Medication-Assisted Treatment For Opioid Use Disorders

What Is Medication-Assisted Treatment For Opioid Use Disorders?

Medication-assisted treatment (MAT) is a common approach used in opioid addiction treatment throughout the United States. MAT is defined by SAMSHA as the use of FDA-approved treatment medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach for the treatment of opioid use disorders.

More recently, organizations like SAMHSA have increasingly adopted the term MOUD (medications for opioid use disorder) when discussing opioid addiction treatment. MOUD refers to the use of FDA-approved medications to treat opioid addiction, manage withdrawal symptoms, and reduce cravings. The term MOUD is used instead of MAT to emphasize that the medication is a primary, core treatment rather than just an assistive or temporary one.

There are 3 common FDA-approved medications used in MOUD for opioid addiction treatment: methadone, buprenorphine, and naltrexone. Due to some of these medications being controlled substances with a potential for abuse, there has been much controversy regarding their long-term use in recovery. However, individuals can use medication for opioid treatment safely for months, years, and sometimes life.

Methadone Maintenance Treatment

Methadone maintenance treatment is commonly used for long-term treatment for individuals with an addiction to opioids, such as heroin. Methadone was approved as a treatment for opioid addiction soon after it was approved as a pain reliever in the United States in 1947; however, the first MAT program was not established until 1971 with methadone maintenance treatment (MMT). Methadone is used to treat adults with opioid use disorders by providing medication maintenance and therapy.

Buprenorphine Treatment

Buprenorphine is a partial opioid agonist that can help reduce physical dependency of opioids and minimize or prevent opioid withdrawal symptoms and cravings. Buprenorphine binds strongly to mu opioid receptors in the brain, but only partially activates them, making it an efficient medication for opioid detox and long-term treatment. It has a much lower overdose risk than full opioid agonists (such as heroin), decreases opioid withdrawals, and reduces cravings and urges for opioids.

Since buprenorphine is a partial opioid agonist, it creates a weaker effect than full opioids. This is incredibly beneficial in opioid addiction treatment because it prevents less euphoria and respiratory depression but can still provide pain relief and treat opioid withdrawals. This means there is less of a risk of overdose, dependence, and addiction with buprenorphine, making it a relatively safe and effective medication.

Naltrexone Treatment

Naltrexone (brand name Vivitrol) is an opioid receptor blocker that works on the mu opioid receptor to block opioids from binding to it. If someone uses an opioid while on naltrexone, they will immediately experience withdrawal because naltrexone kicks opioids off the opioid receptors and blocks the positive symptoms of pain reduction, euphoria, and sedation. When a person no longer experiences these desirable effects, the cravings to use opioids quickly deplete, making naltrexone an effective tool in treating OUD.

Naltrexone comes in a tablet form and is taken orally once per day.

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The Benefits Of Medication-Assisted Treatment

There are many benefits to medication-assisted treatment. Methadone is a synthetic opioid that remains active for 24 hours (or longer) in the body due to its ability to metabolize differently than other opioids. It builds up in an individual’s body and remains active for long periods of time. This is very beneficial for individuals using methadone, as the drug blocks the effects of other opioids while reducing the cravings and withdrawal that an opioid addict would have to overcome daily due to use of other drugs.

Individuals with opioid use disorders typically use opioids multiple times per day. This increases tolerance and results in the need to increase the dosage and frequency of the drug. In general, they get stuck in the cycle of repeating the process of finding drugs, using, being high, and recovering from withdrawal symptoms. When involved in an MMT program, they are free from this cycle. Methadone and buprenorphine specifically help “break the cycle” of addiction by allowing individuals to focus on their recovery, relationships, family, jobs, and improve psychological health.

Mental Health Benefits Of Medication-Assisted Treatment

MMT programs offer psychotherapy and counseling with each methadone dose to improve psychological health and behaviors. Individuals in MMT programs can address co-occurring disorders and, if needed, receive medication to treat these disorders as well. These programs encourage education on healthy coping strategies to prevent relapse, as well as learning to manage stress, anxiety, depression, and conflict. Individuals taking buprenorphine are recommended to take part in psychotherapy while taking their medication.

Behavioral Benefits Of Medication-Assisted Treatment

According to the National Institute On Drug Abuse, there has been an improvement shown through the reduction in certain behaviors of many individuals in MAT programs, including methadone, Subutex, and Suboxone®, such as:

• Illicit drug use
• Criminal activity
• Needle sharing
• HIV infection rates and transmission
• Commercial sex work
• Number of reports of multiple sex partners
• Suicide attempts
• Lethal opioid overdoses

Medical Benefits Of Medication-Assisted Treatment

Medication-assisted treatment programs offer successful strategies that prevent and treat severe, chronic medical conditions such as Hepatitis B or C, HIV, AIDS, and Tuberculosis, all of which are common among opioid addicts due to either intravenous drug use or repeated exposure to environments where this type of drug abuse is common. Also, eating habits and other healthy habits are shown to improve in individuals in MAT programs.

Other Benefits Of Medication-Assisted Treatment

Some MAT programs, such as methadone treatment programs, provide support to individuals by offering education, resources, referrals, and access to various support groups. This additional support helps the recovering addict find healthy alternatives to negative environmental issues, such as housing, financial, employment, education, medical, social, or legal difficulties. Having this kind of support is not only beneficial for the recovering addict but also their families and loved ones.

Most MAT programs also offer drug monitoring and other interventions to help guide the individual throughout the program. With methadone maintenance, all individuals must comply with rules in order to remain eligible to participate. All OTPs require participants to refrain from the use of all mood-altering substances and to participate in treatment programming. According to the National Institute on Drug Abuse, “No matter how ideologically attractive the notion of time-limited methadone treatment for heroin abusers, longer-term methadone maintenance treatment is far more effective.”

Risks Of Medication-Assisted Treatment

There are also downfalls to Medication-Assisted Treatment Programs.

Difficulty Finding A Nearby Program

MMT programs are heavily regulated and must be held at specially licensed treatment centers. MMT programs are limited to geographical areas with the highest rates of addiction. One of the problems with MMT is finding a program close to where the patient resides, as the majority of these programs are still limited to urban areas where addiction rates are more abundant. Methadone is also only dispensed at specially licensed treatment centers.

Medication Side Effects

Another shortcoming of using medications for medication maintenance of opioid addiction includes the reported side-effects of medications. While buprenorphine is reported to have fewer side-effects, and be less intense of an opioid, methadone is reported to have more side-effects with higher rates of dependence and/or addiction. Methadone side-effects may include nausea, constipation, frequent urination, sexual dysfunction, and addiction. Many find that MAT is risky because buprenorphine and methadone are controlled-substances.

Medication Abuse

Another concern with MAT is that since the most common medications used are controlled substances; there is a risk of abuse by addicts who abuse other drugs while on MAT or sell their medication to buy other drugs. With proper monitoring of medication, this can be reduced; however, not all clients on MAT have this kind of structured support, as it depends on which MAT program the individual has chosen.

Overdose

A big issue with MAT is that many addicts have overdosed while on MAT due to the co-administration of other frequently abused illegal or prescribed drugs. Methadone, for example, is commonly abused with benzodiazepines. This is dangerous for all MAT medications because they depress the central nervous system (CNS). Using other CNS depressants, such as benzodiazepines and alcohol, significantly increases the probability of respiratory failure, overdose, coma, and fatal complications. Many believe that since MAT is considered a harm reduction treatment, it is best used as a long-term treatment specifically for addicts with a history of chronic relapse.

The Controversy Surrounding Medication-Assisted Treatment

Members of the community have reported concerns that opioid addicts are substituting one drug for another when using MAT. The controversy of medication-assisted treatment is whether a physician should prescribe opioid-based medicine that continues the opioid habit in order to allow the client the ability to recover and focus on responsibilities and their personal self-growth. There is also debate as to whether a physician should insist on using buprenorphine (or methadone) as an interim solution where individuals should only use it to taper off their opioid of choice in detox, even though withdrawal and higher rates of relapse (often with fatal consequences) threaten the client’s life.

Find Help Today

If you or someone you love are struggling with opioid addiction and think that medication-assisted treatment contact a treatment provider today for more rehab-related information.