Medically Assisted Treatment for Addiction
As the cost of opioid epidemic hits $1 trillion, it’s crucial that we have serious conversations about addiction treatment. Medically Assisted Treatment (MAT) is an option that many doctors and rehabilitation facilities are using, but it comes with some controversy.
Many people, including the Secretary of Health and Human Services Tom Price, seem to believe that MAT is no better than “trading one opioid for another.”
But is that truly the case? Let’s explore.
What is Medically Assisted Treatment for Addiction (MAT)?
In order to understand MAT, we must first understand how opioids work in the brain. Opioids cross the blood brain barrier and attach to the brain’s opioid receptors to block pain. The brain naturally produces some opioids, and that’s why we have opioid receptors in the first place. But we never produce enough to block all pin, and that’s why doctors prescribe opioid pain relievers – to artificially boost our natural pain relief system. Unfortunately, the flood of opioids often leads to physiological dependence.
There are two commonly-used types of drugs in MAT.
Opioid agonists – Doctors may prescribe slow-release opiates that activate the same brain regions as opioid painkillers or heroin. The opiates are released slowly into the patient’s system in an effort to stave off physical withdrawal symptoms, but they aren’t given enough to provide any sort of high.
Opioid antagonists – These are non-opioid drugs that attach to opioid receptors. Their purpose is to block the opioids from attaching, so they won’t have any effect. This treatment can be risky, though. For example, if a person on an opioid antagonist relapses, they may be more likely to overdose. The opioid antagonists help to quickly reset a person’s tolerance to opioids, so if they take anywhere near the doses they were previously taking, it can easily lead to overdose.
Within these two groups, there are three commonly-prescribed medications:
- Methadone – This is an opioid agonist that prevents physical withdrawal symptoms but does not block other narcotics. Patients must get methadone from a methadone clinic. At such a clinic, patients receive methadone in a pill or water form as a type of replacement therapy to block the effects of opiates, including morphine, oxycodone, codeine and heroin. There are both public and private methadone clinics in the United States, but they are all strictly regulated by state and federal laws.
- Naltrexone – This non-addictive opioid antagonist blocks the effects of all narcotics. Naltrexone can also be used to treat alcoholism. Patients can get naltrexone from their doctor’s office in a daily pill or monthly injection, but they must be sober for at least 7 days before starting this drug. Doctors will perform a urine test or a naloxone challenge test to check for recent opiate use.
- Buprenorphine – This medication was approved by the FDA for use in 2002 and is unique because it works as an agonist and antagonist. Buprenorphine was the first MAT medication that was approved for use at home by prescription, which helps increase access. This medication blocks all narcotics while reducing withdrawal risk. Patients can get buprenorphine from a doctor’s office as a daily dissolving tablet, cheek film or 6-month implant that goes under the skin.
Benefits of MAT
Even though it can seem counter-intuitive, MAT does have benefits for people in recovery, and it helps many people overcome drug abuse.
MAT produces the following benefits for patients in recovery:
- Reduced withdrawal symptoms – When MAT provides a slow-release opiate to the patient’s system, it can reduce physiological symptoms of withdrawal.
- Reduced cravings – With a slow flow of opiates, patients experience reduced cravings on MAT.
- Improved treatment outcomes – An easier withdrawal and reduced cravings make it easier for patients to remain abstinent from drugs and alcohol, especially in the early stages of recovery when it is most difficult.
When MAT works, we all benefit. Fewer overdose deaths and emergency room visits will lessen the impact of the current opioid epidemic on society.
Medically Assisted Treatment comes with some controversy, but it works for many patients. Still, like any addiction treatment, what works for some may not work for others. When treating patients who suffer from addiction, MAT is a good first-line of defense, but patients should be closely monitored to determine whether treatment is working.