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What opioid use disorder actually is
A chronic condition. Not a character flaw.
Opioid use disorder is recognized by the NIH and major medical societies as a chronic condition — one that involves the brain, genetics, environment, and life experience. It is not reducible to a single cause, and it is not a moral failing. Research from the NIH shows that prolonged opioid use changes the brain's reward and motivation systems in ways that drive continued use, independent of willpower.1
This is why telling someone to "just stop" rarely works — and why medication is so effective. Buprenorphine works directly on the same brain systems affected by opioids, reducing withdrawal and cravings at the source.2
Fewer than 1 in 5 people with opioid use disorder in the US receive medication treatment — despite it being the most effective option available.3 Access is the problem. MyStreetHealth exists to help close that gap.
What the numbers show
The evidence is strong and consistent.
Across dozens of clinical trials and large population studies, patients who receive buprenorphine consistently do better than those who don't — on every measure that matters.
Staying in treatment is the single strongest predictor of good outcomes for opioid use disorder. Buprenorphine keeps people in treatment longer than any other approach studied.
Telehealth specifically
Telehealth works — and removes the barriers that cause people to drop out.
Multiple independent studies have compared telehealth buprenorphine to in-person treatment. The results are consistent: telehealth patients attend more appointments, stay in treatment longer, and report higher satisfaction — largely because it removes the logistical barriers that cause people to miss visits.5,7
A 2023 study in JAMA Psychiatry found that expanded telehealth access to buprenorphine was associated with lower odds of fatal overdose among Medicare patients.7
Dosing and the fentanyl era
Treatment has had to evolve. The science has kept up.
The opioid crisis has changed significantly with the rise of fentanyl — which is far more potent than the opioids for which original buprenorphine dosing guidelines were developed. Research published in 2023 found that patients on standard doses were 20% more likely to discontinue treatment than those on higher doses.8
This is why individualized dosing matters. There is no one-size-fits-all dose — and the evidence supports flexibility, not rigid protocols.
Primary sources
Where this comes from.
Every claim on this page links to a primary source — federal agencies, peer-reviewed journals, or major medical societies. Nothing is proprietary data or marketing material.
NIDA: Understanding Drug Use and Addiction
Plain-language explanation of what addiction is and how it affects the brain.
National Institute on Drug Abuse
FDA: Medications for Opioid Use Disorder
Official FDA overview of all approved medications including buprenorphine, methadone, and naltrexone.
U.S. Food & Drug Administration
Medications for OUD Save Lives (2019)
Comprehensive review by the National Academies concluding medications are effective, underutilized, and should be more accessible.
National Academies of Sciences
ASAM National Practice Guideline (2020)
The current US standard of care for OUD — buprenorphine prescribing, dosing, and patient management.
American Society of Addiction Medicine
ASAM: Buprenorphine in the Fentanyl Era (2023)
Updated expert consensus on dosing and initiation for patients using high-potency synthetic opioids like fentanyl.
Journal of Addiction Medicine
SAMHSA Federal Guidelines for OTPs (2024)
Updated 2024 federal standards — includes telehealth flexibilities made permanent after COVID.
SAMHSA
Comparative Effectiveness of OUD Treatment Pathways (2020)
JAMA Network Open. Buprenorphine and methadone significantly outperformed non-medication approaches on every outcome measured.
Wakeman et al.
Telehealth Buprenorphine Retention (2022)
80% of insured telehealth patients remained in treatment at 90 days vs. 44% industry average. No-show rate 9.5% vs. 23%.
BMJ Innovations — Rollston et al.
Telehealth Expansion and Overdose Mortality (2023)
Telehealth buprenorphine associated with lower odds of fatal overdose among Medicare patients.
JAMA Psychiatry — Cantor et al.
Higher Buprenorphine Doses and Retention (2023)
Patients on standard 16mg doses were 20% more likely to discontinue treatment than those on 24mg — supporting individualized dosing.
NIDA / JAMA Network Open
Words Matter: Language and Addiction
Why clinical language affects whether people seek care — and what terms clinicians should use.
National Institute on Drug Abuse
SAMHSA Dear Colleague: Medication First Model
Federal guidance stating that medication should not be withheld if a patient is not participating in counseling. Counseling should be offered, never required.
SAMHSA / FDA
Pew: Policies Should Promote Access to Buprenorphine for OUD
Supports low-threshold buprenorphine access, timely initiation, medication without mandatory counseling, and retention-focused care.
Pew Charitable Trusts
1 NIDA. Understanding Drug Use and Addiction. nida.nih.gov
2 ASAM. National Practice Guideline for the Treatment of OUD, 2020 Focused Update. asam.org
3 NIDA. Medications for Opioid Use Disorder. nida.nih.gov
4 Sordo L, et al. Mortality risk during and after opioid substitution treatment. BMJ, 2017. bmj.com
5 Rollston R, et al. Collaborative, patient-centred care model that provides tech-enabled treatment of OUD via telehealth. BMJ Innovations, 2022;8:117–122. bmjinnov.bmj.com
6 Wakeman SE, et al. Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Network Open, 2020. pubmed.ncbi.nlm.nih.gov
7 Cantor J, et al. Association of Receipt of OUD-Related Telehealth Services and MOUD With Fatal Drug Overdoses. JAMA Psychiatry, 2023;80(5):508–514. jamanetwork.com
8 NIDA. Higher buprenorphine doses associated with improved retention in treatment for OUD. September 2023. nida.nih.gov
9 van Boekel LC, et al. Stigma among health professionals towards patients with substance use disorder. Drug and Alcohol Dependence, 2013. pubmed.ncbi.nlm.nih.gov