Opioid overdoses cause one death every 20 minutes. Medication-assisted treatment (MAT) improves outcomes, even more so when a treatment regimen that consists of a combination of psychosocial therapy MAT. Thus far, it has proven to be the most effective intervention to treat opioid use disorder (OUD). In fact, studies have shown that dual therapy is more effective than either behavioral interventions or medication alone. MAT significantly reduces opioid use when compared with non-drug approaches treatment programs. These same studies show that increased access to these therapies can reduce overdose fatalities. However, MAT is often unavailable to those in need of it, largely because of inadequate funding for treatment programs coupled with a lack of qualified providers. Renaissance Recovery started its MAT program in early 2019, recognizing the successes as shown by studies as there is great evidence to support the notion that medication-assisted treatment improves outcomes.
What is MAT?
MAT pairs non-drug therapies, such as counseling or cognitive behavioral therapy, with an FDA-approved medication to treat OUD. These drugs—methadone, buprenorphine, and naltrexone—are available in various product formulations and doses. Each medication differs in the way it works to relieve symptoms of opioid withdrawal and/or block the euphoric effects of the drugs. Consistent with the approach used for other chronic diseases such as diabetes, treatment plans for OUD are patient-specific and created with input from the patient, the prescriber, and other members of the health care team. This dual approach to OUD treatment is supported by medical and behavioral health groups, including the American Society of Addiction Medicine and the National Council for Behavioral Health, patient advocate groups, and federal entities including the White House Office of National Drug Control Policy and the U.S. surgeon general. Although the science shows that medication-assisted treatment improves outcomes, it must be used in conjunction with traditional behavioral treatment methodologies.
Behavioral health treatment is recommended in conjunction with all drug therapies for OUD. Patients receiving behavioral treatment are shown to have better outcomes than patients who don’t. Common therapeutic goals of behavioral treatment are to:
- Modify underlying behaviors that may lead patients to misuse opioids.
- Encourage patients to adhere to their prescribed medications.
- Treat any other existing psychiatric disorders. Psychosocial treatment begins with an assessment of a patient’s psychosocial needs and the development of a patient-specific treatment plan. Treatment may include one or more of the following:
- Individual or group counseling.
- Connection to family support systems, including family therapy.
- Referrals to community-based services.
- Contingency management—an evidence-based intervention that provides tangible rewards (often vouchers to exchange for retail goods and services) for positive behaviors such as abstaining from opioids.
- Mutual help programs, such as the Narcotics Anonymous 12-step facilitation therapy, may also be offered as an ancillary service.
Collectively, medication-assisted treatment improves outcomes when used in conjunction with traditional treatment methods for opioid abuse.
Methadone, buprenorphine, and naltrexone are the only FDA-approved medications to treat OUD. Under federal regulations for methadone treatment, the drug must be administered daily in a certified opioid treatment program (OTP). In accordance with federal law, buprenorphine may be prescribed on a weekly or monthly basis for at-home use, but clinicians must apply for waivers to be able to prescribe these drugs. In contrast, naltrexone can be prescribed by any clinician authorized to dispense medications. These three treatment options have different mechanisms of action. The drug effects—in addition to patient-specific factors, such as response to past treatment—guide therapy selection.
How OUD Medications Work
Receptors, which are found on human cells, are places where a drug or substance made by the body binds to either cause or block an effect. Methadone and buprenorphine are opioid agonists, meaning they activate or occupy the mu-opioid receptor, the same one activated by heroin. Methadone is a full agonist. By fully occupying the mu-opioid receptor, methadone lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of other opioid drugs. Unlike heroin and other misused opioid agonists, methadone is longer-lasting, usually 24 to 36 hours, preventing the frequent peaks and valleys associated with drug-seeking behavior. No optimal length of treatment with methadone has been established; however, 12 months is considered a minimum for methadone maintenance. Buprenorphine is a partial agonist, meaning it does not completely bind to the mu-opioid receptor. As a result, buprenorphine has a ceiling effect, meaning that its effects will plateau and will not increase even with repeated dosing. Buprenorphine does not produce euphoria and does not have some of the dangerous side effects associated with other opioids. The optimal duration of treatment is unknown, and decisions to discontinue treatment with buprenorphine are patient-specific. Once this decision is made, the process of safely tapering the buprenorphine dose often spans many months. Naltrexone is an opioid antagonist, meaning that it covers, rather than activates, the mu-opioid receptor, effectively blocking the effects of opioids if they are used. Opioid antagonists do not produce any euphoric effects, so no physical dependence is associated with their use. Opioid antagonists are recommended for relapse prevention and for abstinence-based treatment, not for withdrawal management.
Medications used in MAT Programs
Curbing opioid use disorders with MAT
Medication-assisted treatment improves outcomes as evidenced by science. In fact, MAT is now considered to be among the most effective treatment solution for OUD. The individual treatment plan may include multiple types of cognitive therapies, and patients may need to try more than one drug to achieve goals. Improving awareness of how MAT works, ensuring comprehensive coverage of all services, and expanding access to eligible providers will be integral factors in curbing the opioid epidemic.