Medication Assisted Treatment Guide: Opioid Use Recovery Can Become Long-Term
Medication Assisted Treatment, or MAT, is defined by the Substance Abuse and Mental Health Services Administration — or SAMHSA – as the use of FDA-approved medications as part of the treatment process to help individuals struggling with a substance abuse disorder. Most commonly, MAT is used to treat opioid use disorders in conjunction with therapy, counseling and support groups in rehabilitation programs.
MAT used to treat opioid addiction is one of the most innovative of its forms. There are three medications commonly used to treat opioid addiction as outlined by SAMHSA:
- Methadone — an opioid agonist distributed in clinics by professional healthcare providers. Methadone lessens the painful withdrawal symptoms from opioids while also blocking the euphoric effects of those drugs, effectively managing the individual’s symptoms from drug abuse. Methadone can come in a pill, liquid or wafer form and can last from four to eight hours. Methadone is used to help individuals as they withdraw from opioid drug abuse and approach entirely sober treatment. Methadone must be closely monitored for vulnerable patients.
- Naltrexone — a non-addictive opioid antagonist that comes as a pill or as an injectable liquid. Naltrexone works to block opioid receptors in the brain and suppress cravings. Naltrexone works to nearly completely mute the effects of opioids, which poses potentially life-threatening danger if the individual taking Naltrexone decides to take an opioid and is unaware of the strength of the dose. For this reason, Naltrexone use is closely monitored by healthcare providers.
- Buprenorphine — an opioid partial agonist that produces the effects of euphoria like opioids but at a weaker level. Buprenorphine is administered in three phases. The Induction phrase is closely monitored and given to a patient after abstaining from opioid use for 12-24 hours, to lessen the effects of withdrawal. The Stabilization phase is a period of maintenance to ensure the individual doesn’t relapse with their drug addiction. The Maintenance phase is a steady transition off of buprenorphine and into medically supervised withdrawal where the individual can become completely sober with as decreased discomfort as possible.
These forms of MAT have been heavily researched and are used in many credible rehabilitation programs to help individuals transition off of drug use and into sobriety. Fortunately, in recent years, government programs have come to widely support the use of MAT to address opioid addiction and support recovery. As stated in the National Institute of Health’s (NIH) Testimony on Addressing the Opioid Crisis in America, “[An] issue is a lack of health system and healthcare provider capacity to identify and engage individuals, and provide them with high-quality, evidence-based opioid addiction treatment, in particular the full spectrum of medication-assisted treatment (MAT). It is well-documented that the majority of people with opioid addiction in the U.S. do not receive treatment, and even among those who do, many do not receive evidence-based care.”
Since this announcement, policy has been shifting in a positive direction to support the use of MAT and to make MAT programming more accessible to a more diverse range of populations. In his 2017 budget, former President Obama set aside a $1.1 billion budget towards tackling the opioid epidemic — with much of that funding going towards MAT treatment and research.
In tandem, in April of 2018, the National Institute of Health (NIH) launched the HEAL (Helping to End Addiction Long-term) Initiative, which is “an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis. This Initiative will build on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with Medication-Assisted Treatment (MAT) for opioid use disorder (OUD),” the NIH site explains. This program was part of current President Trump’s approval of a $1 billion budget to combat the national opioid epidemic.
However, it hasn’t come without push-back. As NPR outlined in a 2016 article, “Methadone and buprenorphine, two of the drugs used for treatment, are themselves opioids. A phrase you often hear about medication-assisted treatment is that it’s merely replacing one drug with another. While doctors and scientists strongly disagree with that characterization, it’s a view that’s widespread in recovery circles.”
There’s enough to be said about negative cultural and societal perceptions of individuals with drug addiction — but for skepticism towards the use of MAT to come from within recovery programs can be especially damaging to those individuals whom the treatment would well serve.
The promising news is that many treatment centers have begun to adopt MAT programming into their treatment plans for opioid addicted individuals, largely based on government support but also proven success from it’s implementation that informed such government support.
In a National Institute on Drug Abuse (NIDA) follow-up report in 2015 that tracked the success rates of opioid users’ sobriety after being treated with MAT — the first long-term follow-up study of its kind — yielded “cause for optimism.” Of those in the study treated with MAT, 50% reported abstinence from drugs 18 months after starting therapy. After 3.5 years, the number increased to 61%, and fewer than 10% of those in the study still met the criteria for dependence on drugs.
“‘Our findings are cause for optimism for these specific patients,’ says Dr. Roger Weiss, of McLean Hospital and Harvard Medical School, who co-led the study,” the follow-up report notes.
So what exactly leads to greater success for opioid addicted individuals? It seems the leading factor is reduced suffering. By using MAT as part of a longer-term treatment plan — in conjunction with behavioral therapy, counseling, support groups, educational tools and transitional living programs — patients are able to foresee a future without addiction when the transition does not require such wrenching withdrawal. MAT assists in immediate, physical withdrawal symptoms, allowing the individual to come to a place of physical stability in order to transition into more social, psychological, behavioral and cognitive rehabilitation programming. The prospect of reducing suffering — both in the short-term and in the long-term — through science-based treatment, is nothing short of hopeful.