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Medication-Assisted Treatment (MAT)?

Medication-assisted treatment (MAT) is a treatment approach that focuses on the entire person, combining both medications and counseling to manage opioid addiction.

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More than 2.5 million Americans struggled with opioid addiction in 2015, the American Society of Addiction Medicine (ASAM) reports. This includes abuse of both prescription painkillers and illicit opioids like heroin.

MAT uses a combined approach, including one of three FDA-approved medications along with counseling to treat opioid dependence and manage addiction.

Opioid drugs are highly addictive and can cause significant dependence even with short-term use. MAT helps to level out brain chemistry.

MAT is offered through opioid treatment programs (OTPs) and accredited providers throughout the country. It is part of a comprehensive treatment program that can minimize relapse and sustain recovery.

MAT Explained

Addiction is defined as a brain disease that impacts the chemical balance of the body. Opioids are a class of drugs that can cause physical and psychological dependence quickly, as brain chemistry changes to accommodate the interaction of the drugs.

For this reason, medications are often used to balance the chemical makeup of the brain during medical detox. Often, opioid medications themselves must be tapered off slowly to minimize withdrawal symptoms.

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MAT is the use of medications in recovery to keep brain chemistry stable. The medications aid in managing cravings and withdrawal symptoms to reduce instances of relapse and enhance overall recovery.

The Drug Addiction Treatment Act (DATA) of 2000 was the first law of its kind to allow narcotic medications used to treat opioid dependence to be dispensed on an outpatient basis. This opened up access to MAT, expanding care for those in need. Nearly every state in the United States has an operational OTP that provides MAT services today, per the Substance Abuse and Mental Health Services Administration.

MAT can be used as part of a complete opioid addiction treatment plan in both inpatient and outpatient settings. There is no timeline for MAT, and it can be continued as long as needed. Ultimately, the medications used in MAT can be used to maintain long-term recovery.

Does MAT Work?

Heroin use has drastically increased throughout the United States even in populations that were previously not impacted much by the drug. The Centers for Disease Control and Prevention (CDC) reports that deaths related to heroin overdoses were four times higher in 2013 than 2002 — a big indicator of increasing drug use.

Heroin is highly addictive and commonly injected. MAT is known to reduce incidence of injection drug use. MAT is often considered one of the best ways to treat opioid dependence, as it can be used to prevent overdose by minimizing relapse.ain to make them stop.

When you take an opioid drug, it binds to opioid receptors in the brain. This causes a flood of dopamine, which is one of the brain’s chemical messengers, or neurotransmitters, that helps to regulate your moods, thinking, memory, movement, and sleep functions. When levels of dopamine are elevated quickly, as with heroin use, it can create a euphoric high that is hard to replicate without drugs.

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When the drug wears off, there can be a significant low as dopamine levels drop. Anxiety, depression, fatigue, sleep problems, and physical flu-like symptoms can accompany opioid withdrawal.

These side effects can be significant. They can lead to intense cravings and a desire to use the drug again to make them stop.

MAT can work in one of two ways:
  • Medications can be used to bind to and activate opioid receptors in a similar fashion to opioids, often just to a lesser extent. This can keep the low from being so drastic.
  • Other medications can block the receptors and prevent the opioid high. Since there is no associated high, it increases abstinence rates.

Some medications are a combination of both agonist, opioid receptor activators, and antagonist (opioid receptor blocker) medications.

When used as part of a treatment plan that also includes counseling and behavioral therapy, MAT is considered highly effective and one of the gold standards of opioid dependence and addiction treatment.

Medications Used to Treat Opioid Addiction

The FDA approves three types of medications for managing opioid dependence: methadone, buprenorphine, and naltrexone.

Methadone

Methadone is a full opioid agonist drug that is one of the longest-acting opioids on the market. It is a narcotic drug that has a long half-life, which means it stays active in the body for a full day or longer.Methadone can only be dispensed through OTPs that are federally regulated by SAMHSA. Methadone is usually taken once per day, and methadone treatment generally lasts at least one year.

Methadone is available in the following FDA-approved forms for use with MAT:
  • Methadose: oral concentrate
  • Dolophine: tablet

Buprenorphine:

As a partial opioid agonist, buprenorphine activates opioid receptors — just not as much as full agonists do. It can also stay active in the body longer than many short-acting opioids.Buprenorphine can be prescribed by physicians and dispensed in several different settings, including community hospitals, offices, correctional facilities, and health departments. This makes it more accessible than methadone in many cases, per SAMHSA.

Since buprenorphine is not a full opioid agonist, the euphoric effects are weaker, and the effects of the drug level off after a certain amount is taken, called the “ceiling effect.” This can decrease its potential for abuse and make it effective for use during MAT.

Buprenorphine is also dispensed as a combination medication mixed with the opioid antagonist naloxone, which typically remains dormant unless the medication is misused via injection. This can further decrease the possibility of misuse and increase treatment compliance and abstinence.

The following medications containing buprenorphine are FDA-approved for opioid dependence treatment:
  • Subutex: sublingual tablet
  • Sublocade: extended-release injection
  • Probuphine: subdermal implant
  • Cassipa: buprenorphine/naloxone sublingual film
  • Suboxone: buprenorphine/naloxone film or tablet
  • Bunavail: buprenorphine/naloxone buccal film
  • Zubsolv: buprenorphine/naloxone sublingual tablet

Naltrexone

This is an opioid antagonist drug that can block the impact of opioids by affixing to opioid receptors in the brain and keeping opioids off them. This prevents the pleasurable impact of opioids.If you take an opioid drug while naltrexone is in your system, you can actually get sick and suffer from opioid withdrawal symptoms. In this way, naltrexone serves as a deterrent to promote abstinence and prevent relapse.

Naltrexone is FDA-approved for treating opioid dependence as Vivitrol, an extended-release intramuscular injectable.

Addictive Potential of MAT Medications

Methadone and buprenorphine are both narcotic opioid drugs that can be addictive.

Naltrexone, the opioid antagonist medication, is less likely to be abused. It has hardly any positive effects, so it is not generally abused.

Both buprenorphine and methadone have the potential for abuse, dependence, and addiction. Almost 350,000 Americans misused a methadone product in 2016, the National Survey on Drug Use and Health (NSDUH) reports. Twice as many people abused a product containing buprenorphine.

Since methadone is a full opioid agonist and buprenorphine is only a partial agonist with a ceiling effect, methadone is typically considered to be more addictive. Buprenorphine may be largely abused to stave off withdrawal symptoms in an attempt to self-detox, but it can also lead to opioid dependence and withdrawal.

Both of these opioid-containing MAT options are carefully regulated and tightly controlled. They are only dispensed through accredited programs and physicians.

Pros & Cons of MAT

The National Institute on Drug Abuse (NIDA) publishes that MAT can have the following benefits:
  • Reduced rate of opioid use
  • Fewer overdose deaths related to opioids
  • Decreased criminal activity
  • Lowered rate of infectious disease transmission
  • Increased retention in treatment programs and social functioning
  • Improved outcomes for babies born to mothers battling opioid addiction and fewer symptoms of neonatal abstinence syndrome
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Relapse rates for drug addiction are 40 to 60 percent, according to NIDA, and MAT can help to decrease instances of relapse. While MAT uses medications in place of opioid drugs to regulate brain chemistry, these medications are not considered to be substitutes for other opioids. They are merely a tool for helping you regain balance.

The medications need to be used in conjunction with counseling and behavioral therapies as part of a comprehensive treatment program for maximum effectiveness.

MAT is not the same as complete abstinence. Some rehab and 12-step programs may not condone the use of these medications. There are plenty of support groups and treatment programs that welcome the use of MAT, so it’s important to find a good fit in recovery.

MAT is not a short-term solution. The National Council says that remaining on maintenance medications for at least one to two years is associated with the highest success rates.

Once a person has achieved stability in recovery, the supervising physician will gradually reduce the regular dosage of the maintenance medication. They will be slowly weaned off the medication over a period of weeks or months until they are no longer taking any at all.

MAT may not be for everyone. Have a discussion with your treatment provider to determine if the pros outweigh the cons.

Locating a MAT Program Near You

MAT is vastly underused. SAMHSA reports that less than a third of treatment providers offer MAT, and less than half of people in these programs who are eligible actually get these medications.

Insurance can help to cover the costs of MAT. All states provide Medicaid reimbursement for at least one of the three FDA-approved MAT medications for treating opioid dependence.

Access to MAT is expanding, however. More programs and providers are seeing the value of MAT and implementing it to manage opioid addiction.

Footprints to Recovery offers MAT services. Please contact us to discuss your options. You can also talk to your primary care provider to find MAT services near you.

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