How Medication Assisted Treatment Offers Hope
Understanding Medication-Assisted Treatment
Unraveling the complexities of substance use disorders (SUDs), including opioid use disorder, requires an in-depth understanding of all available treatment methods. One such method rising in prominence is medication-assisted treatment (MAT).
Overview of MAT
Medication-assisted treatment (MAT) is a therapeutic approach that combines the use of medications with counseling and behavioral therapies to treat substance use disorders and certain mental health conditions. This holistic and personalized path to recovery addresses the biological aspects of addiction or mental health disorders, offering a comprehensive solution.
MAT typically involves the use of medication along with counseling and other behavioral health therapies to primarily treat opioid use disorder and prevent overdose. The choice and dosage of medication are tailored to each patient, following a thorough assessment by a licensed physician that accounts for various patient situations such as pregnancy, mental illnesses, or incarceration [2].
In some cases, MAT is being provided by primary care clinicians on an outpatient basis in their offices. This approach increases access to treatment, decreases costs, and allows for the building of relationships between clinicians and individuals with SUDs, which is considered crucial for successful treatment [3].
Importance of MAT
Medication-assisted treatment is considered the gold standard of care for opioid addiction. MAT offers numerous benefits such as reduced cravings and withdrawal symptoms, improved treatment engagement, prevention of relapse, enhanced effectiveness of behavioral therapies, and an individualized treatment approach.
By integrating medications, social support services, and counseling, MAT enables patients to return to productive lives within their families, jobs, and communities. This comprehensive approach to treating substance use disorders underscores the importance of MAT in transforming lives and offering hope.
For a deeper understanding of the evolution of MAT, visit our article on when medication assisted treatment began. To learn more about the outcomes of MAT, refer to our article on what are the outcomes of mat.
Medications for Opioid Use Disorder
When it comes to medication-assisted treatment (MAT) for opioid use disorder (OUD), three medications are currently approved by the U.S. Food and Drug Administration (FDA): Methadone, Buprenorphine, and Naltrexone. Each of these medications operates differently and has unique safety and efficacy profiles, making them suitable for various patient needs.
Methadone
Methadone, a synthetic, long-lasting opioid agonist, occupies mu-opioid receptors in the brain, moderating the painful "lows" of opioid withdrawal and dampening the euphoric "highs" of shorter-acting opioids like heroin. Additionally, it relieves physiological opioid cravings, normalizes the body's functioning impaired by illicit opioids, and diminishes the euphoric effects of other opioids, which is essential in aiding recovery [4].
While methadone treatment is associated with a heightened risk of opioid overdose death within the first 2 weeks, the risk decreases significantly after this period. Methadone has also been shown to reduce opioid use, opioid use disorder-related symptoms, infectious disease transmission, and criminal behavior associated with drug use.
Buprenorphine
Buprenorphine is a high-affinity partial opioid agonist that can reduce opioid cravings and the rewarding effect if the patient uses opioids while taking buprenorphine [5]. This medication is also effective for less advanced substance use disorders as it can reduce cravings and withdrawal symptoms without the dramatic highs and lows of illicit drug abuse.
Buprenorphine is associated with a lower risk of overdose than methadone and other opioids. It has also been linked to improved maternal and fetal outcomes in pregnant women with OUD. Studies have shown no differences in opioid-positive drug tests or self-reported heroin use when treating with methadone or buprenorphine at medium-to-high doses.
Naltrexone
Naltrexone is an opioid antagonist that blocks the activation of opioid receptors, decreasing cravings and preventing the production of a "high" [4]. Extended-release naltrexone treatment initiation requires medically supervised withdrawal and at least 4 to 7 days without any opioids. Naltrexone is not associated with physical dependence or rewarding effects of opioids [5].
Extended-release injectable naltrexone (XR-NTX) has been shown to significantly increase opioid abstinence, with the XR-NTX group having 90 percent confirmed abstinent weeks compared to 35 percent in the placebo group. Treatment retention was also higher in the XR-NTX group, while subjective drug craving and relapse were both decreased.
These medications, as part of a comprehensive medication-assisted treatment approach, can significantly improve the outcomes for individuals battling opioid use disorder. For more information on the differences between MAT and other treatment approaches, refer to our article on the difference between MAT and other treatment protocols.
Benefits and Efficacy of MAT
Medication-assisted treatment (MAT) brings a host of benefits to individuals struggling with opioid use disorder. These benefits range from reducing opioid use to preventing overdose and positively impacting social functioning.
Reduction in Opioid Use
Methadone and buprenorphine, two of the medications used in MAT, have been found to be equally effective at reducing opioid use. There were no differences in opioid-positive drug tests or self-reported heroin use when treating with methadone or buprenorphine at medium-to-high doses [6].
When given at a sufficiently high dose (generally 16 mg per day or more), buprenorphine has been effective in treating opioid use disorders. Patients on these doses were 1.82 times more likely to stay in treatment than those who received a placebo.
Prevention of Overdose
Medications like methadone, buprenorphine, and naltrexone have been shown to reduce the likelihood of a person overdosing. They also increase the chances of a person remaining in treatment, which is associated with a lower risk of overdose mortality.
Extended-release injectable naltrexone (XR-NTX) has shown significant results in opioid abstinence, with 90 percent confirmed abstinent weeks compared to 35 percent in the placebo group. Treatment retention was also higher in the XR-NTX group, while subjective drug craving and relapse were both decreased.
Impact on Social Functioning
MAT also has a positive impact on social functioning. It's reported to decrease criminal activity associated with drug-seeking behaviors and decrease infectious disease transmission like HIV and hepatitis C. Additionally, MAT increases social functioning and retention in treatment programs.
In a nutshell, the benefits of MAT are numerous and far-reaching. While it aids in the reduction of opioid use, it plays a crucial role in the prevention of overdose and improving social functioning. To understand more about the outcomes of MAT, check out our article on what are the outcomes of mat.
Accessing Medication-Assisted Treatment
Medication-assisted treatment (MAT) is a comprehensive, evidence-based approach to treating substance use disorders, particularly opioid use disorder. It combines the use of specialized medications with counseling and behavioral therapies, making it a holistic and personalized path to recovery. However, access to MAT can sometimes be a challenge. For individuals seeking help in Kansas, there are several avenues to access MAT.
Treatment Centers
Specialized treatment centers are one of the primary sources for accessing MAT. These centers offer a comprehensive approach to managing substance use disorders, combining medication, social support services, and counseling. However, it's important to note that fewer than half of privately funded substance use disorder treatment facilities offer MAT.
Primary Care Physicians
Given the gap between the number of individuals with substance use disorder and the number of treatment centers, primary care clinicians have started providing MAT on an outpatient basis in their offices [3]. This approach not only increases access to treatment but also helps in building crucial relationships between clinicians and individuals with substance use disorder. However, to understand the difference between MAT and other treatment programs, it's recommended to consult with a healthcare professional.
Community Health Clinics
Community health clinics are another avenue for accessing MAT. Along with primary care physicians, psychiatrists, mental health professionals, and outpatient substance abuse programs, these clinics provide a comprehensive approach to managing substance use disorders or certain mental health conditions.
In addition to the above, telemedicine services and community mental health organizations also offer MAT. All these avenues highlight the availability and accessibility of this comprehensive approach. However, despite the proven efficacy of MAT, adoption has been slow, partly due to misconceptions about substituting one drug or addiction for another, or the belief that abstinence is the best method for promoting sobriety. For a more detailed understanding of MAT, its history, benefits, and outcomes, explore our resources on when medication assisted treatment began and what are the outcomes of MAT.
Challenges and Barriers to MAT
While medication-assisted treatment (MAT) offers a promising approach to managing opioid use disorders (OUD), there are several challenges and barriers that can hinder the accessibility and effectiveness of this treatment method. These challenges range from societal stigma and misconceptions about MAT to legal and regulatory hurdles, as well as issues related to provider availability.
Stigma and Misconceptions
Stigma towards individuals with OUD and medications used to treat OUD poses significant barriers to the uptake of medication-based treatment. Negative attitudes towards individuals with prescription OUD exceed those reported for other medical conditions, and individuals with OUD are often viewed as lacking self-discipline.
Stigmatizing attitudes towards people with OUD are found among health professionals, public safety and criminal justice settings, the housing sector, and the child welfare system. Moreover, stigma towards opioid agonists like methadone and buprenorphine is grounded in the misperception that these medications are substituting one drug for another. Clarifying the difference between MAT and opioid treatment programs (OTP) can help dispel such misconceptions.
Legal and Regulatory Hurdles
Legal and regulatory barriers prevent broad access to medication-based treatment for OUD within the mainstream of the medical care system. For instance, methadone can only be dispensed by opioid treatment programs, buprenorphine can only be prescribed by providers with specialized certification, and naltrexone can be prescribed by any licensed health care provider. Understanding when medication-assisted treatment began can shed light on why such regulations were put in place.
Provider Availability
Concerns about the misuse and diversion of medications for OUD contribute to the insufficient numbers of providers willing to prescribe them. However, evidence suggests that rates of misuse and diversion decline as buprenorphine availability increases.
Nationwide, fewer than half of privately funded substance use disorder treatment facilities offer MAT, and only a third of patients with opioid use disorders have access to those treatments. The slow adoption of MAT could be due to misconceptions about substituting one drug or addiction for another or the belief that abstinence is the best method for promoting sobriety. More education about the difference between MAT and substance use disorders (SUD) can help address these barriers.
In conclusion, although MAT is a proven effective method for treating OUD, significant challenges and barriers exist. Addressing these issues is essential for expanding access to MAT and improving the lives of individuals struggling with OUD. For more information on the outcomes of MAT, you can explore our other articles.
History and Evolution of MAT
The journey of medication-assisted treatment (MAT) has been transformative, marking significant milestones in the medical approach to treating substance use disorders, particularly opioid use disorder (OUD).
Early Treatment Approaches
In the 1960s, MAT was initially designed to address opioid use disorder, with methadone maintenance surfacing as one of the primary forms of treatment. By the 1970s, federally-funded treatment programs began to emerge, and the term "maintenance treatment," referring to MAT, was first used in the Narcotic Addict Treatment Act of 1974. For a deeper look into the early difference between MAT and other programs, visit our article on difference between mat and otp.
Development of MAT Options
By the 1990s, the National Institutes of Health published recommendations that clarified opioid addiction as a treatable disorder, not a lack of willpower or moral failing. This significant shift in perspective helped in reducing the stigmatization tied to MAT, paving the way for the exploration and adoption of more MAT options. The emergence of accreditation systems for opioid treatment programs (OTPs) also played a crucial role in standardizing treatment methods across the United States.
During this period, key milestones included the introduction of methadone maintenance programs in the 1960s-1970s, and the introduction of Naltrexone and Buprenorphine in the 1980s-1990s, all aimed at expanding and improving MAT. For a detailed timeline, see our article on when medication assisted treatment began.
Current Holistic Approaches
In the 21st century, the focus of MAT has shifted towards a more holistic and personalized care approach. Modern MAT incorporates the use of medications with counseling and behavioral therapies to provide comprehensive treatment for substance use disorders and certain mental health conditions. The key objective is to address the biological aspects of addiction or mental health disorders, thus offering a personalized path to recovery [1].
Today, studies affirm that effective agonist medication used for an indefinite period of time is the safest option for treating OUD. Methadone and buprenorphine treatment retention have been linked to substantially decreased risks of all-cause and overdose-related mortality among people with OUD. Increased access to treatment using agonist medication is associated with reduced opioid overdose deaths.
The evolution of MAT reflects the medical community's continued commitment to understanding and effectively treating substance use disorders. As research advances, so does the hope for more effective, personalized, and holistic approaches to recovery. For more information about the outcomes of MAT, see our in-depth article what are the outcomes of mat.
References
[1]: https://relevancerecovery.com/blog/understanding-the-benefits-of-medication-assisted-treatment/
[2]: https://www.naco.org/articles/medication-assisted-treatment-substance-use-disorders
[3]: https://pubmed.ncbi.nlm.nih.gov/31800513/
[4]: https://www.bhgrecovery.com/blog/medications-used-in-mat
[5]: https://www.ncbi.nlm.nih.gov/books/NBK541393/
[7]: https://www.ncbi.nlm.nih.gov/books/NBK541389/
[8]: https://americanaddictioncenters.org/addiction-medications
