What is Medication-Assisted Treatment (MAT)?

Drugs of abuse cause long-term changes in brain chemistry, and addiction is rooted in the development of a very real physical dependence on a drug. Addictive drugs essentially rewire the brain to believe that the drugs are as important for continued survival as food or water. Just like we will compulsively seek water when we’re thirsty, people with addictions compulsively seek out their drug of choice. Addiction is not a choice or a lack of willpower, but the consequence of physical brain changes that drive further drug use.

Medication-assisted treatment (MAT) is based on the theory that addictive drugs can be replaced with drugs that are chemically similar to addictive drugs but that do not produce the addiction-reinforcing “highs” associated with drugs of abuse. MAT drugs essentially trick the brain into believing that the drug it is dependent on is present, but without the highs and lows that are associated with substance abuse. The legality of MAT has been highly contentious among regulators and policymakers despite consistent support from healthcare providers, who continue to struggle with onerous federal restrictions that limit their ability to provide care to their patients.

The 2018 “Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities” (SUPPORT) Act gave healthcare providers increased flexibility to prescribe MAT, although numerous restrictions still exist. For example, MAT providers are limited to 100 patients in their first year and, if they meet several criteria, can provide care to a maximum of 275 patients after one year. With only 2.2% of physicians approved to provide MAT, very few patients have access to it. Furthermore, MAT costs over $100 per week, which makes it an impossibility for many people. These barriers to treatment hinder recovery in an estimated 80% of people with opioid use disorders.

When is Medication-Assisted Treatment Recommended?

People who seek professional rehab may be candidates for MAT. Initial evaluations (e.g. screening, Brief Intervention and Referral to Treatment (SBIRT)) identify problematic drug use and can guide early intervention strategies.

Importantly, only treatment programs that are certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) are able to provide MAT treatment.

Currently, FDA-approved MAT is restricted to opioid and alcohol use disorders. In spite of mounting evidence that MAT is effective for methamphetamine use disorders, the FDA has not yet approved it as a treatment option.

Benefits of Medication-Assisted Treatment

The most significant benefit to MAT is the ability to quit using opioids that reinforce addiction. For some people, long term MAT is the only way they can transition from struggling with a debilitating substance use disorder to a healthy, productive lifestyle. Numerous studies have demonstrated that MAT drugs are safe and highly effective.

Key benefits of MAT include:

• Improved health and wellbeing
• Increased treatment retention and long-term abstinence
• Reduced risk for transmission of infectious disease
• Reduced risk for legal consequences of illegal drug use

Effectiveness of MAT

One recent study found that MAT reduced opioid-related overdose deaths by 82%. Another study found that 93% of people who did not receive MAT relapsed within the first weeks after quitting, compared to 49% of people who were given MAT. This study also found that people who were given MAT were significantly more likely to be abstinent from opioid abuse 3.5 years after beginning treatment than those who were not.

The conclusion among medical professionals is that MAT is by far the most effective treatment option for people with opioid use disorders. While there is less data on the effectiveness of MAT for alcohol use disorders, current evidence also strongly supports its effectiveness, and SAMHSA recently published a comprehensive overview of MAT prescribing for alcohol use disorders and stated that, “medications are underused in the treatment of alcohol use disorder.”

The MAT Debate

While the medical and professional rehab communities have shown overwhelming support for MAT, there are some people who are against its use. They argue that MAT simply substitutes one addictive drug for another, which highlights a lack of understanding of the neurobiology of addiction and the effects of MAT drugs in the brain.

The reality is that addictive drugs cause significant changes in the brain, and these changes are associated with persistent addictive behaviors. When people with a substance use disorder try to cut back or stop taking the drug they are dependent on, they experience debilitating withdrawal symptoms that are strongly associated with relapse and serious negative health and social consequences. MAT drugs relieve physical and psychological withdrawal symptoms without causing the self-reinforcing highs that are associated with drugs of abuse. Thus, rather than trading one addiction for another, MAT gives people a real chance at pursuing a healthy, productive lifestyle.

MAT for Opioid Use Disorder

In recent years, the opioid crisis has inflicted tragic losses across America, and no demographic has been spared. Between 1999 and 2017, more than 700,000 drug-related overdose deaths occurred, and nearly 68% of those deaths were attributed to a prescription or illegal opioid.

Opioid Treatment Programs

Opioid treatment programs (OTPs) are comprehensive recovery programs that provide MAT in conjunction with counseling, evidence-based therapies like cognitive behavioral therapy, vocational rehabilitation and education. OTPs must undergo a rigorous accreditation process in order to provide patient care.

Opioid Addiction Medications

There are three FDA-approved options for MAT in opioid use disorders:

• Methadone: Methadone (brand names include Dolophine and Methadose) was the first FDA-approved MAT drug, and it is highly effective at controlling cravings and reducing withdrawal symptoms. Although methadone activates opioid receptors, it does not cause euphoria or reinforce addiction when it is taken as prescribed. However, there is some risk for abuse when taken at high doses
• Buprenorphine: Buprenorphine (brand names include Subutex and Buprenex) is a partial opioid agonist, meaning that it partially activates opioid receptors. In addition, buprenorphine has a “ceiling effect,” so larger doses don’t increase its effects. Consequently, buprenorphine has a lower risk for abuse than methadone. Buprenorphine is often provided in combination with the opioid inhibitor naloxone (brand name Suboxone), which further reduces the risk for abuse
• Naltrexone: Unlike methadone and buprenorphine, naltrexone (brand names include Vivitrol and Revia) completely blocks opioids signaling in the brain. Naltrexone can actually increase opioid withdrawal symptoms in the first days of recovery, because any residual opioids in the body cannot activate receptors. Thus, naltrexone is recommended for people who have abstained from opioid use for at least seven days and who are highly motivated to maintain abstinence. Naltrexone is not associated with a risk for abuse

Importantly, MAT drugs are intended to be used for a minimum of three months, and many addiction specialists suggest a minimum of 12 months for maximum benefits.

MAT for Alcohol Abuse

Alcohol use disorders are a significant problem in America, with 14.4 million adults meeting criteria for alcohol use disorders. In addition, alcohol is associated with 88,000 preventable deaths every year. MAT for alcohol use disorders is effective at helping motivated people overcome their addictions.

Medications for Alcoholism

There are currently three FDA-approved medications for treatment of alcohol use disorders:

• Disulfiram: Disulfiram (brand name Antabuse) was the first FDA-approved MAT drug for alcohol use disorders, and is very effective at preventing alcohol use when it is taken as directed. Disulfiram prevents normal alcohol metabolism, so when someone has even one drink they experience an acute physical reaction that includes vomiting, headache and increased heart rate. Disulfiram does not reduce cravings; rather, it aims to prevent people from drinking.
• Naltrexone: Naltrexone blocks opioid signaling in the brain, so it limits the addiction-reinforcing properties of alcohol and reduces cravings. Naltrexone is often provided as an extended-release injectable formulation to improve its efficacy.
• Acamprosate: Acamprosate normalizes signaling pathways in the brain that are dysregulated by alcohol use and reduces cravings, but how it works is not yet clear. Acamprosate is particularly useful for people with liver disease, since it is metabolized in the kidneys.

What to Expect with MAT and Rehab

People who enter rehab with an opioid or alcohol use disorder will first undergo screening tests to evaluate the degree of dependence/addiction and help determine the most appropriate recovery plan. In many cases, people who are candidates for MAT will undergo a period of medically supervised detox before MAT begins. Medical detox gives the body time to clear all traces of the drug out of the body.

After medical detox, many people will transition to a residential rehab program for continued care during early recovery, which is when MAT will begin. Others may elect to participate in an outpatient program that provides support but allows more flexibility for clients to carry out their normal daily activities. Importantly, people who are at high risk for relapse should participate in a residential program before moving to an outpatient program.

MAT is a long-term strategy to manage symptoms of addiction and withdrawal, and most people should expect to stay on MAT drugs for at least one year. While some people use MAT as a stepping stone to complete sobriety, other people choose to participate in MAT programs for the rest of their lives.

MAT at The Recovery Village Cherry Hill at Cooper

The Recovery Village Cherry Hill at Cooper is an accredited MAT provider. Our experts understand addiction and recovery and are equipped to help clients manage every facet of recovery, including physical and psychological withdrawal symptoms. We offer medical detox, residential and outpatient rehab programs and aftercare programs.

Other Questions About Medication-Assisted Treatment

Some common questions about MAT are addressed here.

Can MAT be used if you’re pregnant?

Yes. Methadone, buprenorphine and buprenorphine/naloxone are safe for pregnant women and have reduced the risk for delivering a baby who is suffering from neonatal abstinence syndrome, which occurs when babies are born with opioid dependence. In addition, the buprenorphine/naloxone combination has been shown to be safe for breastfeeding mothers.

Does MAT substitute one addiction for another?

No. MAT drugs help people manage physical and psychological withdrawal symptoms without reinforcing opioid addiction. For many people, MAT is the only way they can successfully abstain from opioid abuse.

Is there MAT for smoking?

Yes. FDA-approved MAT for tobacco use disorders include nicotine replacement therapy, varenicline and the bupropion.

How long does medication-assisted treatment last?

FDA guidelines recommend a minimum of 3 months for MAT treatment, although evidence suggests that a minimum of 12 months is required for maximum effectiveness. Some people maintain MAT for the rest of their lives with no adverse health consequences.

Does insurance cover MAT?

In many cases, insurance (including Medicaid) will cover MAT. In addition, the American Academy of Family Physicians (AAFP) recently penned an open letter to The Centers for Medicare & Medicaid Services stating that, “The AAFP calls on HHS to require comprehensive coverage of MAT and counseling, as recommended by the FDA, in all public and private health insurance plans.”

Is MAT an evidence-based practice?

Yes. Overwhelming evidence supports the use of MAT in opioid and alcohol use disorders, and preliminary data suggests that MAT will be equally helpful in treating methamphetamine use disorder, although there are no FDA-approved MAT drugs for methamphetamine.