AstraZeneca terminated OUD drug AZD4041 development due to drug-drug interaction with antifungal itraconazole. Despite challenges, non-opioid medications are under development, but efficacy data is lacking. Opioid agonist therapies are expected to drive $1.75 billion in sales by 2033, reflecting patient preference and lack of alternatives. KOLs view OUD as a relapsing-remitting disorder, naturally inclined towards opioid use, making non-opioid treatments only adjunctive. The market lacks effective non-opioid therapies, but a strong profile could disrupt the OUD market.