of immediate-release opioids instead of opioids that have a long duration (long-acting) or opioids that are released over time (extended release). Other recommendations include prescribing the lowest opioid dose that successfully addresses the pain in opioid-naïve patients and collaborating with patients who already take opioid therapy to maximize the effect of non-opioid analgesics. While receiving opioid therapy, patients should be periodically evaluated for opioid-related complications and clinicians should review state prescription drug monitoring program systems. The latter should be assessed to reduce the risk of overdoses in patients due to their opioid dose or medication combinations. For patients receiving opioid therapy in whom the risks outweigh the benefits, clinicians and patients should develop a treatment plan to decrease their opioid dose incrementally. For more specific mitigation strategies regarding opioid overdoses, see Opioid overdose. Management Opioid use disorders typically require long-term treatment and care with the goal of reducing risks for the individual, reducing criminal behavior, and improving the long-term physical and psychological condition of the person. Some strategies aim to reduce drug use and lead to abstinence from opioids, while others attempt to stabilize on prescribed methadone or buprenorphine with continued replacement therapy indefinitely. No single treatment works for everyone, so several strategies have been developed including therapy and drugs. Though treatment reduces mortality rates, the first four weeks after treatment begins and the four weeks after treatment ceases are the riskiest times for drug-related deaths. These periods of increased vulnerability are significant because many of those in treatment leave programs during these periods. Medication Opioid replacement therapy (ORT), also known as opioid substitution therapy (OST), involves replacing an opioid, such as heroin, with a longer-acting but less euphoric opioid.Richard P. Mattick et al.: National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD): Report of Results and Recommendation Commonly used drugs for ORT are methadone and buprenorphine, which are taken under medical supervision. , buprenorphine/naloxone is preferentially recommended, as the addition of the opioid antagonist naloxone is believed to reduce the risk of abuse via injection or insufflation without causing impairment when used appropriately (sublingual administration). Naltrexone, a μ-opioid receptor antagonist, also blocks opioids' euphoric effects by occupying the opioid receptor, but it does not activate it, so it does not produce sedation, analgesia, or euphoria, and thus has no potential for abuse or diversion. Buprenorphine, methadone, and naltrexone are approved by the U.S. Food and Drug Administration (FDA) for medication-assisted