Modern Medication-Assisted Treatment (MAT)
“Medications are an effective treatment for opioid addiction,” says Kelly J. Clark, the president of the American Society of Addiction Medicine in an interview with Business Insider Magazine.
What is Medication Assisted Treatment?
Medication-assisted treatment is the use of medications along with behavioral therapies to reduce a person’s dependence on drugs, especially opioids. Different medications are available that can help reduce the effects of withdrawal during opiate addiction treatment, as well as prevent the likelihood of relapse.
How Does Medication Assisted Treatment Work?
During Your Detox
Different approaches exist for the detox treatment process, and the best approach often depends upon each individual. One detox approach is to have a person go “cold turkey” and stop using illegal substances. Withdrawal symptoms will occur, which a suboxone program is entirely prepared for, and medication-assisted treatments may start after detox. This may occur in order to reduce cravings or reduce the likelihood of returning to substance abuse.
Another option is to use a tapering plan or medication treatment plan to reduce the detox process. Sometimes, a person may start medication-assisted treatment, such as methadone maintenance, within suboxone treatment centers. This approach can be especially helpful in cases of heroin abuse.
Aftercare for Medically Assisted Treatment
The U.S. Food & Drug Administration (FDA) has approved three medications in aftercare treatments to help enhance a person’s sobriety as well as reduce the likelihood of relapse. These medications include:
- Buprenorphine: This partial-agonist medication helps to block some of the opioid receptors in the brain. This medication can help to reduce cravings and relieve pain without creating the same “high” that can be experienced when using painkilling medications.
- Methadone: Methadone is a medication used to reduce painkiller and heroin abuse. The medication is a full-agonist medicine that can relieve pain. The medication is taken daily and is available in pill, liquid, and wafer forms (1). However, methadone must be prescribed via an opioid treatment program, which the Substance Abuse and Mental Health Services Administration regulates. Participants must be monitored regularly to ensure that excess methadone is not present in their systems and to ensure the person is continuing to pursue their sobriety. Methadone maintenance therapies can take 12 months or more to be effective, according to The Pew Trust (1).
- Naltrexone: Naltrexone is a medication used to assist in the reduction of opioid abuse. It is an antagonist medication, meaning it blocks the effects of opioid receptors. If a person is on naltrexone and takes an opioid, they may not experience the “high” they usually would. Naltrexone is available as a pill formulation a person can take daily or as an extended-release injectable medication that is given monthly (1). People take naltrexone to reduce the likelihood they will relapse, but it does not assist in reducing withdrawal symptoms.
Medication assisted treatments are available for those addicted to alcohol as well. These medications for alcoholism are usually intended to deter drinking by causing unpleasant side effects if a person does drink again after being sober. Examples of medicines used in medication assisted treatment for alcohol abuse include:
- Acamprosate: Acamprosate is a medication used for those in recovery for alcohol dependency. Acamprosate is taken three times a day, in tablet form. It cannot be taken until a person has completed the detox phase. The medicine can take several days to a week to have the full effect on the body. Acamprosate prevents users from feeling the “high” when drinking by controlling the reward center of the brain. When this happens, there is no positive reinforcement to consume alcohol, which leads to fewer urges to drink.
- Disulfiram (Antabuse): As part of an alcoholism treatment program, this medication is available as a pill taken once every day. If a pill is taken and alcohol drank, unpleasant side effects include headache, nausea, and vomiting (2). These symptoms can occur within 10 minutes of drinking alcohol.
- Naltrexone: Naltrexone is used in medication assisted treatment for both opioids and as part of an alcohol treatment plan. People who have suffered from alcohol abuse take it because it does not cause an intoxicated feeling when drinking after taking the medicine. As a result, a person is ideally less likely to turn to alcohol (2).
Dangers of Mixing Medications
A person who uses medication-assisted treatment should talk to their doctor about all their current medications. Some medications, especially those to treat opioid addiction, can cause fatal side effects when combined with medications like benzodiazepines, which are used to relieve anxiety, such as Xanax or Valium.
What Are Some Misconceptions About MAT?
It’s A Substitute
A common misconception about medication-assisted treatment is that the process simply substitutes one approach for another (2). Doctors prescribe medications to reduce cravings and minimize withdrawal symptoms whenever possible. These medications can be taken more safely when a person can see a doctor for monitoring.
“People ask me all the time, ‘Well, aren’t they just substituting one drug for another?’ The answer is no. These are evidence-based treatments and they work,” said Patrice A. Harris, a board-certified psychiatrist and the chair of the American Medical Association’s opioid task force interviewed in Business Insider magazine (3).
It’s The Only Solution
Another misconception about medication-assisted treatment is that it is the only line of treatment a person needs for their treatment to be effective (3). Medication-assisted treatment can help address the physical addiction and cravings side to addiction, but it doesn’t address the mental pull that alcohol or opioids can have on a person. Psychotherapy and behavioral therapies are vital to help with overcoming addictions.
Evidence Is Effectiveness
According to the non-profit organization and research group The Pew Charitable Trusts, “the use of medications combined with psychosocial treatment is superior to drug or psychosocial treatment on its own” (1). According to the Trust, a person who uses medication-assisted treatment is more likely to adhere to their treatment program and reduce their illegal drug use (1). By using medication-assisted treatment, a person is less likely to contract infectious diseases, such as HIV and hepatitis C (1).
In addition, to support from The Pew Trust, the Substance Abuse and Mental Health Services Administration (SAMHSA) also reports that combining medical therapies and counseling can help to successfully treat substance abuse disorders (2). Some of the proven benefits associated with medication assisted-therapies include (2):
- improved patient survival rates
- enhanced retention in treatment programs
- enhanced ability to gain employment and stay employed
- improved birth outcomes among pregnant women
- decreased criminal activity among those who suffer from substance abuse
Other advocacy groups who support medication-assisted treatment include the National Council for Behavioral Health, the American Society of Addiction Medicine, the U.S. surgeon general, and the White House Office of National Drug Control Policy (3).
In addition to these benefits, there are several studies that outline the effectiveness of medication-assisted treatment. This includes one published in the American Journal of Public Health, which studied heroin overdose deaths in Baltimore, Maryland, between the years of 1995 and 2009. The authors found the availability of treatments, like methadone and buprenorphine, decreased deaths from overdoses by roughly 50 percent (4).
What is Suboxone?
Suboxone is a medication used to treat opioid dependence, containing buprenorphine and naloxone. According to the World Health Organization (1), an estimated 15 million people suffer from opioid dependence in the U.S. and estimates are that this will increase to over 17 million in 2018.
- About 275 million people worldwide (5.6 percent of the global population aged 15 – 64 years) used drugs at least once during 2016. Among them, there were about 34 million people who used opioids and about 19 million who used opiates.
- There were an estimated 27 million people who suffered from opioid use disorders in 2016. The majority of people dependent on opioids used illicitly-cultivated and manufactured heroin, but an increasing proportion used prescription opioids.
Buprenorphine and naloxone, formulated as Suboxone, are used to treat this dependence. Buprenorphine is considered a “partial opioid agonist,” (2) meaning that it produces a milder form of the effects produced by opioids (which are “full opioid agonists”). It essentially fills the brain’s opioids receptors without producing the same high as full opioids. One of the advantages of using Suboxone is that it cannot be taken to achieve a full opioid effect, making it more difficult to abuse than other forms of medication-assisted treatment. Suboxone can be utilized for both detox withdrawal symptoms and long-term opiate addiction treatment.