Many individuals are suffering from substance use disorder. For substance abuse treatment to be effective, it must be specific to individual needs and tailored to each person’s unique struggle with addiction. There are times when the use of various medications greatly helps those battling addiction in their quest for recovery.
What is MAT?
Medication-assisted treatment (MAT) is when medications are used alongside therapies and counseling to help patients recover from addiction. It includes various medications to help reduce debilitating withdrawal symptoms, ward off cravings, and to tamp down temptations. Stabilizing body and brain functions can increase the likelihood of retention and engagement in treatment and recovery for many. Nevertheless, the goal must always be for the client to reach independence from all mind-altering substances. It is important to seek guidance from addiction treatment professionals and physicians when deciding the proper course of action for each individual client. Medication, when used appropriately as an aid to counseling, behavioral therapies, and self-discovery, can be very valuable in driving lasting positive outcomes.
Understanding Medication-Assisted Treatment (MAT)
In recent years, the concept of addiction as a disease rather than a moral failing has become fully accepted across the field of addiction treatment establishments. With that realization, the option of MAT has become much more integrated within mainstream treatment philosophy.
It must always be remembered that as of now, we have no cure for addiction. Recovery requires an understanding of what drives the addiction in each individual, and a well-constructed management plan. Because of this, medication by itself is rarely enough to fully resolve addiction. However, when used as a supplement and aid to evidence-based treatment modalities, and is carefully administered by medical and addiction professionals, it can provide great benefits and help with reaching recovery.
Requirements for MAT Candidacy
- Diagnosis of Opioid Use Disorder (OUD) or Alcohol Use Disorder (AUD)
- The patient is willing and able to comply with the prescription instructions.
- The patient is free of any health problems that would cause conflict with medications.
Medication-Assisted Treatment for Opioid Use Disorder
There are a number of FDA-approved options for medication-assisted treatment. Correctly choosing which one works best for a particular user requires careful consideration and the guidance of doctors and professionals trained in the recovery field. The following provides a broad overview about popular MAT treatment options.
MAT Drugs Chart
| Type of MAT Drug | How it Works |
|---|---|
| Buprenorphine (Also known as Suboxone®, Buprenex® Sublocade®, Subutex®, and Butrans®) | Buprenorphine is partially an agonist and partially an antagonist. This means that in its role as an antagonist, it blocks opioids from brain receptors. While on this medication, an addictive opioid such as heroin will not produce the usual effects on the addicted individual, thereby discouraging use. Furthermore, because it also has the properties of agonists, it will provide feelings of normalcy and even levels of euphoria associated with illegal drugs, thus reducing the withdrawal symptoms common in people beginning to practice abstinence. |
Methadone (Also known as Dolophine®, DISKETS®, and Methadose®) |
Unlike some forms of buprenorphine, methadone is a full opioid agonist. It activates the opioid receptors in the brain and brings about a sense of euphoria common in all opioids. Effectively, it is a substitute for other more dangerous substances, such as fentanyl and heroin. Its effectiveness is due to its stability and length of onset. Although it latches on to opioid receptors like other opioids, it acts much slower, widening the gap between required doses. Its half-life is between 24 and 36 hours, fending off withdrawal for detox patients. |
| Naltrexone (Also known as Vivitrol®, Depade®, and Revia®) | Naltrexone is an opioid antagonist and does not create highs or euphoria. It is used as a longer-term option to ward off cravings while in recovery. It is the only approved medication for drug and alcohol dependence that is not a controlled substance. |
Medication-Assisted Treatment for Alcohol Addiction
As well as a medicated treatment for opioid addiction, there have been developments in the region of medicine to treat alcohol withdrawal. Two medicines have been found to be a good option for alcoholics who do not wish to enroll in an inpatient treatment program. These drugs are called acamprosate and naltrexone, already widely used by people who are dealing with addictions to alcohol and other substances.
Naltrexone is a helpful medicine for alcohol cravings – it reduces urges to drink and helps people to cut back on very heavy drinking, while other medications show better results in helping alcoholics who haven’t been drinking for a while to continue to stay sober and prevent relapse.
Advantages and Disadvantages of Using MAT in Recovery
Medication-assisted treatment has pros and cons. While some argue that MAT is substituting one drug for another, not all medications used for treatment have addictive qualities. Even in the event where there is potential for addiction, many doctors still believe that MAT treatment is replacing a dangerous, life-threatening drug with a drug that allows a person to function.
There are many benefits of medication-assisted treatment. MAT drugs allow a person to start rehabilitating their life. They can work and redevelop relationships. MAT may not be as effective to the same extent for everyone. The life someone has been leading until then, their degree of severity and other factors can play a role in efficacy.
The medication-assisted treatment definition implies that medicine is used to help the process of sobriety success. It is specific to what substance you’re addicted to and what your motivation level is.
To be effective, it must always be used alongside counseling and behavioral therapies. It is not something that can stand alone as a solitary treatment.
Additionally, some MATs are not addictive and come with high benefits. There are also times when medication-assisted treatment has shown to be more effective when certain processes are used.
What is Abstinence-Based Treatment?
Abstinence-based treatment is focused on achieving sustained recovery without the use of any medication to treat withdrawal and addictive symptoms. Working in therapy, a client will overcome any ambivalence about terminating substance use and achieve the level of motivation required to succesfully overcome their addiction. Proper clinical work develops more productive ways of thinking and behaving, and achieves the self-awareness necessary to overcome struggles and maintain positive lifestyle changes. The abstinence-based treatment model is also referred to as the Minnesota model, which insists on clients completely stopping any use of mind-altering substances.
Insurance Coverage for MAT Treatment
Medically assisted treatment is similar to any other aspect of substance use disorder treatment. Insurance companies are obligated to cover treatment when a doctor certifies that the course of treatment is needed. Medicaid and Medicare cover MAT too.
More on MAT Drugs
When and How is Buprenorphine Taken?
Subutex is taken in the form of a tablet. It is administered sublingually, meaning it is placed under the tongue and dissolved. When chewed or swallowed, it is ineffective. Like Subutex, Suboxone is taken primarily sublingually.
Sublocade is an extended-release form of buprenorphine injected into the belly once a month. Generally, a patient will not be prescribed Sublocade until he or she has used Subutex for at least seven days. Doses of buprenorphine generally start at 4 mg daily. It can be adjusted by physicians to a maximum of 32 mg, depending on individual response to the treatment.
Can Buprenorphine Cause Dependence and Addiction?
Subutex and Sublocade can cause severe withdrawal symptoms if used while under the influence of other opioids. A doctor will therefore only prescribe Subutex once the drugs have completely left the body. Therefore, it should only begin once drug or alcohol withdrawal symptoms have appeared. Each drug varies in how it cycles through the system. Subutex should be administered accordingly.
Although it can create physical dependence, its combined properties greatly lessen risk and reduce withdrawal symptoms. Buprenorphine is not prone to causing overdose because of its limited status as an opioid agonist.
How Long Should People Take Buprenorphine For?
Any decision regarding discontinuation of the drug should only be made while viewing and considering the entire treatment plan designed for the individual patient, together with the input of doctors and treatment counselors. There is a potential for relapse, and the client’s stability and progress in recovery until then is a significant factor in making that decision.
Do I Need a Prescription to Get Buprenorphine?
Yes, Buprenorphine is a regulated substance and a prescription from your doctor is necessary. Pharmacies and physicians need to acquire a waiver to dispense and administer Buprenorphine.
Buprenorphine Side Effects
Some common side effects of buprenorphine include:
- headache
- stomach pain
- nausea
- vomiting
- constipation
- chills
- increased sweating
- weakness
- back pain
When and How is Methadone Taken?
Most often, Methadone is taken orally. It comes in the form of dissolvable tablets or solutions. It is also found as an intravenous (IV), but can only be administered by a certified healthcare provider in that form.
Where Can Methadone be Administered?
Methadone is strictly regulated as it is a highly addictive substance. With proper supervision it can be effective, but taking it without supervision and oversight by doctors is very dangerous. Methadone Medication Assisted Treatment certification is needed with the Substance Abuse and Mental Health Services Administration (SAMHSA) as well as registration with the DEA. A provider dispensing methadone, popularly known as methadone clinics, is absolutely required for this.
What is a Methadone Clinic?
There are both private and public methadone clinics. Although public clinics are usually cheaper, there can be long waiting lists and other inconveniences, due to government funding limitations. Currently, there are more than 400,000 people in the USA taking methadone at close to 20,000 clinics across the country.
Care should be taken to find a methadone or treatment facility of integrity, with properly qualified medical professionals who have the necessary medication-assisted treatment training.
Can Methadone Create Dependence and Addiction?
Because Methadone is highly addictive and causes dependence, it has been the subject of intense controversy regarding its safety as opiate replacement therapy (ORT). Many studies have been dedicated to the pros and cons of methadone treatment. Some benefits include a reduction of the use of injections, thereby reducing HIV spread. Other studies have shown a significant lowering in the death rate in relation to opioids such as heroin and fentanyl. Criminal activity decreases among methadone users as well. However, the significant risk of overdose and threat of dependence has others suggesting that other forms of MAT are better, like vivitrol and suboxone. Both sides of the debate contain merit. It should only be pursued upon the advice of credible physicians and in the context of an effective treatment plan.
How Long Should People Take Methadone For?
Although the goal of reaching abstinence is strongly recommended, the duration of Methadone Maintenance Programs varies greatly from patient to patient. There are no timelines set in stone, and a primary care physician in conjunction with addiction health professionals should always be consulted.
Methadone Side Effects
Common side effects of methadone include but are not limited to the following:
- Constipation
- Lightheadedness or dizziness
- Sleepiness or drowsiness
- Nausea or vomiting
- Impaired cognition or confusion
- Forgetfulness
- Impaired balance or coordination
When and How is Naltrexone Taken?
Naltrexone is typically injected monthly and works as an extended-release intramuscular injection. In rare cases, where a patient is seen to metabolize the drug quickly, it can be given every 21 days. The oral form, called Naltrexone, needs to be taken daily.
Can Naltrexone Create Dependence and Addiction?
No. As mentioned above, it is not addictive and cannot be abused. It has been shown to significantly lower relapse risks and cravings.
How Long Should Naltrexone Be Taken For?
Naltrexone, like every other MAT drug, is not a cure for addiction or SUD. Taking it independent of clinical treatment will many times lead to relapse. It is important to find a treatment provider who can guide you as to how long naltrexone will be beneficial while concurrently doing the work of addiction recovery. Whether it is short-term or long-term, it should be accompanied by good clinical treatment and oversight. This will allow for sustained recovery.
Can Naltrexone be Taken While Drugs are Still in the System?
It can be dangerous to take Naltrexone while there are opioids in your system. It can cause severe withdrawal symptoms and precipitate sudden opioid withdrawal. Checking into a treatment facility to carefully monitor when it is safe to begin is the most recommended option.
Naltrexone Side Effects
Common side effects of naltrexone include but are not limited to the following:
- Headache
- Nausea
- Diarrhea
- Constipation
- Stomach pain
- Dizziness
- Anxiety
- Nervousness
- Restlessness
- Irritability
- Drowsiness
- Insomnia
- Loss of appetite
- Increased thirst
- Muscle or joint pain
- Weakness
- Pain, bruising, swelling, itching, and infection (at the site of injection)
Additional Medication-Assisted Treatment Resources
- Agency for Healthcare Research and Quality MAT Guide
- SAMHSA Medication Assisted Treatment
- The University of Colorado MAT Toolkit
- LA Public County MAT Booklet
- MAT Guide for Addiction Counselors
- Medication Assisted Treatment Insurance Coverage
MAT Treatment at Avenues Recovery
At Avenues Recovery, an insurance expert will help you understand your policy and even talk to your insurance rep to make sure that everything is taken care of. Financial constraints never has to be an obstacle to getting the addiction treatment you need. Reach out today to talk to us about personalized, effective addiction treatment. Start your journey to recovery today!