Medication-Assisted Treatment (MAT) for Opioid Dependence
Using Medication to Help Treat Opioid Addiction
Medication-assisted treatment (MAT) helps manage withdrawal symptoms and reduce cravings in people who have been addicted to opioids.
This article will discuss the use of MAT to help people with opioid use disorders, including what MAT is, how long it lasts and how much it costs.
What Is Medication-Assisted Treatment?
MAT combines the use of medications and behavioral therapy to treat people who have substance use disorders.11 The use of certain types of medications has become a central part of the treatment of opioid use disorders (e.g., heroin, Vicodin, OxyContin, etc.), tobacco use disorders, and alcohol use disorders.1
Medications are also used in the treatment of cocaine use disorders, benzodiazepine use disorders, and other types of substance use disorders.
MAT is one of many options for treating opioid use disorders. No single option is appropriate for everyone. MAT is an adjunctive treatment or assistive therapy to the overall treatment of a person with a substance use disorder. MAT will not “cure” the person’s addiction or ensure success in recovery unless the person additionally engages in behavioral treatments such as counseling, therapy, social support and long-term aftercare.
How Does MAT Help With Opioid Addiction?
People who have been abusing opioid drugs and abruptly stop will experience withdrawal symptoms. The symptoms are so unpleasant that many people start taking the drugs again. People in the midst of an opioid withdrawal syndrome will also experience extreme cravings to take their drug of choice.
MAT works to:2
- Reduce uncomfortable withdrawal symptoms using an opioid replacement medication. The medications help to lower the risk of relapse during the early stages of recovery.
- Address cravings for the drug in the early stages of recovery.
- Facilitate a slow, controlled taper of the drug so that the person can adjust to living without opioids.
- Provide medical supervision of the early stages of the person’s recovery. Supervision can be extremely helpful in addressing triggers and potentially stressful situations that can increase the probability of relapse.
How Long Does It Last?
MAT often addresses the acute withdrawal process. However, its length can vary. In some cases, MAT can be indefinite if the person has serious issues with relapse.
Most of the intense withdrawal symptoms from opioid medications resolve within a few weeks, after which the supervising physician can initiate a tapered dosing schedule for the medication. The decision to initiate a taper—with an MAT end-point in sight—is based on the person’s particular circumstances, the physician’s judgment, and the input of the treatment team.
How Much Does It Cost?
The cost of MAT varies depending on the medication being used, but generally, it is expensive (approximately $500 per month including physician visits).3
Several medications are used in medication-assisted treatment for opioid use disorders.4 The most common medications are listed below.
Buprenorphine is a partial opioid agonist, which means that it occupies the same receptors in the brain that opioid drugs target. Buprenorphine produces similar but less pronounced opioid effects while preventing withdrawal symptoms. When taken as prescribed, users will not get the same “high” or the other effects of the drug they abused.
Buprenorphine can help people recover from opioid use and avoid withdrawal. As an opioid, it does have mildly addictive properties. However, the goal of buprenorphine treatment is not to exchange one addiction for another. The user is first stabilized with a substance, then the dose is gradually tapered.
Naltrexone is an opioid antagonist, which means that it locks onto the opioid receptors in the brain and keeps other drugs from attaching to those receptors.
It does not produce any of the effects that other opioid drugs produce. It also blocks the “high” that users normally experience when they use opioid drugs. This effect helps to discourage further drug use and minimize relapse risk.
Suboxone contains both buprenorphine and naloxone, an opioid antagonist. The combination of both drugs helps to assist with the detoxification of opioids and has a built-in mechanism designed to make it less prone to being abused.
Methadone is a relatively long-acting opioid drug that is used in MAT because it is able to stabilize an opioid dependent person without the overwhelming highs and crashing lows that heroin and other opioids produce. Like any opioid drug, it does have the potential for addiction. Similar to buprenorphine, however, methadone isn’t meant to replace an addiction. Instead, methadone therapy introduces a safer, controlled dose of opioid medication that will eventually be tapered off over a period of time.
People can get involved in MAT through any physician who specializes in addiction treatment (including psychiatrists) or at an addiction treatment center that uses MAT techniques. A physician must supervise MAT, and the medications require a prescription. 1, 3
The typical MAT treatment process is outlined below. 5
- Physician consultation. The process begins with contacting a physician who is qualified to administer MAT or by otherwise consulting with an a therapist or addiction treatment team to make the appropriate physician referral.
- Determining suitability. The physician evaluates the person and determines his or her suitability for MAT. During this process, the person will receive a complete physical, education about the MAT procedure and a consent to treatment form.
- Prescribing medication. If the physician determines that the person is a good fit for MAT, he or she will prescribe the appropriate medication once the person begins to experience mild withdrawal symptoms. The person should avoid any opioid medications during this stage.
- Stabilization/maintenance of medication.The treatment process typically includes 3 to 4 phases:
- An induction phase to establish the dose of the medication.
- A stabilization phase where the minimal dose required to avoid withdrawal symptoms is established, the person continues to use the medication (which can be adjusted depending on symptoms) and the person refrains from opioid use.
- A maintenance or withdrawal phase from the medication, which can take place in 2 separate phases or 1 complete phase.
Individual Differences With MAT
A person’s experience with the treatment process can vary based on:
- Medical history and substance abuse history.
- Complicating factors, such as court-ordered treatment.
- The specific opiate or opioid drug being abused.
- The physician administering the treatment.
Typically, people with extensive histories of relapse and recovery will spend longer periods of time in each of the phases. In some cases, the maintenance phase may last indefinitely. 2, 5 More serious drugs of abuse—such as heroin, Vicodin, and OxyContin—will require more attention than drugs such as codeine or tramadol, which tend to have less severe physical withdrawal symptoms. Because relapse is very common in all forms of substance use disorders, people who relapse at one stage of the process are encouraged to start over. For many people with substance use disorders, relapse is a learning experience that can be built upon to achieve success, as opposed to being viewed as a failure or an inability to recover from their substance use disorder.2, 5
MAT should also incorporate behavioral treatment that includes:
- An assessment of the person’s psychosocial needs.
- Individual or group counseling (or both).
- Inclusion of family support.
- Referrals to services in the community.10
Therapies that may particular helpful for people in MAT include:
Benefits of Medication-Assisted Treatment
MAT offers several benefits to a person who wants to quit using opioids.2, 5
- MAT leads to a smoother transition to a drug-free lifestyle in the early stages of recovery.
- MAT can minimize withdrawal symptoms. These symptoms are associated with higher relapse rates.
- MAT can help control cravings, which are also associated with relapse.
- The treatment program and treatment team can include multiple areas of expertise and input into the treatment process.
- MAT focuses on developing skills for long-term recovery as opposed to focusing on withdrawal and detox symptoms.
- The person in MAT has a lower potential for relapse-related illnesses, legal issues, relationship issues and other social issues.
- MAT has solid empirical evidence that supports its use.1, 2, 5
MAT, particularly with opioid agonist medications, has been shown to: 10
- Reduce morbidity and mortality.
- Reduce deaths from overdose.
- Reduce infectious disease transmissions.
- Reduce criminal activity.
- Help keep people in treatment.
- Improve social functioning.
Precautions About Using Medication for Opioid Addiction
While MAT has several advantages, it also has some potential drawbacks.5
- The medications used in MAT can produce unpleasant side effects.
- Some of the medications used in MAT are potentially addictive themselves. Eventually, the user will have to taper down the dosage of these to become totally drug-free.
- If a person in MAT relapses, his or her tolerance level to the original drug of abuse is often lowered. If the person uses the original drug, his or her risk of overdose is increased.
- MAT is not a stand-alone treatment approach. In order to ensure recovery, the person must address the root causes of the substance use disorder. This can only be accomplished by engaging in a comprehensive substance use disorder recovery program that includes counseling/therapy, social support and long-term aftercare treatment planning.
Controversy Over Medication-Assisted Treatment
There is controversy over the use of drugs to assist users in recovering from addiction. Some of the arguments against MAT are listed below. 2, 5
- Replacing one addiction with another is not actually treating an addiction.
- Many of the medications used in MAT are addictive drugs themselves. For instance, methadone has high potential for addiction, and methadone and other MAT medications can be diverted and misused.
- Some opponents argue that society and the medical profession are in effect endorsing long-term addiction by placing people on MAT medications indefinitely.
- People in MAT can still relapse.
Other Types of Medication-Assisted Treatment
MAT is commonly used for opioid use disorders. But several medications are used to help treat other substance use disorders.
- Antabuse is used to treat chronic alcoholism. 6
- Naltrexone is also used to treat alcohol use disorders.
- Wellbutrin, an antidepressant, has been used to treat nicotine addiction.8
- A number of medications such a topiramate (Topamax), an anti-seizure medication, are being investigated as potential treatments for cocaine use disorder.9
- Other drugs such as antidepressants, anti-anxiety medications, and analgesic medications can be used to deal with specific symptoms from discontinuing a drug or symptoms of more chronic psychological disorders.
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- Center for Substance Abuse Treatment. (2005). Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville, MD: US Department of Health and Human Services.
- Doweiko, H. (2011). Concepts of Chemical Dependency. Stamford, CT: Nelson Education.
- Sullivan, L. E., Fiellin, D. A. (2008). Office-Based Buprenorphine for Patients with Opioid Dependence. Ann Intern Med, 148(9), 662-670.
- American Society of Addiction Medicine. (2015). The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.
- Wikler, A. (2013). Opioid dependence: Mechanisms and treatment. New York: Springer Science & Business Media.
- Ellis, P. M., Dronsfield, A. T. (2013). Antabuse’s diamond anniversary: Still sparkling on? Drug Alcohol Rev, 32(4), 342-344.
- Garbutt, J.C., Greenblatt, A.M., West, S.L., Morgan, L.C., Kampov-Polevoy, A., Jordan, H. S., Bobashev, G. V. (2014). Clinical and biological moderators of response to naltrexone in alcohol dependence: a systematic review of the evidence. Addiction, 109(8), 1274-1284.
- Hughes, J. R., Stead, L. F., Lancaster, T. (2014). Antidepressants for smoking cessation. Cochrane Database Syst Rev, 1.
- Johnson, B.A., Ait-Daoud, N., Wang, X.Q., Penberthy, J.K., Javors, M.A., Seneviratne, C., Liu, L. (2013). Topiramate for the treatment of cocaine addiction: A randomized clinical trial. JAMA Psychiatry, 70(12), 1338-1346.
- Substance Abuse and Mental Health Services Administration. (2016). Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. SAMHSA Advisory 15(1).
- Substance Abuse and Mental Health Services Administration. (2019). Medication-Assisted Treatment.