Guide to MAT for Opioid Use Disorder

April 18, 2022

Table of Contents

MAT, Medication-Assisted Treatment or Medication for Addiction Treatment, is the most  successful treatment  for OUD that uses medications to minimize withdrawal symptoms and cravings. By doing so, MAT lowers the risk of opioid use, prevents overdoses, and supports long-term recovery.

According to the National Survey on Drug Use and Health (NSDUH), nearly 3 million Americans had an opioid use disorder (OUD) in 2020.[1] 

MAT includes the use of 2 main medications: Methadone and Suboxone. Suboxone contains 2 medications: Buprenorphine and naloxone. This medication can help to reduce opioid cravings reduce the odds of relapse. 

Suboxone can be prescribed by a certified medical professional and picked up in your local pharmacy, making it accessible and convenient. 

MAT is an effective treatment method for OUD. Contrary to the widespread stigma associated with MAT, it is not replacing one opioid drug for another. Instead, it aims to sustain recovery and lower the risks associated with opioid addiction. 

The National Institute on Drug Abuse (NIDA) calls Medication-Assisted Treatment the gold standard of care that is evidence-based and effective in treating opioid use disorder.[2] Both Buprenorphine and Methadone are classified as essential medications by the World Health Organization (WHO).[3] 

What Is MAT?

MAT (Medication assisted treatment) is the use of medication - namely Methadone or Suboxone -  to treat opioid use disorder. Ideally, it should be combined with other therapies including behavioral therapy for an individual and whole-patient approach. MAT can also be used for a varying length of time and potentially indefinitely, depending on the needs of the individual. 

MAT can be provided in a variety of settings, ranging from inpatient addiction treatment centers to outpatient programs to telemedicine. 

Opioid drugs like heroin and prescription painkillers change the chemistry of the brain and the way pleasure and rewards are processed. With regular use, the brain usually becomes physically dependent on opioid drugs. 

Even when prescription opioid pain relievers are taken as prescribed, the brain and body can become dependent on them. When these drugs process out of the body, difficult withdrawal symptoms make it hard to stop using. 

Physically, withdrawal symptoms are similar to a bad case of the flu: hot flashes, sweats, tremors, shakiness, nausea, vomiting, diarrhea, depression, anxiety, and insomnia are all common side effects

MAT uses medications to balance out brain chemistry that has been altered by opioid use and keep things more even. MAT medications are opioid agonists which means they bind to opioid receptors in the brain to help the brain feel it is still receiving the opioid medications it is used to, helping to prevent withdrawal symptoms. 

These medications can reduce powerful cravings and minimize withdrawal symptoms, but unlike full opioid agonist drugs, they will not cause the same “high” and therefore prevents euphoria and the rewards of opioid misuse as well as the risk for overdose. 

MAT can offer a safe and effective way to detox initially from opioid drugs without hospitalization and also help more long term to prevent relapse and to sustain recovery.

How MAT Is Used in Recovery

Medications are an important part of an opioid addiction treatment program. 

MAT can be used during detox early on in treatment to decrease the side effects of acute withdrawal and alleviate cravings. After acute detox and a level of physical stability is reached, continuing MAT therapy  can help to prevent cravings and maintain abstinence long term. 

In addiction treatment, medications can be used on both a short-term and long-term basis to maintain recovery. MAT should be used in conjunction with counseling and behavioral therapies to teach coping mechanisms, life skills, and tools to manage emotions and actions to prevent relapse.

Medications Used in MAT

There are three FDA-approved medications for the treatment of opioid dependence:[4]

  • Naltrexone
  • Methadone
  • Buprenorphine

Suboxone is a brand-name version of buprenorphine that also contains naloxone.

Naltrexone

Naltrexone is a medication that can be given after detox is complete and opioids are out of the system. Generally, this takes between 7 and 10 days, so this form of MAT cannot be started immediately in treatment. 

Naltrexone is an opioid antagonist, so it actually blocks opioid receptors in the brain. This means that if a patient relapses and takes a pill or uses intravenous drugs, the action of those drugs will be “blocked” so the patient cannot get high While Naltrexone is a good option for patients who do not want or cannot be on opioid agonists like Suboxone and Methadone, the disadvantage is mainly that it does not prevent cravings for the drug in the same way as opioid agonists like methadone or buprenorphine. Naltrexone is therefore ideal for patients who are pretty stable in their recovery and are not currently using, as opposed to Suboxone and Methadone which are more appropriate to use acutely after drug misuse. It  comes in both oral and monthly injectable (Vivitrol”) formulations. 

Methadone

Methadone is a long-acting opioid agonist that must be dispensed at a special clinic in variations like Dolophine tablets or Methadone oral concentrate.[5] It can only be dispensed in a SAMHSA-certified OTP (opioid treatment program). 

Methadone works by activating the same opioid receptors as other opioid agonists. It is itself an opioid, albeit a long acting one that is less likely to cause acute overdose if taken in stable, appropriate doses. Because it is long-acting, it can be taken in lower doses over a longer period to keep cravings and withdrawal symptoms to a minimum without creating the same euphoric high.

Buprenorphine

Buprenorphine products include both single therapy options and combination products, such as Suboxone, which contains both buprenorphine and naloxone.[6,7] 

As a partial opioid agonist, buprenorphine does not create the same “high” as full opioid agonists like heroin and OxyContin. It still activates the same receptors, just to a lesser degree, to reduce cravings and withdrawal symptoms. Because it is only a “partial agonist” of  opioid receptors, it is also much less likely to cause an overdose if taken in excess.

Unlike Methadone which must be dispensed by a methadone facility, Buprenorphine can be dispensed by any doctor who is certified. Most doctors that prescribe buprenorphine are general primary care doctors, addiction specialists, psychiatrists, or pain management specialists. 

Suboxone (Buprenorphine-Naloxone combination) 

Suboxone is a brand-name combination medication that contains buprenorphine and naloxone. It is dispensed in a sublingual film that can be placed under the tongue and dissolved. This formulation of buprenorphine has lower abuse potential: when dissolved under the tongue, only the buprenorphine absorbs into the system. However, if it is misused and injected, the Naloxone also enters the bloodstream, binding to the opioid receptors and preventing an accidental overdose on the Buprenorphine. The Nalone is therefore “built in” to the medication as a protective mechanism to prevent patients from injecting the suboxone to get high.

Efficacy vs. Other Treatment Options

There are several forms of treatment programs for opioid use disorder, including inpatient rehab, outpatient addiction treatment programs, various therapies, and counseling. Treatment programs that include medications like MAT are clinically proven to be effective and help to reduce the need for inpatient detoxification.[8] 

MAT can help people to live more independent lives. It can offer the following benefits:

  • Helps to keep people in treatment programs
  • Improves survival rates
  • Reduces illicit opioid use and criminal activities
  • Lowers risk of contracting an infectious disease, such as hepatitis C or HIV
  • Improves rate of gaining and maintaining employment
  • Better birth outcomes for pregnant women with opioid use disorder

Drug addiction has rates of relapse that are similar to other chronic diseases — between 40% and 60%.[9] The use of MAT as a treatment protocol can help to lower the risk for relapse and sustain recovery. 

MAT for opioid use disorder can help to improve functional abilities and lead to sustained recovery.[10]

Availability of MAT

Medication for Addiction Treatment can be administered by a qualified provider. As of September 2020, there were 85,000 qualified practitioners registered with the DEA (Drug Enforcement Administration).[12] 

These practitioners can prescribe, dispense, and administer controlled substances, such as buprenorphine The number of qualified and registered practitioners continues to rise, making MAT more accessible and available than it was previously.

MAT can be offered in a variety of settings, including addiction treatment centers, rehab facilities, clinics, community health centers, your local doctor’s office, and through trained professionals via telemedicine. 

Buprenorphine (Suboxone) can be prescribed by a qualified provider. It can then be picked up at a local pharmacy without needing to go to a specialized clinic, as is required for Methadone. Because of this increased accessibility, Suboxone is often preferred to Methadone.

How to Find MAT Treatment

MAT is covered by insurance, including Medicaid. Now, state Medicaid programs are including MAT treatment as part of their opioid addiction treatment protocols.[13]

There are several resources for finding an MAT program:

  • Opioid Treatment Program Directory: This directory is hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA). It features a drop-down menu where you can select your state to find local opioid treatment programs including those that offer MAT.[14]
  • Buprenorphine Practitioner Locator: This locator is also operated by SAMHSA. You can select a state on the map, input your zip code or city, or use the drop-down menu to find practitioners near you who are authorized to provide buprenorphine for the treatment of OUD.[15]
  • Behavioral Treatment Services Locator: SAMHSA provides an anonymous and confidential locator tool to find behavioral health treatment services, including treatments for opioid use disorder such as MAT, near you by inputting a local address.[16]

Your medical or mental health professional can also often provide resources and referrals for local MAT options. Insurance providers can offer information on what your plan covers and the treatment resources and providers that will be considered in-network for you. 

Preventing Stigma Surrounding MAT

There are several stigmas surrounding the use of MAT to treat opioid use disorder, including the incorrect notion that using an opioid medication to treat opioid addiction is merely replacing one drug for another. This is simply not the case. 

Medications like buprenorphine do not create the same type of euphoric high that other full and short-acting opioids like heroin or methadone do. When used as prescribed, Suboxone is a safe and effective treatment for addiction.

Addiction is not a moral failing. Rather, opioid addiction creates changes in the brain. It often requires pharmaceutical help to stabilize the brain, lessening withdrawal symptoms and cravings so recovery can be achieved.[17]

Disseminating education on the neurobiology of addiction and the chemical changes that opioids make in the brain can be a good step toward reducing the stigma surrounding MAT. It’s important to provide resources to family members and friends of individuals with opioid use disorder. 

MAT can be lifesaving in treating OUD. They are evidence-based and proven successful in sustaining recovery. The more people know this, the more stigma associated with MAT can be reduced over the years. 

Some medical and health care professionals discriminate against MAT, and this stigma can interfere with patient care.[18] This is a dated view that is rapidly changing. 

Health care providers, family and friends, and society as a whole should be educated on the benefits of MAT for OUD. Lets continue to work together to de-stigmatize MAT and reappraise it as the often life saving treatment that it is.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/data/report/2020-nsduh-annual-national-report. October 2021. Accessed April 2022.
  2. Effective Treatments for Opioid Addiction. National Institute on Drug Abuse (NIDA). https://nida.nih.gov/publications/effective-treatments-opioid-addiction.  November 2016. Accessed April 2022.
  3. World Health Organization Model List of Essential Medicines. World Health Organization (WHO). https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf. 2019. Accessed April 2022.
  4. Information About Medication-Assisted Treatment (MAT). U.S. Food and Drug Administration (FDA). https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat. February 2019. Accessed April 2022.
  5. Methadone. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone. March 2022. Accessed April 2022.
  6. Buprenorphine. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine. March 2022. Accessed April 2022. 
  7. Buprenorphine/Naloxone (Suboxone). National Alliance on Mental Illness (NAMI). https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed April 2022.
  8. Medication-Assisted Treatment (MAT). Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment. March 2022. Accessed April 2022.
  9. Drugs, Brains, and Behavior: The Science of Addiction. Treatment and Recovery. National Institute on Drug Abuse (NIDA). https://www.samhsa.gov/medication-assisted-treatment. July 2020. Accessed April 2022.
  10. Effects of Medication-Assisted Treatment (MAT) for Opioid Use Disorder on Functional Outcomes: A Systematic Review. Rand Health Quarterly. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302321/. June 2020. Accessed April 2022.
  11. Drug Overdose Deaths. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/drugoverdose/deaths/index.html. February 2022. Accessed April 2022.
  12. Medication Assisted Treatment (MAT) for Opioid Use Disorder. Drug Enforcement Administration (DEA). https://www.deadiversion.usdoj.gov/pubs/docs/mat.htm. Accessed April 2022.
  13. Reports to Congress: Utilization Management of Medication-Assisted Treatment in Medicaid. Medicaid and CHIP Payment Access Commission (MCPAC). https://www.macpac.gov/publication/report-to-congress-utilization-management-of-medication-assisted-treatment-in-medicaid/. October 2019. Accessed April 2022.
  14. Opioid Treatment Program Directory. Substance Abuse and Mental Health Services Administration (SAMHSA). https://dpt2.samhsa.gov/treatment/directory.aspx. Accessed April 2022. 
  15. Buprenorphine Practitioner Locator. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/find-treatment/treatment-practitioner-locator. Accessed April 2022.
  16. Behavioral Health Treatment Services Locator. Substance Abuse and Mental Health Services Administration (SAMHSA). https://findtreatment.samhsa.gov/. Accessed April 2022. 
  17. Medication-Assisted Treatment: Tool Tackling Opioid Crisis Faces Stigma, Other Barriers. Social Work Today. https://www.socialworktoday.com/archive/JA18p10.shtml. Accessed April 2022. 
  18. Intervention Stigma: How Medication-Assisted Treatment Marginalizes Patients and Providers. Social Science & Medicine. https://pubmed.ncbi.nlm.nih.gov/31125801/. July 2019. Accessed April 2022.

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