82. Optimal Duration of MOUD (Medications for Opioid Use Disorder)82. Optimal Duration of MOUD (Medications for Opioid Use Disorder)
Addiction Medicine Journal Club
Two addiction medicine doctors review a large VA study on how long medications for opioid use disorder are linked with survival and discuss what this might mean for real-world tapering decisions. They also talk about a VA GLP-1 trial for alcohol use disorder and potential Medicare increases for substance use counselling reimbursement.
32:35•7 Sept 2026
How Long Should MOUD Last? Veterans Data, Real Clinics and Honest Chat
Episode Overview
- Longer durations of MOUD were associated with better survival for veterans, with especially large gains around the first two years of treatment.
- Most deaths in the cohort occurred after discontinuation of MOUD, underscoring the risks that come with stopping medication.
- Only about half of patients reached six months of continuous treatment, reflecting how difficult retention remains even in a supported system like the VA.
- The hosts stress that decisions about tapering should be individual, with clinicians offering evidence and patients making the final call.
- Proposed Medicare changes may increase reimbursement for substance use and tobacco counselling, potentially valuing this work more fairly in primary care.
“The decision to discontinue treatment, it's not really my decision… Certainly, I want to give them all the information and tools to succeed if they're going to do so.”
What insights can experts and survivors share about addiction? This episode of Addiction Medicine Journal Club zeroes in on a question many clinicians face daily: how long should someone stay on medications for opioid use disorder (MOUD) such as buprenorphine, methadone or extended‑release naltrexone? Dr Sonya Del Tredici and Dr John Keenan chat through a large Veterans Health Administration study looking at treatment duration and survival.
John walks through the design in plain language, highlighting that over 32,000 veterans were followed and that “longer treatment duration was associated with progressively increased survival, at least up to six years.” Sonya pushes on practical questions clinicians actually ask, like what counts as “continuous” treatment and how to talk about tapering when patients want a clear number, not just a shrug. Along the way, they keep things human.
You’ll hear about school runs, admin days, bike rides and the reality of patients drifting on and off buprenorphine as life chaos intrudes. The discussion never loses sight of the people behind the data: veterans with high rates of chronic pain, PTSD, alcohol and tobacco use, and housing instability.
The episode also takes a detour into two hot topics: a VA trial of semaglutide (a GLP‑1 medication) for alcohol use disorder, and a proposed Medicare fee increase for substance use and tobacco counselling. Sonya admits to slogging through a 1,600‑page fee schedule so you don’t have to, while John jokes about “free smoking cessation counselling” and the joys of underbilling.
If you’re a clinician working with opioid use disorder, you’ll get practical language for conversations about staying on or coming off MOUD, grounded firmly in data rather than guesswork. How might this evidence shift the way you talk with patients about sticking with their meds just a bit longer?
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