Levels of Care
Medication-Assisted Treatment
Medication-assisted treatment — increasingly called medication for opioid use disorder, or MOUD — combines FDA-approved medication with counselling and behavioural therapy. For opioid use disorder it is the most effective treatment that exists. Large bodies of research consistently show that treatment with buprenorphine or methadone roughly halves the risk of death compared with treatment without medication, and it substantially improves the odds of staying in treatment at all.
It is worth being blunt about one thing early, because it stops many people from getting help: taking buprenorphine or methadone is not “still being addicted.” These medications occupy opioid receptors in a stable, controlled way that stops withdrawal and blunts craving without producing the cycle of intoxication. Someone stable on buprenorphine can work, drive, parent and function normally. Treating that as a lesser form of recovery is a stigma that measurably costs lives, and it is not supported by the evidence.
A partial opioid agonist — it activates opioid receptors enough to prevent withdrawal and craving, but with a ceiling effect that makes overdose considerably less likely than with full agonists. It is commonly combined with naloxone to deter injection. It can be prescribed in an ordinary office setting, and long-acting monthly injections are available for people who would rather not manage a daily dose.
An important change: the federal X-waiver requirement was eliminated at the end of 2022. Any clinician with a standard DEA registration covering Schedule III medications can now prescribe buprenorphine. Access is meaningfully easier than it was, and if you were told years ago that no local prescriber was available, that information is likely out of date.
Starting it correctly matters. Buprenorphine can trigger precipitated withdrawal — sudden, severe withdrawal — if taken too soon after other opioids, so induction is usually timed to begin once mild-to-moderate withdrawal is already underway. Fentanyl has complicated this, because it accumulates in body tissue and lingers longer than heroin or prescription opioids. Experienced prescribers increasingly use low-dose initiation protocols for people coming off fentanyl. If a previous attempt at buprenorphine went badly, this is very often why — and it is a solvable problem, not a reason the medication won't work for you.
A full opioid agonist, and for many people with long-standing, high-tolerance opioid use it remains the most effective option. For opioid use disorder it can only be dispensed through a federally certified opioid treatment program, not an ordinary prescription. That structure means daily attendance initially, with take-home doses earned over time — demanding, but the daily contact is genuinely valuable for some people early on. Federal rules updated in 2024 made pandemic-era take-home flexibilities permanent and broadened access.
An opioid antagonist — it blocks opioid receptors entirely, so opioids produce no effect. It is not an opioid, carries no misuse potential, and is available as a monthly injection. The significant catch is that you must be fully withdrawn — typically seven to ten days opioid-free — before the first dose, or it will precipitate severe withdrawal. Getting through that window is the main obstacle, which is why naltrexone is often started during or immediately after medically supervised detox or a residential stay. It also carries a specific risk worth naming: tolerance drops while on it, so a return to use after stopping carries a heightened overdose risk.
Medication is badly under-used for alcohol use disorder — most people who could benefit are never offered it:
None of these treat withdrawal. Alcohol withdrawal can cause seizures and delirium tremens and can be fatal — that requires medical detox first, and these medications come afterwards.
Honesty matters here: there is no FDA-approved medication for methamphetamine or cocaine use disorder. Anyone selling you one is misleading you. The strongest evidence for stimulant use disorder supports contingency management — structured incentives for verified abstinence — alongside behavioural therapy. California has been an early adopter of contingency management through Medi-Cal, and if stimulants are the primary issue it is worth asking a program specifically whether they offer it. See methamphetamine treatment for what that looks like in practice.
The evidence for MAT is strongest when medication is paired with real clinical support — IOP, outpatient therapy, and treatment for co-occurring conditions, which are present in a large share of cases. Medication makes the rest of recovery possible by removing the physiological pressure of craving and withdrawal; it does not by itself rebuild a life. Equally, counselling alone for opioid use disorder has consistently worse outcomes than counselling plus medication. Both halves matter.
Often for years, and sometimes indefinitely — and that is a legitimate clinical outcome, not a failure. Relapse and overdose risk rise sharply after stopping, particularly when stopping is driven by external pressure rather than clinical readiness. Any tapering decision should be made with a prescriber, gradually, at a point of genuine stability. Be wary of any program that requires you to stop as a condition of participation.
Medi-Cal covers medication-assisted treatment, and California has invested substantially in expanding access through the state's MAT Expansion Project. Commercial plans cover it under parity requirements, though specifics depend on the pharmacy benefit — some plans require prior authorisation or step therapy for particular formulations, and long-acting injectables are more often subject to authorisation than tablets. We will check your benefits for free. See also Kaiser coverage and Aetna coverage for how those two handle it.
Call 213-321-6518 for a confidential conversation about whether medication is appropriate and how to arrange it. If you are using opioids now, ask us about naloxone — it reverses an overdose, it is available without a prescription at California pharmacies, and everyone at risk should have it within reach.
In a crisis, call or text 988. If someone may be overdosing, call 911 and give naloxone if you have it.
We're in-network with most major insurers. We confirm your benefits and report back, usually within a few hours. HIPAA & 42 CFR Part 2 protected.
Call 213-321-6518