When people ask me whether MAT is just substituting one drug for another, this is what I tell them: I would gladly trade that medication for the one that killed my son.”
You’ve probably heard of Medication-Assisted Treatment, also known as MAT.
For those who struggle with addiction, MAT is a highly effective tool that can help make recovery possible.
Medication Assisted Treatment is exactly what the name implies: treatment assisted by medications. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines it as:
“the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Research shows that a combination of medication and therapy can successfully treat addiction, and “for some people struggling with addiction, MAT can help sustain recovery.”
While medication helps manage the physical aspects of addiction, such as cravings and withdrawal, it takes a full range of counseling and other support services to help a person understand what they are going through and how to deal with it. It’s not unlike treatment for a person with diabetes: the doctor prescribes insulin, but the patient is provided counseling and behavioral steps to help change their lifestyle. Insulin helps manages the chronic disease of diabetes.
MAT requires supervision by a licensed professional or program, but can also be done on an outpatient basis. Treatment can be on a short-term basis or long-term maintenance.Treatment involves first removing dependence (the need to take drugs to avoid withdrawal), and then controlling addiction (the intense craving for the drug and subsequent compulsive use). Medications intended to assist with treatment work by inserting chemicals that better control what is going on with a substance-dependent person’s opioid receptors.
MAT is also for more than just opioids, it is also used for alcohol and tobacco.
Three medications are currently approved by the FDA to use for MAT: buprenorphine, naltrexone and methadone.
According to the American Society of Addiction Medicine, no matter which medication is prescribed the goal is the same: getting the patient to feel normal, have little to no side effects or withdrawal symptoms, and have controlled cravings for opioids.
Buprenorphine is a partial opioid agonist. That means it binds to and activates opioid receptors in the brain, but with less intensity than full agonists. It can reduce cravings and withdrawal symptoms, but does not produce the level of euphoria found in heroin and prescription pain relievers. Buprenorphine is most commonly prescribed in a clinical setting, It also blocks other narcotics while reducing withdrawal risk; and is available as a daily dissolving tablet, cheek film, or 6-month implant under the skin.
- Suboxone® – Contains both buprenorphine and naloxone. Because it is formulated with naloxone — which reverses opioid overdoses — it also reduces the potential of misuse. If a person were to take more Suboxone than prescribed, they would also receive more Naloxone. (Note: Suboxone can cost less than Vivitrol (see below), and one is less likely to experience sudden withdrawal than with Vivitrol. Some also say it is more effective than Vivitrol.)
- Subutex® – Only contains buprenorphine,and does not contain Naloxone. (Note: It also costs less, and a person is less likely to have sudden withdrawal than with Vivitrol.)
Naltrexone is an opioid antagonist, which means that it blocks the activation of opioid receptors in the brain.. Instead of controlling withdrawal and cravings, it treats opioid use disorder by preventing any opioid drug from producing the “high” or euphoric effect of opioids..
Because Naltrexone prevents any opioids from attaching to the receptors, it is critical that a patient go through medically managed withdrawal so the brain’s receptors are “re-sensitized.” If not, withdrawal will be extra strong. A person must go through withdrawal under their doctor’s care, and must be free of any opioids for at least 7-10 days. Naltrexone causes serious side effects if a person attempts to use opioids while being treated.
- It’s available in pill form and is available in a low cost generic, or under two brands called ReVia® or Depade®. You take the pill every 1 to 3 days.
- Vivitrol® is an extended release version of Naltrexone. It’s available in an injectable form and administered by a physician or other treatment provider once a month. As an opioid antagonist, it fills receptors and controls cravings without being an opioid itself. Just like the oral version of Naloxone, a person must be opioid free for 7 to 10 days or will experience a very severe opioid withdrawal. Price may be a factor – average costs for a monthly injection is $1200 and up.
Methadone – Attaches to the mu receptors without creating the euphoric effects of opioids, and lasts much longer than other opioids. However, methadone is a synthetic opioid which has shown to be addictive and lead to dependence. However, because it dramatically reduces cravings, it reduces relapse rates when used in a clinical setting.
- Methadone – clinic-based opioid agonist that does not block other narcotics while preventing withdrawal while taking it; daily liquid dispensed only in specialty regulated clinics.
How MAT Makes a Difference
Easier and faster access to MAT helped Vermont’s Chittenden County reduce its opioid-related overdose deaths by 50% in 2018. Vermonters with substance use disorder who want MAT no longer have to wait to get started, because the state significantly expanded the number of providers offering it.
The state developed an innovative “Hub and Spoke” model providing quick access to higher or lower levels of care as needed, Nine regional “Hubs” offer daily support for people with complex addictions, plus another 75 local “Spokes” provide ongoing treatment integrated with general healthcare and wellness.
Despite the cost for treatment, a study of Vermont’s program in the journal Substance Abuse Treatment showed that health care costs for Vermonters in MAT were lower than those not receiving MAT.
Other states are making efforts to increase the use of MAT to encourage people with opioid addictions to seek help. In fact, California’s MAT expansion program funds radio and TV ads across the state as well as a website where Californians can now easily locate medication assisted treatment.
DISCLAIMER: This information is provided for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Content was based on information provided by SAMHSA, National Institute of Drug Abuse, American Society of Addiction Medicine, and the Surgeon General’s Office.