CleanSlate Blog

Medication-Assisted Treatment Works. Here’s 4 Reasons Why It’s Rarely Used.

by Tracey Cohen, M.D. | May 31, 2019

We know that medication-assisted treatment (MAT) saves lives. So why is it used by only a fraction of people with opioid use disorder (OUD)?

It’s a question that bedevils experts.

The evidence is clear: outcomes for patients with opioid use disorder (OUD) are vastly improved when they’re on medication-assisted therapy. OUD is a chronic brain disease that changes the structure of the brain. Simply stopping cold turkey is excruciating and mostly unsuccessful.

The three FDA-approved medications normalize brain structure and function, reducing cravings, significantly decreasing risk of relapse, preventing overdoses, and helping to prevent infectious diseases like HIV.

MAT has been effective in every treatment setting where it has been studied. Echoing the position of many other major health bodies, the National Academies of Sciences, Engineering, and Medicine asserts, “To stem the opioid crisis, it is critical for all FDA-approved options to be available for all people with opioid use disorder.”

But as the opioid epidemic rages on, a great majority of people with opioid use disorder (OUD) don’t receive MAT.

Most people receive no treatment of any kind at all.

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The Veterans Administration is Making Progress on the Opioid Battlefield

by Tracey Cohen, M.D. | May 20, 2019

May is National Military Appreciation Month, when Americans are asked to recognize current and former U.S. service members as a symbol of unity. The observation culminates in Memorial Day, when we honor those who died in the pursuit of freedom.

But veterans are suffering on the opioid battlefield at home in far greater numbers than on any battlefield overseas.

According to the U.S. Department of Veterans Affairs, veterans and service members of all ages are disproportionately afflicted with opioid use disorder (OUD). The VA estimates that 68,000 veterans are addicted to opioids, a threefold increase in 15 years. They’re ten times more likely than the general public to abuse opioids and twice as likely to overdose.

Addressing the opioid epidemic as it relates to the active duty and veteran population comes with added complications. This includes the stigma that service members worry about when they seek help within the insular military community.

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MAT Facts: Why is There Any Stigma Against Medication-Assisted Treatment?

by Tracey Cohen, M.D. | Apr 2, 2019

MAT Facts is a special CleanSlate blog series that answers questions, corrects misunderstandings, and combats stigma around addiction and medication-assisted treatment (MAT).

Since it was first developed 50 years ago, medication-assisted treatment (MAT) has become the gold standard for opioid use disorder (OUD). The combination of behavioral therapy and medications to treat OUD has been shown to be the most effective intervention for people with OUD. The longer that people stay in treatment with medication, evidence proves, the better their health and functioning.

MAT decreases cravings and symptoms of withdrawal while preventing patients from getting high; reduces the chance of overdose; is cost-effective and convenient; and allows people to resume their normal functioning so that they’re able to address the full scope of their recovery. That’s why MAT is increasingly recommended by leading healthcare organizations, public policy experts, and community stakeholders across the country.

So why is MAT still stigmatized by some within the addiction treatment field?

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MAT Facts: How Does Methadone Work?

by Tracey Cohen, M.D. | Mar 20, 2019

MAT Facts is a special CleanSlate blog series that answers questions, corrects misunderstandings, and combats stigma around addiction and medication-assisted treatment (MAT).

Medication-assisted treatment involves the use of one of three medications approved by the U.S. Food and Drug Administration (FDA): buprenorphine, naltrexone, or methadone. The oldest of these medications is methadone, a safe and effective treatment which treats withdrawal, controls cravings, and blocks the effects of other opioids.  

Because methadone offers the strongest opioid dosage of the medications, it is highly regulated and only dispensed in licensed opioid treatment programs. Those who choose to pursue this treatment must adhere to strict limitations, such as visiting a clinic every day to receive the medication and following specific guidelines to receive behavioral counseling and support.  

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MAT Facts: How Does Naltrexone Work?

by Tracey Cohen, M.D. | Mar 14, 2019

MAT Facts is a special CleanSlate blog series that answers questions, corrects misunderstandings, and combats stigma around addiction and medication-assisted treatment (MAT).

Amongst the three FDA-approved addiction medications, naltrexone - better known by its brand names, Vivitrol or Revia - is the least utilized.

While Suboxone (buprenorphine) and methadone are more popular, naltrexone helps people suffering from opioid use disorder (OUD) and alcohol use disorder (AUD) through different properties.

One of the unique qualities of naltrexone is that it can be administered once per month as an extended-release injectable (Vivitrol). This is one reason that Vivitrol is often given when a person is released from the prison system or a detox.  It reduces the risk of overdose for a full month to give the person time to get into treatment. 

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MAT Facts: How Does Buprenorphine Work?

by Tracey Cohen, M.D. | Mar 12, 2019

MAT Facts is a special CleanSlate blog series that answers questions, corrects misunderstandings, and combats stigma around addiction and medication-assisted treatment (MAT).

The U.S. Food and Drug Administration (FDA) has approved three treatment medications for addiction: buprenorphine, naltrexone, and methadone. (Naloxone [Narcan] is a rescue medication for overdose, not a treatment for addiction.)

All three medications control cravings for opioids and block the effects of other opioids. Each medication affects patients somewhat differently, based on whether they act as what doctors call opioid agonists or opioid antagonists.

But here’s what they have in common: addiction medications are effective and affordable, and have been shown to cut premature death rates in half.

Let’s take a look at the first of the three medications we’ll review: buprenorphine.

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MAT Facts: What is Medication-Assisted Treatment?

by Tracey Cohen, M.D. | Mar 5, 2019

Across the country, the stigma around medication-assisted treatment (MAT) is slowly subsiding, and many more people who suffer from addiction are accessing medication that can save their lives. A growing chorus of leaders in healthcare, public policy, law enforcement, and other areas of expertise agree that MAT is a critical pillar of care for people suffering from opioid use disorder (OUD).

But misunderstandings remain, and MAT is still vastly underutilized.

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Emergency Rooms are Starting to Treat Addiction Patients Like They Have a Disease. Because They Do.

by Tracey Cohen, M.D. | Feb 8, 2019

For reasons related largely to stigma and lack of understanding about addiction, the mainstream medical industry has long been reluctant to integrate addiction treatment into the traditional healthcare system.

But as the opioid epidemic grinds on, experts and policymakers are recognizing that the old solutions aren’t working. More people are suggesting that medication-assisted treatment (MAT) should play a significant role in how we help people with addiction, and that this treatment should be approached as part of the standard patient-doctor experience.

Some leaders around the country are acknowledging that one of the best times to engage people in addiction treatment is during a visit to the emergency room, especially during withdrawal or after an overdose. Massachusetts, for example, has now enacted legislation to mandate that all ERs in the state treat addiction patients with medication.

If more widely adopted, this shift could help people who suffer from addiction immediately begin medical treatment and stem withdrawals, thus minimizing or avoiding relapses that might find them back in the ER.

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What You Don't Know About a Pill Could Kill You

by Tracey Cohen, M.D. | Jan 24, 2019

Through our work in addiction medicine, the CleanSlate team is on the frontlines of the vast human suffering caused by the opioid epidemic. Some of the most tragic stories we currently encounter involve counterfeit medications.

Last year, at the Healthy Tennessee Opioid Summit, Carrie Luther shared the story of her 29-year-old son, Tosh. After Tosh came down with a case of hives that was keeping him up at night, a friend gave him a Xanax to help him sleep. As instructed, Tosh took one quarter of one pill. Unbeknownst to Tosh or his friend, the Xanax was actually fentanyl. From just a sliver of one pill, Tosh ingested thirteen times the lethal dose of fentanyl and died within 30 minutes from an overdose.

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