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The Facts About Medication Treatment for Opioid Addiction

by Kelly J. Clark, MD | Mar 6, 2018

MAT  - 240_F_125554661_n3yTlDaUC4PFftnBUT0axKBlAQr2LMxy.jpgAs the opioid epidemic devastates every corner of this country, there’s a reason that medication-assisted treatment (MAT) has been getting more and more attention by the media and policymakers:  

It works.

But misunderstandings around MAT persist. This starts with the term MAT itself, based on the idea that medication is an assistance to other, primary forms of treatment for addiction, such as counseling. The Substance Abuse and Mental Health Services Administration recently clarified this view with a new recommendation stating that patients with opioid use disorder (OUD) should be given access to the three FDA-approved medications: methadone, buprenorphine or naltrexone. SAMHSA, which is part of the U.S. Health and Human Services Department, is clear on this point: “It is not sound medical practice to deny people with OUD access to FDA-approved medications for their illness.”

For this reason, many in the medical addiction field object to the word “assisted” in the term MAT, favoring the term "medication for addiction treatment" instead.

Still, the confusion and judgment around MAT are contributing factors to the extremely low rates of utilization for this kind of medical care.

So first, let’s talk about what MAT is. As defined by SAMHSA, MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.

Perhaps the easiest way to understand MAT is by recognizing what it is not. As laid out by the National Council for Behavioral Health, here are some of the common myths around MAT:

Myth v Fact MAT Infographic

According to SAMHSA, MAT is effective treatment. It is not about trading one addiction for another, and it does not prolong addiction. People in active addiction lose control of their drug use and lose control of their lives. When people are on medication for their opioid addiction, they regain control of their lives.

Addiction is a chronic, relapsing brain disease that requires ongoing management, just like any other disease. The data shows that the old approach to treating opioid addiction without medication is typically ineffective on its own and is often harmful or even deadly.

The risk of overdose climbs when patients do not use medication. In fact, people are at the highest risk of overdose after rehab without the use of medication. Their bodies are no longer tolerant of high doses and a single use even at half of their prior dose can be deadly.   

Detoxification alone is not a treatment. It can be seen as a bridge to ongoing medication management, which is treatment. But relying on detox as the sole solution without ongoing medication management puts patients on a risky path to a possible overdose.

The gold standard of addiction treatment

MAT for opioid addiction isn’t new; in fact, it’s an approach that’s been in place for more than 50 years. The data have shown that the longer people stay in MAT, the better their health and functioning. Today, MAT has become the gold standard for opioid addiction treatment, recommended by the American Society for Addiction Medicine, the World Health Organization, the U.S. Department of Health and Human Services, and many other top health organizations.

Science matters. As a country, we must focus on evidence-based treatment if we are ever to reverse this epidemic. And the science is clear and irrefutable: medication with psycho-social interventions - like supportive interactions with a patient’s prescriber - is the best treatment for opioid use disorders. Proven medications such as buprenorphine (Suboxone, Subutex, Zubsolv, Bunavail, Probuphine) and naltrexone (Vivitrol) reduce cravings to opioids - such as heroin and prescription drugs like Percocet, Vicodin and OxyContin. This saves lives.

Outpatient office-based addiction treatment is convenient, cost effective and typically covered by public and private insurance. Methadone is available through licensed opioid treatment programs throughout the country.

At CleanSlate, a leading national medical group that provides outpatient addiction treatment, and for which I serve as the Chief Medical Officer, patients make a routine appointment to visit one of our centers and are treated quickly and safely. We work with patients to develop individualized treatment plans, usually recommending one of the two proven medications which can be prescribed in an office:

  1. Suboxone (buprenorphine) is a medication that comes in film and tablet form. By taking the place of the opioids used by patients, buprenorphine prevents cravings and makes withdrawal from opioids feel less intense. Patients on buprenorphine report feeling normal, functional and having a clear mind all day long, which allows them to make positive choices the way that they did prior to their addiction. When buprenorphine is combined with counseling and other forms of support, it can be highly effective in helping patients recover from addiction.
  2. Vivitrol (depo-naltrexone) is a monthly injectable medication that is useful for the treatment of opioid addiction and alcohol addiction. Naltrexone has been clinically proven to reduce the probability of relapse. For those suffering from an opioid addiction, naltrexone may be initiated only after opioid detoxification. Naltrexone may also be used by patients who have completely tapered off of buprenorphine (Suboxone, Zubsolv, generics) or methadone to prevent relapse.

Both medications blunt or block the effect of illicit opioids and reduce or eliminate the craving to use opioids.

Of course, no medication can instantly erase all the damage wrought by addiction, especially long-term addiction. But medication saves lives and allows people the opportunity to change their lives for the better.

We see the positive results of MAT on a daily basis. Patients can start feeling like their old selves quickly, sometimes within days. We hear many patients tell us how this new mental clarity gives them the capability to rebuild their lives, especially when combined with counseling or other kinds of support.

Because addiction is a chronic disease, some people may be on medication for long periods of time - and that should be perfectly fine. We don’t expect all patients with diabetes to stop taking insulin, nor do we judge people with high blood pressure. Similarly, all patients suffering from the disease of addiction should not be expected to “graduate” from MAT. According to leading addiction organizations such as Alcoholics Anonymous, Hazelden Betty Ford, and the American Society of Addiction Medicine, taking addiction medications as prescribed is consistent with abstinence.

The more that the facts about MAT are understood, the more success we will have in fighting the battle against the opioid epidemic.

 

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Also read:

The Economic Costs Of The Opioid Epidemic Means We Invest Now Or Pay Later

Pennsylvania's Newly Declared Disaster Emergency Raises Hopes In Hard-Hit Philadelphia

In Massachusetts, Progress With Reducing Overdoses Related To The Opioid Epidemic Has A Catch

Picture of Kelly J. Clark, MD

Kelly J. Clark, MD

Kelly J. Clark, MD, MBA, DFAPA, FASAM, is the Chief Medical Officer of CleanSlate, a leading national medical group that provides office-based outpatient medication treatment for the chronic disease of addiction, primarily alcohol and opioid use disorders. Dr. Clark also serves as President of the American Society of Addiction Medicine.

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