MOUD Basics
These are the three FDA‑approved medications for opioid use disorder.
What are methadone, buprenorphine, and extended‑release naltrexone?
This MOUD typically comes as a liquid supplied by a licensed Opioid Treatment Programs (OTP).
What is methadone?
Subutex/Suboxone tablets take about this long to dissolve under the tongue.
What is ~15–20 minutes?
Diversion is cited as the number one concern to these institutions implementing MOUD.
What are correctional facilities (jails/prisons)?
Interviews from Massachusetts jails found diversion was ______ common than expected
What is less?
This term is NOT treatment and is less effective than maintenance therapy.
What is 'detox' (short‑term withdrawal management)?
Name one effective protocol to limit diversion during methadone dosing.
What is a thoroughly observed mouth check or providing crackers/water post‑dose?
Name one diversion tactic for buprenorphine film.
What is cheeking/dry mouth, sticking to the ID card, or spitting into a shirt?
Diversion attempts often occur for this reason.
What is helping others/self‑treating withdrawal?
In one site, only this many documented diversion events occurred out of over 4,000 doses.
What is six (6)?
One core goal of MOUD is to directly lower mortality risk.
What is decreasing the risk of fatal overdose?
A common diversion tactic for liquid methadone.
What is storing the dose in the mouth and spitting it out later?
This step should be done by patients with partials/dentures prior to the final mouth check.
What is removing the partials/dentures?
This approach, rather than immediate dose cuts, is recommended after diversion incidents.
What are treatment contracts and graduated consequences?
MOUD programs had this effect on contraband buprenorphine markets in jails.
What is reduction/disruption of the illicit market and related violence?
This MOUD is a partial opioid agonist.
What is buprenorphine?
This visible modification helps distinguish methadone from other liquids in facilities.
What is using blue‑colored methadone?
Describe one component of a 'really good' mouth check.
What is inspecting hands and the full mouth with a flashlight (lips, under tongue, back of tongue/throat)?
When diversion occurs, name one key step in the follow‑up process.
What is medical review, investigate causes (e.g., extortion), counsel/document, consider med change, coordinate with security?
Treated individuals are more likely to achieve this post‑release outcome.
What is staying sober/maintaining recovery?
This opioid antagonist is administered by intramuscular injection every 28 days.
What is extended‑release naltrexone (Vivitrol)?
True or False: There is minimal diversion with methadone if observed properly.
What is True?
Name one positioning/apparel protocol that deters film diversion.
What is no long sleeves and seating/standing with hands visible?
Providing MOUD at this point reduces demand for diverted medication.
What is immediately upon intake?
Diversion was more likely to occur under this condition.
What is when usual dosing protocols were disrupted (e.g., during COVID‑19)?