Addiction is one of the most pressing public health crises that the United States faces today. Approximately 21.5 million Americans above the age of 12 had some form of substance use disorder in 2014, according to the National Survey on Drug Use and Health (NSDUH). With so many people struggling, addiction is a problem that touches nearly everyone in some way.
To help combat this issue and connect individuals to the care they need, rehab centers across the country offer a broad range of care options, including medication-assisted treatment (MAT). MAT is a method of addiction care that combines traditional rehab approaches in combination with medications. These medications can be used to increase client safety, alleviate withdrawal symptoms, lessen cravings and help promote long-term recovery.
While MAT is an evidence-based practice that has been shown to yield positive client outcomes, it’s currently underutilized. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the proportion of heroin admissions with treatment plans that included MAT fell from 35 percent in 2002 to 28 percent in 2010.
What Is Medication-Assisted Treatment (MAT)?
MAT is a method of drug and alcohol rehab that uses medication in combination with behavioral therapy to address substance use disorders. MAT programs can be customized to every client’s needs, so they receive quality, tailored care. MAT is particularly useful for people struggling with addictions to physically addictive substances, including alcohol, prescription opioids and illicit opioids like heroin.
Individual and group counseling are key components of all forms of MAT. With the help of a medication-assisted treatment counselor, clients can begin to understand the roots of their addiction and build a new life in sobriety, while curbing much of the initial discomfort and cravings that come with recovery. Group counseling, including 12-step programming, helps clients find support and build solidarity with peers who share in their recovery. This comprehensive approach is largely why medication-assisted treatment works so well: It addresses many of the roadblocks that can lead to relapse while allowing clients to focus on the inner, personal work of recovery.
Medication-Assisted Treatment for Opioid Addiction
It’s no secret that opioid addiction is a growing problem. According to the National Institute on Drug Abuse, more than 115 people in the United States die of an opioid overdose every day. Incidents of neonatal abstinence syndrome (NAS), or babies born addicted to opioids because of maternal opioid use during pregnancy, are also on the rise, increasing five-fold from 2000 to 2012.
With the opioid epidemic reaching such extremes and impacting so many lives, the need for evidence-based opioid treatment programs is higher today than ever before. That’s where medication-assisted treatment for opioid addiction comes in. With MAT, a person’s chances of sustaining long-term recovery from opioid addiction increase significantly when compared to non-drug approaches. MAT for opioid addiction can be used to alleviate withdrawal symptoms, curb cravings, block the effects of opioids and reverse overdose.
Opioid Addiction Medications
Opioids are extremely addictive, making recovery from an opioid use disorder (OUD) particularly difficult. Fortunately, opioid addiction medications can help alleviate many of the roadblocks in the way of recovery from an OUD. For example, opioid replacement therapy medications, like methadone and buprenorphine, can be used to help curb cravings and diminish withdrawal symptoms. Others, like naltrexone, block the effects of opioids altogether. When used in combination with a comprehensive rehab program, opioid addiction medications can dramatically improve patient outcomes.
One of the most common opioid replacement medications, methadone is used to alleviate opioid withdrawal symptoms and cravings by providing a controlled, mild dose of opioids. Each dose is customized to the client’s needs, which is typically the smallest dose necessary to stabilize their condition. This medication is available in pill, liquid and wafer form, and is typically taken once a day. The effects of each dose can last anywhere from four to eight hours.
When taken as directed, methadone can be a useful tool in MAT. However, methadone is still an opioid with the potential for abuse; it’s crucial that it only be used in a professional, supervised treatment setting. According to the National Institute on Drug Abuse, methadone treatment should be used for a minimum of 12 months. Once a patient is ready to stop methadone treatment, they must do so gradually to prevent withdrawal symptoms.
Like methadone, buprenorphine is used in MAT to help suppress and reduce cravings for opioids. However, the mechanisms behind this medication are slightly different than those employed by methadone. Buprenorphine is an opioid partial agonist, meaning that it produces effects that are similar — but significantly less intense — than that of other opioids, including mild euphoria and respiratory depression. However, these effects level off after a moderate dose is consumed, even if the dose is increased. This “ceiling effect,” combined with the long-lasting effects of the medication, help improve its safety in MAT and limit the potential for abuse. Typically, treatment with buprenorphine begins after a client has abstained from using other opioids for between 12 and 24 hours.
Buprenorphine is available in four main forms:
- Subutex: Available in sublingual tablet form, Subutex is chemically pure, meaning that it only contains buprenorphine. When taken as directed, this medication can be an invaluable part of an MAT program. However, when taken in large amounts or injected, Subutex carries some potential for abuse.
- Suboxone: Also primarily available in tablet form, Suboxone is an opioid addiction medication that contains a mixture of buprenorphine and naloxone. While Suboxone is a partial opioid agonist, naloxone is a full opioid antagonist, meaning that it blocks the effects of opioids at receptor sites. This significantly lowers the medication’s potential for abuse. If an individual attempts to inject or consume large amounts of Suboxone, the combination of partial and full opioid agonists can trigger intense and unpleasant withdrawal symptoms.
- Probuphine: This medication is delivered into the body through an implant that administers a constant, low dose of buprenorphine over a period of six months. Unlike Subutex and Suboxone, Probuphine is convenient because it does not have to be taken every day. This method of administration limits the potential for abuse, though it should be noted that if the implant is moved out of place or removed altogether, there is still a possibility of intentional misuse or accidental exposure.
- Injectable Buprenorphine: One of the newest medications available for opioid MAT, injectable buprenorphine works in much the same way that other forms of buprenorphine do. However, instead of receiving the medication through tablets or implants, this form of the medication is administered in monthly buprenorphine subcutaneous injections. This helps reduce the burden and potential abuse risk that comes with the tablet form of the medication. Treatment with injectable buprenorphine cannot begin until clients have completed the detox process, are psychiatrically stable, and have engaged in the induction phase. The induction phase can last anywhere from three to seven days.
Like most other opioid addiction medications, naltrexone suppresses cravings. However, while medications like methadone and buprenorphine do this by activating opioid receptors, naltrexone works by binding to opioid receptors, effectively blocking them off. This suppresses cravings, but it also has an additional, useful effect: even if a person relapses and uses an opioid, naltrexone prevents them from achieving a high. This medication carries few risks and there is no potential for abuse since naltrexone blocks opioid receptors instead of activating them.
Withdrawal from all opioids or all other opioid addiction medications must be complete for at least seven to ten days before naltrexone can be administered. This medication is available in both pill (ReVia and Deparde) and injectable, extended-release forms (Vivitrol).
Opioid Overdose Medication
Consuming illicit opioids, prescription drugs, or opioid addiction medications in high doses can have life-threatening consequences, including overdose. However, it’s important to keep in mind that overdose isn’t always the result of deliberate misuse. Overdose can also occur after an individual accidentally takes an extra dose of an opioid addiction medication, or combines one of these medications with another psychiatric drug. Because of this risk, it’s important that individuals receiving MAT for opioid use disorder have access to overdose-reversing drugs. Fortunately, there are opioid overdose medications available that can stabilize individuals in the midst of an overdose, including naloxone.
Naloxone is a medication that can be used to reverse the effects of an opioid overdose. Within a few minutes after it is administered through an intranasal spray (Narcan), injected into the muscle or injected under the skin, naloxone temporarily binds to opioid receptors in the brain, preventing additional opioids from binding to and activating these receptors. This reverses respiratory depression, which could otherwise lead to death, and gives emergency professionals enough time to transport the overdosing individual to a medical facility for further care and examination.
This drug is often prescribed to patients undergoing MAT, particularly if the individual is taking opioid addiction medications that carry some risk of overdose. It can also be given to friends and family members to administer to their loved ones in case of emergency overdose.
Medications for Alcohol Abuse
When it comes to substance use disorders, recovery from alcohol addiction can be particularly challenging. Alcohol is legally and readily available at bars, liquor stores and clubs, and its consumption is deeply ingrained in daily life in the United States. In addition, alcohol withdrawal can trigger severe symptoms, including delirium tremens (DT) and seizures.
While recovery from alcohol use disorder can be difficult, the process is made significantly easier and safer with MAT. Medication for alcohol abuse can reduce cravings and disincentivize alcohol use. When used in combination with counseling and other evidence-based treatment methods, MAT can lead to healthier outcomes for clients with alcohol use disorders, according to SAMHSA.
Some of the medications most commonly used in MAT for alcohol use disorder are disulfiram, naltrexone and acamprosate.
Disulfiram is most effective for people who have already gone through detox and are in the early stages of recovery. Taken once a day in tablet form, disulfiram deters individuals from consuming alcohol by producing unpleasant side effects when even small amounts of alcohol are ingested, including:
- Chest pains.
- Difficulty breathing.
These side effects can set in within 10 minutes after consuming alcohol and may persist for an hour or more. Because these side effects can be uncomfortable or even dangerous, some treatment centers elect not to use this drug for MAT.
Naltrexone is a medication that blocks the euphoric effects and feelings of intoxication that people experience after consuming alcohol. Over time, this diminished effect can help individuals disassociate alcohol from previously pleasurable feelings, and make it easier to stay committed to sobriety in recovery. This medication is most commonly administered in its tablet (ReVia and Depade) and injectable forms (Vivitrol). Like all other medications used in MAT, naltrexone treatment works best when paired with counseling and a comprehensive recovery plan.
Like disulfiram and naltrexone, acamprosate is ideal for people who have already worked through the initial withdrawal symptoms of recovery. Treatment with this medication typically begins on the fifth day of abstinence and reaches its full effectiveness within five to eight days. Acamprosate comes in tablet form and must be taken three times a day.
Acamprosate has been shown to reduce cravings and improve a person’s chances of abstinence when used in conjunction with a comprehensive recovery plan. However, despite its success, there is still no clear answer to the question “How does acamprosate work?”
Success Rates of Medication Assisted Treatment
There is no one-size-fits-all approach to addressing substance use disorder. While complete abstinence from drugs or alcohol might work for some people, the reality of the situation is that it may not work for everyone. Some people need additional help early on in recovery.
When it comes to evidence-based care, medication-assisted treatment is one of the most useful — and unfortunately, underutilized — methods available today. When compared to nondrug approaches, research suggests that medication-assisted treatment’s effectiveness is significant, improving a client’s chances of sticking with treatment and reducing illicit opioid consumption. For example, one study involving criminal justice offenders showed that extended-release naltrexone use was associated with a significantly lower rate of relapse than traditional treatment methods.
Medication-assisted treatment success rates, in general, are shown to be high, particularly when it comes to decreasing overdose deaths. A study that examined the impact between expanding methadone and buprenorphine treatment in Baltimore, Maryland, found that buprenorphine treatment was associated with a decrease in heroin overdose deaths. Additional research found that buprenorphine and methadone maintenance treatment (MMT) were associated with a reduction in both all-cause and opioid-related mortality.
MAT has no impact on a person’s intelligence, mental capabilities, physical functioning or employability, according to SAMHSA. MAT for opioid and alcohol addiction has been shown to:
- Decrease opioid use.
- Decrease criminal activity.
- Improve an individual’s ability to gain and maintain employment.
- Improve birth outcomes among pregnant women who have substance use disorders.
Pros and Cons of MAT
Like any treatment method, medication-assisted treatment has its pros and cons. MAT is a harm-reduction approach, which means that it aims to view the problem of addiction in a realistic light and decrease the negative consequences of substance. By reducing the risk of drug abuse, MAT can decrease the chance of overdose, and improve a client’s likelihood of remaining in recovery.
Additionally, MAT has shown to be particularly beneficial for clients struggling with co-occurring conditions like depression. Dr. Roger Weiss, of McLean Hospital and Harvard Medical School who co-led a study on the effectiveness of MAT, reported that “Patients with a lifetime history of major depressive disorder were nearly twice as likely as patients without such a history to have a good outcome during the 12-week Bp/Nx treatment.”
While the benefits of medication-assisted treatment are many, this method does come with its share of challenges:
- MAT must be used as part of a wider treatment program to be effective.
- Most methods of MAT require daily dosing.
- Clients may face stigma for partaking in MAT.
- Medications used in MAT can cause medical complications in some cases.
- Some medications utilized in MAT can be abused if use is not carefully monitored.