A Breakthrough in Addiction Treatment
For decades, the primary approach to treating opioid addiction was abstinence-only treatment. While this works for some people, many others struggled with repeated relapses and the devastating consequences that followed. Today, a growing body of research shows that Medication-Assisted Treatment (MAT) offers new hope for people struggling with opioid use disorder.
MAT combines FDA-approved medications with counseling and behavioral therapies to provide a whole-patient approach to treating substance use disorders. The results are promising: studies show that MAT can reduce opioid use, overdose deaths, criminal activity, and infectious disease transmission while improving social functioning and retention in treatment.
What is Medication-Assisted Treatment?
Medication-Assisted Treatment uses medications, in combination with counseling and behavioral therapies, to treat substance use disorders. For opioid use disorder, MAT has been shown to be highly effective and is considered the gold standard of care by medical professionals.
MAT is not replacing one drug with another. The medications used in MAT are prescribed and monitored by healthcare professionals. They work by normalizing brain chemistry, blocking the euphoric effects of opioids, relieving physiological cravings, and normalizing body functions without the negative effects of the abused drug.
FDA-Approved Medications for Opioid Use Disorder
Buprenorphine
Buprenorphine is a partial opioid agonist, which means it activates opioid receptors in the brain but to a much lesser degree than full opioids like heroin or prescription painkillers. This allows it to relieve withdrawal symptoms and cravings without producing the euphoric high of other opioids.
Benefits of buprenorphine include lower risk of overdose compared to full opioid agonists, can be prescribed in an office-based setting, reduces cravings and withdrawal symptoms, allows people to function normally in daily life, and has a ceiling effect that makes it safer than other opioids.
Buprenorphine is available in several forms including Suboxone (buprenorphine combined with naloxone), Subutex (buprenorphine alone), Sublocade (monthly injection), and Zubsolv (sublingual tablet).
Methadone
Methadone is a full opioid agonist that has been used to treat opioid addiction since the 1960s. It is dispensed through specialized opioid treatment programs and requires daily visits to a clinic, at least initially.
Benefits of methadone include proven effectiveness over decades of use, reduces cravings and withdrawal symptoms, allows people to stabilize their lives, and can be used long-term. Methadone must be dispensed through certified opioid treatment programs with strict regulations and monitoring.
Naltrexone
Naltrexone is an opioid antagonist, which means it blocks opioid receptors in the brain. Unlike buprenorphine and methadone, naltrexone does not activate opioid receptors at all. This means it does not relieve cravings or withdrawal symptoms, but it does block the effects of opioids if someone uses them.
Benefits of naltrexone include no potential for misuse or diversion, blocks the euphoric effects of opioids, available as a monthly injection (Vivitrol), and can also be used to treat alcohol use disorder. Naltrexone requires complete detoxification from opioids before starting, typically 7-10 days of abstinence.
How MAT Works
MAT is most effective when it combines medication with counseling and behavioral therapies. This comprehensive approach addresses the physical, psychological, and social aspects of addiction.
The Medication Component
Medications help stabilize brain chemistry, reduce cravings, prevent withdrawal symptoms, and block the effects of opioids. This creates a stable foundation that allows people to engage in therapy and rebuild their lives.
The Counseling Component
Counseling and behavioral therapies help people understand their addiction, develop coping skills, address underlying mental health issues, rebuild relationships, and create a meaningful life in recovery. Common therapeutic approaches include Cognitive Behavioral Therapy, Motivational Interviewing, Contingency Management, and Group Therapy.
The Support Component
Recovery support services help people maintain their recovery long-term. This includes peer support groups, case management, housing assistance, employment support, and family therapy.
Breaking Down Myths About MAT
Myth: MAT is just replacing one addiction with another
Fact: MAT medications are prescribed and monitored by healthcare professionals. They do not produce a euphoric high when taken as prescribed. They allow people to function normally and engage in recovery activities. The goal is to stabilize the person so they can work on their recovery.
Myth: People on MAT are not really in recovery
Fact: Recovery is defined by improved health, wellness, and quality of life. People on MAT often experience significant improvements in all these areas. MAT is recognized as an evidence-based treatment by all major medical organizations. Many people maintain long-term recovery with the help of MAT.
Myth: Everyone should eventually taper off MAT medications
Fact: Some people do successfully taper off MAT medications after a period of stability. However, many people benefit from long-term or even lifelong MAT. This is similar to how people with diabetes may need insulin long-term or people with depression may need antidepressants long-term. The decision about duration should be made individually with healthcare providers.
Myth: MAT is only for people who have failed other treatments
Fact: MAT can be an effective first-line treatment for opioid use disorder. Research shows that starting MAT early can prevent the progression of addiction and its consequences. There is no need to fail at other treatments before trying MAT.
Who Can Benefit from MAT?
MAT can be beneficial for anyone with opioid use disorder, but it may be particularly helpful for people who have tried abstinence-only treatment without success, have severe opioid use disorder, are at high risk for overdose, have co-occurring mental health conditions, need to maintain employment or family responsibilities during treatment, or have medical conditions that make withdrawal dangerous.
What to Expect in MAT
Initial Assessment
Treatment begins with a comprehensive assessment of your substance use, medical history, mental health, and social situation. This helps determine which medication and what level of care is most appropriate.
Induction Phase
This is when you start taking the medication. For buprenorphine, this typically happens when you are in mild to moderate withdrawal. For naltrexone, you must be completely detoxified from opioids first. For methadone, you start at a low dose that is gradually increased.
Stabilization Phase
During this phase, the medication dose is adjusted until you are stable - meaning you have minimal cravings, no withdrawal symptoms, and can function normally in daily life. This phase can take several weeks to months.
Maintenance Phase
Once stable, you continue taking the medication while engaging in counseling and working on your recovery. The length of this phase varies by individual - some people need MAT for months, others for years, and some indefinitely.
Tapering Phase (If Appropriate)
Some people eventually taper off MAT medications, but this should only be done under medical supervision and when the person is stable in all areas of life. Tapering too quickly increases the risk of relapse.
Finding MAT Services
MAT is becoming more widely available, but access can still be challenging in some areas. Here is how to find services:
For Buprenorphine
Many primary care doctors, psychiatrists, and addiction specialists can prescribe buprenorphine in an office-based setting. Use the SAMHSA Buprenorphine Practitioner Locator at SAMHSA.gov to find providers near you. Some telehealth services now offer buprenorphine treatment remotely.
For Methadone
Methadone must be dispensed through certified Opioid Treatment Programs. Use the SAMHSA Opioid Treatment Program Directory at SAMHSA.gov to find programs near you.
For Naltrexone
Many doctors can prescribe naltrexone. Ask your primary care doctor or contact addiction treatment programs in your area.
Insurance and Cost
Most insurance plans, including Medicaid and Medicare, cover MAT services. The Affordable Care Act requires insurance plans to cover substance use disorder treatment. Many states have expanded Medicaid coverage for MAT. Some programs offer sliding scale fees based on income. Patient assistance programs may be available for medications.
The Evidence for MAT
Decades of research support the effectiveness of MAT for opioid use disorder. Studies show that MAT reduces opioid use by 50 percent or more, decreases overdose deaths by 50 percent or more, improves retention in treatment, reduces criminal activity, decreases infectious disease transmission, and improves social functioning and quality of life.
The National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the American Society of Addiction Medicine, and the American Medical Association all recognize MAT as the gold standard for treating opioid use disorder.
MAT and Recovery Support
While medication is an important component of MAT, recovery support services are equally crucial. These services help people address all aspects of their lives affected by addiction.
Peer Support
Connecting with others in recovery provides hope, reduces isolation, offers practical advice, and creates accountability. Many communities have peer support groups specifically for people in MAT.
Case Management
Case managers help coordinate care, connect people with resources, assist with housing and employment, and provide ongoing support.
Family Support
Family therapy and education help repair relationships, improve communication, and create a supportive home environment.
The Future of MAT
Research continues to improve MAT approaches. New developments include longer-acting formulations that require less frequent dosing, new medications in development, expanded access through telehealth, integration of MAT into primary care settings, and reduced stigma and increased acceptance of MAT.
Taking the First Step
If you or someone you love is struggling with opioid addiction, MAT may offer hope. Here is how to get started:
- Talk to your doctor about MAT options
- Contact a local addiction treatment program
- Call the SAMHSA National Helpline at 1-800-662-4357
- Use online resources to find MAT providers
- Reach out to local recovery support organizations
Remember that seeking help is a sign of strength, not weakness. MAT has helped millions of people reclaim their lives from opioid addiction. You deserve the same opportunity for recovery.
Resources
- SAMHSA National Helpline: 1-800-662-4357 (24/7, free, confidential)
- SAMHSA MAT Resources: SAMHSA.gov/medication-assisted-treatment
- Buprenorphine Provider Locator: SAMHSA.gov/medication-assisted-treatment/practitioner-program-data/treatment-practitioner-locator
- Opioid Treatment Program Directory: SAMHSA.gov/medication-assisted-treatment/opioid-treatment-programs
- National Institute on Drug Abuse: DrugAbuse.gov
Conclusion
Medication-Assisted Treatment represents a major advancement in how we treat opioid addiction. By combining medication with counseling and support services, MAT addresses the complex nature of addiction and gives people the best chance at lasting recovery.
If you are struggling with opioid addiction, know that effective treatment is available. MAT could be the key to reclaiming your life, rebuilding relationships, and discovering a future free from the grip of addiction. Take the first step today - reach out for help. Recovery is possible, and you deserve it.