Medication Assisted Treatment (MAT) is the use of medications combined with behavioral therapies to help individuals recover from substance use disorders. Studies have proven that this form of treatment is one of the most effective methods to treat opioid addiction when compared to more traditional non-drug approaches.
The History of Medication Assisted Treatment
In 2000, the Drug Addiction Treatment Act (DATA) began allowing narcotic prescriptions to be used to treat opioid dependence in an outpatient setting. In 2016, President Obama signed the Comprehensive Addiction and Recovery Act (CARA), allowing nurse practitioners and physician assistants to become prescribers. In 2017, more than 47,000 people in the United States died as a result of opioid overdose from fentanyl, heroin, prescription opioids, and illegally manufactured drugs. In response to the crisis, there has been an increased demand for MAT and overdose prevention within treatment centers and medical clinics. With an abundance of research, widespread acceptance and acknowledgement in the medical and treatment community of the benefits of MAT.
In 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) was passed and expanded the ability of doctors and other medical professionals to treat patients with MAT, and that same year the American Medical Association recommended MAT as a groundbreaking approach to treat individuals with opioid use disorder. According to the Substance Abuse and Mental Health Services Administration (SAHMSA), today, nearly every state has an opioid treatment program that provides MAT services.
What Is Medication Assisted Treatment?
MAT is an evidenced-based modality for those struggling with substance use disorder (SUD). It often combines psychotherapy, education, and medication. Medication for opioid use disorder (MOUD), like Suboxone, can also be prescribed independent of treatment to help prevent overdose when people are not ready or cannot access treatment.
While MAT is often used for treatment of opioid use disorder, it can also be beneficial for people struggling with alcohol use disorder. Depending on the medication and what it is used for, MAT can function in different ways. For example, when Naltrexone is used to treat alcohol use disorder, it can help to reduce cravings, and interacts with the brain so that if a person were to drink while on Naltrexone, they would not feel the same euphoric effects.
In addition, medications like Suboxone and Methadone can help manage withdrawal symptoms and physical cravings to help decrease relapse, overdose, and improve the overall wellbeing of those seeking recovery. Medication assisted treatment has no set timeline and should be tailored to help meet people’s individual needs based on the particulars of their substance use, taking into account how much and how often they use, as well as what their cravings and withdrawal symptoms are like. Medication assisted treatment and medication for opioid use disorder can and should be continued for as long as needed. While there are many inpatient rehabs that provide MAT services, MAT is readily available from providers in outpatient settings.
There are numerous studies supporting the outcomes of Medication-Assisted Treatment. These can include but not be limited to:
- Help create long-term recovery
- Reduce the risks of relapse
- Reduce overdose
- Help individuals manage depression, anxiety, and substance use
- Improve quality of life
What Medications Are Used To Treat Opioid Addiction?
Buprenorphine, also known under the brand name Suboxone or Subutex, is an evidence based medication that helps treat opioid dependency. Buprenorphine is a partial opioid antagonist, which means it can produce a similar effect as other opioids while lowering risk of relapse and overdose. Buprenorphine can be prescribed whether someone is in-patient, intensive outpatient, doing weekly individual sessions, or even if they are not seeking any other treatment.
Methadone is an evidenced based medication used to treat opioid use disorder. It is a long-acting opioid antagonist. As with buprenorphine, the purpose of methadone is to alleviate withdrawal symptoms, reduce cravings, and prevent overdose. It can also be used to relieve severe chronic pain.
Naltrexone & Vivitrol
Naltrexone is an opioid antagonist that blocks opioid receptors in the brain. It can be taken orally or be administered as a monthly injection, which is known as Vivitrol. Vivitrol is a long-acting, time-released form of Naltrexone. Regardless of if it is taken orally or via injection, this medication blocks the effects of opioids, meaning someone on this medication will not be able to feel the effects of opioids. If someone with opioid use disorder is on Naltrexone or Vivitrol, their tolerance to opioids will decrease. This creates a major risk for potential overdose. If an individual relapses after a period of abstinence, it can be extremely dangerous because if someone relapses they might use an amount they think is safe that they used to be able to take, and with a reduced tolerance that same amount can lead to fatal overdose.
Medication-Assisted Treatment for Alcohol Use Disorder
Alcohol use disorder affects millions. According to the National Institute on Alcohol Abuse and Alcoholism, nearly 16 million adults and adolescents have developed dependence on alcohol. In order to safely break alcohol dependence, people often require medically supervised detox to monitor withdrawal and prevent potentially fatal symptoms like seizures or DTs. Some medications used in an alcohol detox might include benzodiazepines, clonidine and hydroxyzine.
Beyond detox, there are a number of medications that are used to treat alcohol use disorder, including disulfiram, naltrexone, and acamprosate.
Naltrexone (or the 30 day time-released shot known as Vivitrol) is an evidence based medication for treating alcohol use disorder. It has been shown to decrease cravings for alcohol. The way Naltrexone works, if an individual drinks while on it, they will still feel intoxicated, but the euphoria associated with alcohol will be missing. Unlike Antabuse, drinking on naltrexone will not make someone sick, it just makes it less pleasurable.
Disulfiram, more commonly known by its brand name Antabuse, was the first medication approved by the FDA to treat alcohol use disorder. Disulfiram blocks dopamine receptors and interferes with the metabolic process of alcohol in the body. When an individual uses alcohol while on disulfiram, extreme adverse side effects occur. This means if an individual takes disulfiram and then ingests any alcohol, whether it be drinking or even using a topical ointment like hand sanitizer that contains alcohol, the individual will experience severe “sick” symptoms (headache, vomiting, dizziness). This medication serves to prevent people from drinking based on the threat of how bad it will feel to drink while on the medication.
Acamprosate, known under the brand name Campral is used in tablet form and administered two to three times a day after a person has completed alcohol detox. This drug helps restore functioning of the brain that may have been affected during active addiction and helps reduce and manage alcohol cravings. Most commonly, this drug has been known to be taken for at least a year, though recent studies have concluded that a shorter duration of time. The medication also inhibits the brain’s neurotransmitters so that individuals no longer feel the euphoric effects of alcohol.
Is Medication Assisted Treatment Right For You?
It is important to note that Medication Assisted Treatment is not a replacement for mental health treatment. Mental health treatment serves to help people address underlying emotional and mental health factors that contribute to substance use, as well as to learn practical skills to manage distress and avoid relapse. Medication is a tool to help reduce use and prevent relapse and overdose. It is backed by evidence and can be used independently as well as along with behavioral interventions and mental health treatment. MAT immensely reduces the risk of relapse with opioid use disorder. This treatment method can also be extremely helpful for individuals that have been unable to stay abstinent for a long duration of time with other methods.
MAT should always be an option for anyone looking for substance use treatment, especially opioid use disorder.
When deciding if MAT is a path you may want to consider the following:
- The severity of your substance abuse disorder, the duration of time that you’ve been in active addiction, and what substance you’re currently addicted to.
- Comorbidities including dual diagnosis disorders. Many people with substance use disorders have concurrent mental health disorders, like depression or anxiety.
- The professional opinion of a medical professional should often be a large factor in deciding on whether or not to move forward with pursuing MAT.