OBJECTIVES: Opioid dependence is a growing problem affecting a large number of Americans. Although medications are available to treat opioid dependence, little is known about how these drugs are used in real-world settings and for how long. This study aimed to compare the usage of three different medication-assisted treatments to inform future policy and practice. METHODS: Patients with commercial insurance who were diagnosed with opioid dependence were identified by using Truven Health MarketScan© data from 2013. The frequency of use of three medication-assisted treatments (methadone, buprenorphine, and extended-release naltrexone (XR-NTX)) among patients with a diagnosis of opioid dependence were estimated separately. We conducted a cross-sectional analysis to calculate the medication possession ratio (MPR), a measure of medication adherence, for each medication treatment over the 6-month period following initiation of treatment for those patients who had at least 6 months continuous enrollment after the first drug prescription date. RESULTS: Overall, 82,750 patients with a diagnosis of opioid dependence were included in the study. Approximately 22% of patients received one of the three medication-assisted treatments in 2013. Among all the patients receiving one of these three therapies, most (16,954 or 93%) were prescribed buprenorphine, while 909 (5%) patients received methadone, and 374 (2%) patients received XR-NTX. The average 6-month MPRs for methadone, buprenorphine, and XR-NTX were 0.54 (SD=0.40), 0.82 (SD=0.26), and 0.52 (SD=0.32), respectively. CONCLUSIONS: Among privately insured patients with a diagnosis of opioid dependence, medication-assisted treatment is rare. Among those receiving medication-assisted treatment, buprenorphine is the most common and is associated with the highest 6-month MPR. Future study is needed to investigate the low rates of adherence to methadone and XR-NTX therapy, as well as the association of these treatments with clinical outcomes.