Opioid Use Disorder Supportive Care Protocol
Primary Stack
Core supplements with strongest evidenceModulates glutamate; studied for various substance use disorders; may reduce cravings
Supporting Studies (1)
Supports brain health; may help with mood and cognitive function during recovery
Supporting Studies (1)
Supporting Stack
Additional supplements for enhanced resultsOften deficient in substance users; supports mood and immune function
Supporting Studies (1)
Supports nervous system; may help with sleep and anxiety during withdrawal/recovery
Supporting Studies (1)
Often depleted in substance users; supports nervous system and energy
Supporting Studies (1)
Gut-brain axis support; opioid use disrupts gut microbiome
Supporting Studies (1)
How This Protocol Works
Simple Explanation
Opioid Use Disorder (OUD) is a chronic medical condition characterized by problematic patterns of opioid use that cause significant impairment or distress. It affects millions of people and has reached epidemic proportions.
SIGNS OF OUD:
CRITICAL: OUD is a medical emergency requiring professional treatment. This protocol is SUPPORTIVE ONLY and NOT a substitute for medication-assisted treatment (MAT).
EVIDENCE-BASED TREATMENTS:
WHY MAT IS ESSENTIAL:
OVERDOSE PREVENTION:
* NAC has been studied for various substance use disorders.
* Omega-3s and B vitamins support brain health during recovery.
* Probiotics may help restore gut health disrupted by opioids.
Expected timeline: Recovery is a long-term process. MAT should be continued as long as needed - often years or indefinitely.
Clinical Perspective
Opioid Use Disorder: DSM-5 criteria - problematic pattern of opioid use causing impairment/distress (>=2 criteria in 12 months). Severity: mild (2-3), moderate (4-5), severe (>=6). Pathophysiology: neurobiological changes in reward, stress, and executive function pathways. Complications: overdose death, infections (HIV, HCV, endocarditis), trauma, legal/social.
CRITICAL: Medication-Assisted Treatment (MAT) is gold standard - reduces mortality by 50%+. Buprenorphine or methadone for most; naltrexone for select patients. MAT is NOT "substituting one drug for another" - it's evidence-based treatment. Supplements have NO evidence for treating OUD itself but may support overall health during recovery. Naloxone (Narcan) for all patients and contacts. Harm reduction saves lives.
* NAC (C-grade): Glutamate modulation. Systematic review: (PMID: 28472867). 1200-2400mg daily. Limited OUD-specific evidence.
* Omega-3 (C-grade): Brain health. Review: (PMID: 27840029). 2-3g EPA+DHA daily.
* Vitamin D (C-grade): Common deficiency. Review: (PMID: 28750270). 2000-4000 IU daily.
* Magnesium (C-grade): Nervous system. Review: (PMID: 28445426). 300-400mg daily.
* B-Complex (C-grade): Nutritional support. Review: (PMID: 27450775). Daily.
* Probiotics (C-grade): Gut health. Review: (PMID: 29882905). 10-20 billion CFU daily. Opioids cause constipation, dysbiosis.
Assessment targets: Urine drug screens, retention in treatment, quality of life, employment, legal issues, comorbid mental health.
Protocol notes: MAT: buprenorphine (X-waiver no longer required); methadone (specialized clinic); naltrexone (must be opioid-free 7-10 days). Treatment duration: indefinite for many; mortality risk increases with discontinuation. Withdrawal management alone: high relapse rate (>80%); MAT much more effective. Comorbidities: treat co-occurring mental health disorders; integrated care best. Harm reduction: naloxone distribution, syringe services, fentanyl test strips - all save lives. Pregnancy: buprenorphine or methadone indicated; don't detox during pregnancy. Pain management: can still treat pain in patients on MAT; may need adjustments. Stigma: major barrier to treatment; education essential. PDMP: prescription drug monitoring programs help identify at-risk patients. Fentanyl: contaminated supply major concern; unpredictable potency; fentanyl test strips help.