“Medications are an effective treatment for opioid addiction,” said Kelly J. Clark, the president of the American Society of Addiction Medicine, in an interview with Business Insider magazine (3).
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 as well as prevent the likelihood of relapse when it comes to an alcoholism treatment program. We encourage you to read all of the information on this page as it pertains to alcohol treatment and substance abuse treatment.
While drug addiction, and specifically opioid addiction, has made headlines more frequently in the past decade due to rising deaths and addiction rates from opioids, they are by no means a new problem in addiction. Doctors in Civil War battlefields used opioids to treat pain and there are detailed accounts from this time regarding soldiers who came back from war and were addicted (5).
By the turn of the year 1900, the greatest number of people addicted to opioids were women, many of whom had been prescribed opioids to treat menstrual or menopausal issues (5). While opioid addictions continued to rise in the 20th century, doctors, researchers and government officials sought solutions to help reduce the issues.
One of the first known examples of using opioid tapering plans was Dr. Vincent P. Dole, a New York City-based specialist and chair of the city’s Narcotics Committee of the Health Research Council (5). He received a grant to study the feasibility of opioid maintenance therapies that included the concept of tapering opioid dosages instead of trying to have people detox from the medications and experiencing side effects that could later lead to relapse (5). The researchers examined the possibilities of using existing known medications to treat addiction, including morphine, oxycodone, and meperidine (Demerol). However, these were all deemed too short-acting to be effective and this early form of medication assisted treatment passed into the history books.
As a result, researchers turned their focus to methadone (5). This had challenges in the 1960s because technology wasn’t yet available to test how long a drug lasted in a person’s body. Instead, the researchers observed patients to estimate the length of the effects and understand how long — and at what doses — people seemed to experience fewer side effects. The initial research studies informed the beginning of research related to methadone maintenance for opioid addiction (5). This research, which helped lay the groundwork for modern substance abuse treatment, was then transferred to Manhattan General Hospital, in New York City. The officials at this hospital founded a treatment program that maintained patients on methadone doses from 80 to 120 milligrams a day (5). Several years later, in 1970, methadone maintenance would become a public health initiative due to the leadership of Dr. Jerome Jaffe, who was the head of the Special Action Office for Drug Abuse Prevention for the White House (5).
While researchers attempted to develop other forms of medication-assisted treatment, the next innovation in medication assisted treatment did not hit the market until the early 1980s with naltrexone. The FDA approved naltrexone for the use of medication assisted treatment for opioid abuse in 1984 (5). The FDA would go on to approve naltrexone for the treatment of alcohol abuse in 1995.
One of the most supportive research studies related to medication assisted treatment came in 1994, when the California Department of Alcohol and Drug Programs published the results of a study on substance abuse treatment as a whole in the state (5). The study reported that methadone treatment was one of the most cost-effective treatments, saving $3 to $4 for every dollar spent. The study also found that methadone maintenance caused the greatest reduction in heroin use when compared to other approaches to opioid treatments. Further support was gained for methadone maintenance therapy when two major health institutes released papers and statements supporting medication assisted treatments. The first was in 1995, when the Institute of Medicine released a study called the Federal Regulation of Methadone Treatment (5). The second was in 1997, when a National Institutes of Health panel released a report that called for the expansion of available methadone maintenance treatment programs in the United States and asked for an increase in funding for these programs (5).
Further support was gained for methadone maintenance therapy when two major health
institutes released papers and statements supporting medication assisted treatments. The first
was in 1995 when the Institute of Medicine released a study called the Federal Regulation of
Methadone Treatment (5). The second was in 1997 when a National Institutes of Health panel
released a report that called for the expansion of available methadone maintenance treatment
programs in the United States and asked for an increase in funding for these programs (5).
Different approaches exist to both the detox and substance abuse 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, 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. This approach can be especially helpful in cases of heroin abuse.
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:
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:
A person who uses medication for alcoholism 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 that are used to relieve anxiety.
A common misconception about medication assisted treatment is that the process simply substitutes one approach for another (2). Medication assisted treatment has many different goals compared to suffering from substance abuse. Doctors prescribe medications to reduce cravings and minimize withdrawal symptoms whenever possible. These medications can be taken more safely when a person can to 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).
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. This is why psychotherapy and behavioral therapies are vital to helping with overcoming addictions.
According to 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).
While the Trust has found medication assisted treatment is effective in addiction treatment, there are gaps in available treatment programs. For example, an estimated 23 percent of publicly-funded treatment programs offer medication assisted treatment (1). The number is slightly higher for private treatment programs, yet less than half of all programs offer these medications in their programs (1). Some of the most common barriers cited for not offering medication assisted treatments include a lack of or limited insurance coverage or limited availability of medical personnel who could prescribe these medications.
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):
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).
Medication assisted treatment is offered at varying levels at public and private rehabilitation centers across the United States. For a listing of methadone maintenance clinics in the United States, you can visit the site methadone.us. If are interested in a particular rehabilitation facility and medication assisted treatment, contact the counselors at the facility and ask if they offer medication assisted treatments, and what treatments they are licensed to provide.