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Aim The aim of this article is to summarise the pharmacological principles of opioid maintenance treatment (OMT) for opioid dependent patients. OMT has been available in Norway since 1998 and consists of maintenance treatment with an opioid agonist, combined with psychosocial treatment. While methadone has historically been used as the opioid agonist in question, buprenorphine is now used more often. Other drugs have been used on a smaller scale, for example naltrexone, while a few countries have used heroin. Methods A selection of relevant literature regarding OMT and the use of drugs to treat opioid dependence was collected from searches in PubMed. These studies, in addition to the author’s own knowledge, were summarised. Results Methadone and buprenorphine have partially differing pharmacological properties. While methadone is a full opioid agonist, buprenorphine is a partial opioid agonist. Used correctly, these drugs will give limited intoxication while preventing withdrawal and relapse, thanks to their long duration of action and stable concentrations in the body. The opioid-antagonist naltrexone has also been used and has shown promising results, especially in depot formulation. Both methadone and buprenorphine are potent drugs and can have potentially dangerous adverse effects (such as QT- interval prolongation). Incorrect use/abuse of methadone and/or buprenorphine, or combination of these drugs with other impairing legal or illegal drugs, may lead to intoxication. Conclusion Today’s OMT medication prevents with­drawal symptoms by replacing or blocking other opioids, such as heroin, at the opioid receptor. These drugs have both pharmacokinetic (long half-life) and pharmacodynamic (binding strongly to the opioid receptor, in the case of buprenorphine) properties that make this possible.

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