain, anxiety and dysphoria that drives continued use. Genetics account for roughly half of vulnerability, affecting how rewarding opioids feel and how severe withdrawal is.
Exposure is the other half. Many people develop the disorder after legitimate prescriptions for pain, especially longer courses at higher doses. Chronic pain, untreated depression, anxiety and PTSD, childhood adversity, a family history of addiction, and social factors such as unemployment and isolation all raise risk. Today most illicit opioids are fentanyl or fentanyl analogs, which are far more potent than heroin or prescription pills, which makes tolerance climb faster and overdose far more likely.
About 5.7 million Americans aged 12 and older had opioid use disorder in 2023, but only about one in four received medication for it.
Source: SAMHSA, 2023 National Survey on Drug Use and Health
Buprenorphine and methadone treatment are each associated with roughly a 50 percent reduction in all-cause mortality among people with opioid use disorder.
Source: Sordo et al., BMJ, 2017 meta-analysis; National Academies of Sciences, 2019
Approximately 81,000 Americans died from opioid-involved overdoses in 2023, the large majority involving illicitly manufactured fentanyl.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics
The federal X-waiver requirement for prescribing buprenorphine was eliminated in January 2023, allowing any clinician with a standard DEA registration to prescribe it.
Source: Consolidated Appropriations Act of 2023; SAMHSA
How we diagnose it at Stedfast Psychiatry
The evaluation at Stedfast Psychiatry covers your opioid use in detail: which opioids, how much, by what route, how long, when you last used, prior treatment and prior overdoses. We apply DSM-5 criteria to classify severity and assess current withdrawal with the Clinical Opiate Withdrawal Scale (COWS), which guides timing of the first buprenorphine dose. We screen for depression, anxiety, PTSD, ADHD, bipolar disorder and other substance use, especially alcohol, benzodiazepines and stimulants, because each affects safety and treatment planning. We review your pain history and current pain needs, since many patients have real chronic pain that must be addressed.
Labs include a urine drug screen, liver enzymes, a complete blood count, a metabolic panel, and testing for hepatitis B and C and HIV, which we offer to everyone. We check Florida's or South Carolina's prescription drug monitoring program before prescribing, confirm pregnancy status when relevant, and make sure every patient leaves with naloxone or a prescription for it.
Treatment options
Medication for opioid use disorder
Medication is the core of effective treatment, and the evidence is unambiguous: it cuts the risk of death by about half. Buprenorphine, usually combined with naloxone as Suboxone film or generic tablets, is a partial opioid agonist that relieves withdrawal and craving without producing a high at steady doses and has a ceiling effect that makes fatal overdose from buprenorphine alone unlikely. It can be started once you are in mild to moderate withdrawal, typically 12 to 24 hours after short-acting opioids and longer after fentanyl, with doses adjusted over the first few days to a typical range of 16 to 24 mg daily. Monthly extended-release buprenorphine injections (Sublocade, Brixadi) are an option once stable. Extended-release naltrexone (Vivitrol), a monthly injection that blocks opioid effects, requires seven to ten days fully opioid-free before the first dose, which makes it harder to start but useful for people who want a non-opioid option. Methadone is effective but can only be dispensed through federally licensed opioid treatment programs, and we refer when it is the better choice. There is no fixed duration; longer treatment means lower risk of death and relapse, and we discourage early tapering.
Psychotherapy and recovery support
Medication keeps you alive and stable; therapy helps you rebuild. Cognitive behavioral therapy for substance use focuses on triggers, cravings, refusal skills and the routines of a life without opioids. Motivational interviewing supports people who are not yet sure they want to stop. Contingency management, which rewards verified abstinence, has strong evidence. We treat depression, anxiety, PTSD and ADHD directly, because untreated psychiatric illness is among the strongest predictors of relapse. Peer recovery groups, including those such as Narcotics Anonymous and medication-friendly groups, help many patients, and we support whichever ones work for you. Counseling is encouraged but is never a condition of receiving medication.
Co-occurring psychiatric care
Most people with opioid use disorder have at least one other psychiatric condition, and treating it is part of treating the addiction. SSRIs for depression and anxiety, trauma-focused therapy for PTSD, mood stabilizers for bipolar disorder and careful treatment of ADHD, with stimulants when appropriate and closely monitored, all improve retention and outcomes. We avoid benzodiazepines in combination with buprenorphine because of respiratory risk and use non-sedating alternatives for anxiety and insomnia. Chronic pain is addressed with non-opioid medications, physical therapy and, when needed, coordination with pain specialists; buprenorphine itself provides meaningful pain relief for many patients.
What to expect
Your first visit, in person or by video, is a 60-minute evaluation that ends with a plan, and for most patients a buprenorphine prescription the same day with instructions on when to take the first dose. We follow up within a few days to adjust the dose, then weekly for the first month, then every two to four weeks, and monthly once stable. Urine drug screens are a routine part of care and are used to guide treatment, not to punish. Telehealth is available for much of this care under current federal rules, and we will tell you if an in-person visit is required. Every patient receives naloxone.
When to seek help
Seek help now if you are using opioids daily, if you have tried to stop and could not, if you are using fentanyl or pills that may contain it, if you have had an overdose or a close call, or if someone you love is worried. Treatment can start within a day, and starting medication is the single most effective step you can take to not die from this condition. If someone is unresponsive or breathing slowly after using, give naloxone and call 911. If you are having thoughts of suicide, call or text 988. The SAMHSA National Helpline at 1-800-662-4357 is available 24 hours a day.
Why medication is the standard of care
Every major medical body, including the American Society of Addiction Medicine, the National Academies of Sciences and the World Health Organization, identifies medication as first-line treatment for opioid use disorder. The reason is mortality. Detox followed by abstinence-only treatment has relapse rates above 80 percent within a year, and because tolerance drops during abstinence, the first relapse after detox is often the fatal one. Buprenorphine and methadone roughly halve the death rate, reduce infectious disease transmission, reduce criminal justice involvement and improve employment. Counseling adds value, but medication without counseling saves far more lives than counseling without medication.
The fentanyl era
Illicitly manufactured fentanyl has replaced heroin and diverted pills in most of the US supply, including Florida and South Carolina, and it changes the clinical picture. Tolerance rises faster, overdose happens with smaller errors, and counterfeit pills sold as oxycodone or Xanax frequently contain fentanyl. Fentanyl is also fat-soluble and lingers, so starting buprenorphine too early can trigger precipitated withdrawal; we use longer waiting periods or low-dose initiation protocols to manage this. Xylazine, a veterinary sedative increasingly mixed into fentanyl, causes wounds and sedation that naloxone does not reverse, which is one more reason to move quickly from street supply to prescribed medication.
Co-occurring conditions
Depression, PTSD, anxiety disorders, ADHD and bipolar disorder are each present in a large share of people with opioid use disorder, and untreated they undermine recovery. Alcohol and benzodiazepine use are especially dangerous in combination with opioids because of respiratory depression, and stimulant use is increasingly common alongside fentanyl. Chronic pain is present in a substantial minority and must be addressed honestly rather than dismissed. We screen for all of these at the first visit and build a single plan rather than referring each problem to a different door.
Harm reduction as part of care
We give every patient naloxone and teach the people around them how to use it. We advise never using alone, testing for fentanyl when possible, and keeping doses small after any period of reduced use, because tolerance falls quickly. We offer hepatitis C and HIV testing and treatment referral. None of this signals acceptance of continued use; it reflects the fact that people in early treatment sometimes return to use, and we would rather they survive it and come back than die of it.
Prognosis
Opioid use disorder treated with medication has outcomes comparable to other chronic diseases. Retention in treatment is the key variable: people who stay on buprenorphine or methadone for a year or more have dramatically lower death rates, better health and better social function, and many return to full productive lives. Relapses happen and are managed, not punished. The most dangerous moments are the gaps: after detox, after incarceration, after stopping medication. Our job is to make staying in care as easy as possible, through same-week starts, telehealth, and treating the whole person.
Frequently asked questions
Isn't Suboxone just trading one addiction for another?
No, and this misunderstanding costs lives. Addiction means compulsive use despite harm. A person taking a stable, prescribed dose of buprenorphine is physically dependent, as a person with diabetes is on insulin, but is not impaired, not getting high, not in withdrawal and not at high risk of overdose. They work, parent and drive normally. Medication treatment halves the death rate, and people who stop it early face a sharply higher risk of fatal overdose. Dependence on a medication that keeps you alive is not addiction.
How soon can I start buprenorphine?
Usually within a day of your first visit. Buprenorphine must be started in mild to moderate withdrawal, so we time the first dose for roughly 12 to 24 hours after the last short-acting opioid and often longer after fentanyl, which lingers in the body. We give you a clear plan for the first dose at home or in the office, follow up within a few days to adjust, and most people feel physically normal within a few days. For patients using fentanyl, we sometimes use a gradual low-dose start to avoid precipitated withdrawal.
Can I get treatment by telehealth?
Yes. Federal rules now allow buprenorphine to be started and continued by telehealth under current regulations, and we treat patients across Florida and South Carolina by video. Urine drug screens can be done at a local lab, and injectable medications require an office visit. We will tell you if and when an in-person visit is needed. Telehealth makes it far easier to keep the frequent early appointments that matter most.
Does insurance cover treatment?
Yes. Opioid use disorder treatment is covered under federal parity law, and Stedfast Psychiatry accepts most major commercial plans and Medicare. Generic buprenorphine-naloxone is inexpensive; Sublocade, Brixadi and Vivitrol usually require prior authorization, which our staff handles. For patients without insurance, a self-pay new-patient visit is $185, and generic buprenorphine typically costs under $100 per month with discount programs.
How long will I need to stay on medication?
There is no required endpoint, and longer is safer. The risk of relapse and overdose rises sharply when medication stops, particularly in the first year, so we generally recommend at least one to two years of stability before considering a slow taper, and many people choose to continue indefinitely, as they would for any chronic condition. If you want to taper, we do it slowly, over months, with close follow-up and a plan to restart if cravings return.
What is the difference between buprenorphine and Vivitrol?
Buprenorphine is a partial opioid agonist: it relieves withdrawal and craving and can be started within a day. Vivitrol is extended-release naltrexone, a monthly injection that blocks opioids entirely and has no opioid effect of its own, but it requires seven to ten days fully opioid-free before the first dose, which many people cannot get through without supervised detox. In head-to-head trials both work well once started, but more people succeed in starting buprenorphine. We help you choose based on your situation and preferences.
Will I be treated for my depression and anxiety too?
Yes, at the same time, by the same team. Most people with opioid use disorder have depression, anxiety, PTSD or ADHD, and untreated psychiatric illness is one of the strongest predictors of relapse. We prescribe antidepressants, provide trauma-focused therapy and treat ADHD with careful monitoring. We avoid benzodiazepines with buprenorphine because of respiratory risk and use safer alternatives. Treating the whole person is what makes recovery stick.
What about my chronic pain?
Many patients have real pain, often the reason opioids were first prescribed. Buprenorphine itself is an effective analgesic, and splitting the daily dose into two or three parts often improves pain control. We add non-opioid approaches: duloxetine or gabapentinoids for nerve pain, anti-inflammatories when safe, physical therapy and CBT for pain. When specialist care is needed, we coordinate with pain management. Being in treatment does not mean your pain will be ignored.
Where to get treatment for opioid use disorder
Evaluation and treatment for opioid use disorder is available at every Stedfast Psychiatry office and by video across Florida and South Carolina.
Related conditions
If you are thinking about harming yourself, call or text 988 now, or go to the nearest emergency room. This page is educational and does not replace an evaluation. Clinical content reviewed by Dr. David Husted, board-certified psychiatrist.