Seeing headlines about new opioid use disorder (OUD) medications might leave you wondering: Should I hold out for something better? It makes perfect sense to ask, especially if your current medication feels like a mismatch.

While waiting for a new discovery might sound appealing, putting off care can delay your recovery. OUD is treatable right now, and recovery is possible. To help you make the best decision for your health, it helps to look at the full picture.

Here’s what works today, why researchers want more options, what “in development” means, and which ideas are being tested.

🗳️ Have you talked with a doctor about whether your opioid use disorder medication is right for you?

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Why Are Researchers Looking for New Medications for Opioid Use Disorder?

While today’s medications help many people, they don’t work for everyone. Researchers are looking for new options to solve some major challenges.

Current medications were developed before ultra-strong synthetics like fentanyl became common. Because fentanyl can linger in the body, starting buprenorphine too soon can cause sudden withdrawal. Naltrexone requires a difficult opioid-free waiting period of seven to 14 days, depending on the type of opioid used. This can make it harder for some people to start treatment.

Staying on track is also tough. Many people stop treatment within six months. Side effects, lingering cravings, or the burden of clinic visits for methadone can play a role.

Moreover, many people also use stimulants like methamphetamine or cocaine alongside opioids, but current medications only target opioids. This is one reason researchers are looking at brain pathways beyond opioid receptors, including those linked to stress and reward.

Researchers aren’t trying to replace what works, and they don’t expect any single medication to be a cure-all.

Which New Medications for Opioid Use Disorder Are Being Studied?

Here’s a look at some of the drugs currently being studied, where they are in the testing process, and what else they might already be used to treat.

Mitragynine

Mitragynine, the main active compound in kratom, is at an early stage. Lab and animal studies raised no major safety concerns. So the National Institutes of Health (NIH) announced that the FDA had cleared the way for a first human trial.

The phase 1 trial is designed for about 32 healthy adults. Participants will receive a single dose of mitragynine or a placebo (an inactive treatment pill). The goal is to check for safety and side effects, not to see if it cures OUD.

Kratom is a tree, and many people use it to treat opioid withdrawal. But the purified mitragynine in this trial isn’t kratom. The FDA says no drug made with kratom is legally on the market and warns against using kratom as medical treatment.

Orexin Blockers

Suvorexant (Belsomra) and similar insomnia medicines are being repurposed. They block orexin, a brain chemical tied to wakefulness, stress, and reward. Researchers have run phase 1 and 2 trials in people with OUD.

So far, the best human evidence comes from a hospital study of people slowly tapering off buprenorphine. Those who took suvorexant slept about 1.5 hours more each night and reported fewer cravings. Their opioid withdrawal symptoms were milder after the taper.

That trial was small, and everyone received buprenorphine. So it can’t show whether suvorexant works alone, and most other evidence comes from animal studies.

Safety questions remain. They include breathing problems when combined with opioids, loss of enjoyment, misuse, and next-day drowsiness. The small trial found no evidence of increased breathing problems among participants taking suvorexant, but larger studies are needed to better understand its safety.

Ketamine and Cannabidiol

Ketamine, an anesthesia medication sometimes used off-label for depression, is being studied as a possible treatment for opioid use disorder. Off-label means a medication is prescribed for a condition it hasn’t been FDA-approved to treat. Small randomized studies suggest ketamine may help reduce opioid cravings and withdrawal symptoms, but more research is needed.

The key early studies were done in Russia, before fentanyl, a powerful synthetic opioid, was common. Researchers have also set up a larger phase 2 follow-up study.

Cannabidiol, commonly known as CBD, is further along in development. A phase 3 trial called ACROS is designed to compare two doses of CBD against a placebo in people taking methadone or buprenorphine.

This larger study follows smaller trials where CBD helped reduce craving and anxiety when participants were exposed to drug-related cues. CBD can cause diarrhea, sleepiness, liver injury in some cases, and potentially harmful interactions with other medications.

Research findings may not apply to store-bought CBD products, which aren’t FDA-approved to treat OUD. Neither CBD nor ketamine is FDA-approved for OUD.

Psilocybin and Ibogaine

Psilocybin, the psychedelic compound in some mushrooms, is in phase 2 testing. An NIH-funded trial is designed to test it in people on methadone who still use illicit opioids.

Psilocybin has been almost entirely unstudied for OUD. It’s also a Schedule 1 substance, a group of the most tightly controlled drugs, which limits research.

Ibogaine, a plant-based psychedelic, is at an early stage. Most evidence comes from observational studies of people who used heroin or prescription opioids, rather than controlled trials. Much of the research was also conducted before fentanyl became widespread.

Ibogaine can cause serious heart rhythm problems. Deaths have been reported when people used it without medical supervision. Neither ibogaine nor psilocybin is approved for OUD.

GLP-1 Medications

Some glucagon-like peptide-1 (GLP-1) medications, such as semaglutide, are already FDA-approved for conditions like type 2 diabetes and obesity, as well as reducing certain heart risks. Researchers are studying whether these approved medications could also help with OUD. This would be an off-label use.

Other drugs in this area, such as brenipatide, are still experimental and are not FDA-approved for any use.

Large health-record studies link GLP-1 medications to fewer opioid overdoses, but they can’t prove cause and effect.

A few phase 2 trials are testing this idea. One uses weekly semaglutide shots in adults on buprenorphine or methadone. The other uses the experimental drug brenipatide in people on buprenorphine.

Neither is approved for OUD. Nausea and weight loss can be side effects.

Finding What Works for You

While researchers continue testing new treatments, effective medications for OUD are already available today. Since clinical trials can take years to finish, waiting for a new drug might needlessly delay care that already works.

Instead of waiting, here are a few steps you can take right now. If you are currently taking medication, stick to your prescribed routine and consult your doctor before making any changes.

It also helps to jot down questions for your next appointment, like whether a clinical trial makes sense for you or if you should keep naloxone nearby. Your healthcare provider can help you understand these options and decide what’s right for you.