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Medication for Addiction Treatment (MAT) vs. Abstinence for Opioid Dependence

August 19, 2022

Table of Contents

Both Medication for Addiction Treatment (MAT) and abstinence-based approaches can be effective in the treatment of opioid use disorder, but overall, MAT shows higher rates of success.

Opioid dependence is a growing problem worldwide. The latest estimates suggest that 16 million individuals suffer from some form of opioid use disorder (OUD) around the world.[1] More than 500,000 U.S. citizens are dependent on heroin.[1]

Fortunately, opioid dependence is treatable. Available treatment options include psychosocial rehabilitation programs, medications, or both in combination. 

Keep reading to learn more about Medication for Addiction Treatment vs. abstinence-based treatments for opioid use disorder (OUD).

Abstinence-Based Treatment for OUD

As the name implies, abstinence-based treatment means simply abstaining from opioid use altogether without any medication assistance. 

It is the most common form of treatment for substance misuse in the United States today, mainly because it is difficult to find and access medication assistance.[2] Thus, abstinence-based approaches are most commonly used as a matter of necessity instead of patient preference or efficacy. 

Abstinence-based treatment often focuses on personal willpower along with social and psychological support to help individuals through withdrawal symptoms and keep them motivated to discontinue opioid misuse.[3] It is a reasonable option for patients if they do not want to use medication-based treatment, and it can be successful in the right circumstances and for the right patients. 

Abstinence-Based Treatment Programs

Abstinence-based treatment programs were originally used for alcohol-dependent patients in 1935. The most famous abstinence-based program is Alcoholics Anonymous (AA). 

The program, formally a 12-step program, provides individuals with a social support group and a gradual step-by-step path to counter their alcohol misuse. Since then, multiple 12-step programs addressing a variety of substance use disorders have emerged. 

Many patients swear by these groups as a means of providing the support necessary to abstain from the use of opioids or other substances.

However, 12-step programs have historically discouraged the use of any medication, as they have (incorrectly) asserted that medication assistance merely “substitutes one addiction for another.” While well-intentioned, this often propagates unnecessary and even counterproductive stigma around Medication for Addiction Treatment (MAT).

Although abstinence-based programs are helpful for some individuals, there is a distinct lack of evidence backing their efficacy on a population level.[2] Studies have repeatedly shown that abstinence-based programs for opioid dependence should be supplemented with medications for the best results.[4]

What Is Medication for Addiction Treatment (MAT)?

Medication for Addiction Treatment for opioid dependence advocates combining the use of medications with behavioral and psychological support. 

Using FDA-approved medications for OUD helps reduce cravings and prevent withdrawal symptoms, which are the most common reason for opioid relapse.[5] Extensive research has demonstrated the efficacy of MAT in not only decreasing opioid use but also preventing opioid-related deaths due to overdose.[6]

Medications Used in MAT

Currently, three medications have been approved by the U.S. Food and Drug Administration (FDA) for the medical treatment of opioid dependence. These drugs are methadone, buprenorphine, and naloxone. They act in differing ways on the opioid receptors in the brain.

Methadone

Methadone is the most commonly used medication for opioid dependence worldwide. It binds to opioid receptors in the brain and activates them.[7] 

Put simply, methadone stimulates the same receptors activated by opioids, thereby preventing withdrawal. Thus, methadone reduces withdrawal symptoms without causing many of the adverse effects associated with opioid misuse.

However, since methadone functions similarly to opioids, methadone treatment does carry similar risks associated with opioid use, primarily the risk of misuse, sedation and overdose.

In the United States, Methadone can only be prescribed out of a specially licensed methadone clinic. This proves to be a logistical challenge for many patients, requiring that they come in person on a frequent (daily to weekly) basis to receive their medication dose.

Buprenorphine/Naloxone (Suboxone)

Buprenorphine/naloxone (Suboxone) activates the same receptors as methadone but only partially. Thus, it reduces the risk of misuse or overdose while still preventing withdrawal symptoms. [8] 

Suboxone treatment is the only approved outpatient treatment for opioid dependence, given its efficacy and relatively safe profile. As a result, it is often considered the gold standard in MAT.

Naloxone

Naloxone functions entirely differently from methadone and buprenorphine. 

Naloxone is an opioid antagonist, which means that it binds to opioid receptors but does not activate them. It prevents patients who then take an opioid from getting “high” on that opioid because all the opioid receptors are blocked by the Naloxone.

Although naloxone carries no abuse potential, it does not prevent withdrawal symptoms immediately after stopping opioids in the same way that methadone or buprenorphine/naloxone (Suboxone) do.[9] For this reason, Naloxone is used to maintain someone’s abstinence over time rather than to help them during acute withdrawal.

Effectiveness of Medication for Addiction Treatment vs. Abstinence-Based Treatment 

Overall, MAT boasts much higher success rates than abstinence-based treatment for OUD.

Given the effectiveness of MAT, its use has risen rapidly. Only 7 European countries provided methadone for OUD in 1980. By 2009, it was being used in more than 70 countries worldwide.[10] 

Adoption rates for MAT are also increasing in the U.S., with roughly 50% of individuals with OUD now receiving medications.[11]

Research consistently proves MAT to be the superior treatment modality when compared to abstinence-only treatments.[12] One study found that 49% of individuals on MAT were able to successfully manage their opioid dependence compared to only 7% of individuals following an abstinence-based programs.[13] 

A randomized controlled trial showed that retention (a measurement of how long patients manage to stay away from opioid misuse) was greater for MAT (438.5 days) as compared to abstinence-based treatment (174 days).[14] Another study found that 75% of individuals on buprenorphine remained consistent with their treatment for one year compared to patients who did not use medications.[15]

The National Treatment Outcome Research Study (NTORS) demonstrated significantly lower rates of opioid misuse in individuals using MAT compared to abstinence-based treatment.[16] In this study, participants reported a significant improvement in their quality of life when on MAT. This percentage dropped from 49% in patients receiving Medication for Addiction Treatment to 7% when they were tapered off the medication.[12]

Overall, abstinence treatment programs are associated with significantly higher relapse rates. According to one study, 59% of individuals undergoing an abstinence-based detox program relapsed within one week of receiving treatment, with the number reaching 90% within one year.[17]

MAT Demonstrates Higher Success Rates Than Abstinence Programs for OUD

The evidence is abundantly clear: Medication for Addiction Treatment is much more efficacious than abstinence-based programs for treating opioid use disorder. 

Coupled with the proven safety profile of buprenorphine, naloxone, and methadone, Medication for Addiction Treatment is our most potent tool against opioid misuse and dependence.

Medically Reviewed By 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. Opioid Addiction. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK448203/. April 2022. Accessed July 2022.
  2. Primary Care Management of Opioid Use Disorders. Canadian Family Physician. https://www.cfp.ca/content/cfp/63/3/200.full.pdf. March 2017. Accessed July 2022.
  3. Evidence-Based Treatment of Opioid Dependent Patients. The Canadian Journal of Psychiatry. https://pubmed.ncbi.nlm.nih.gov/17052031/. September 2006. Accessed July 2022.
  4. After Drug Treatment: Are 12-Step Programs Effective in Maintaining Abstinence? American Journal of Drug and Alcohol Abuse. https://pubmed.ncbi.nlm.nih.gov/10078980/. February 1999. Accessed July 2022.     
  5. Review Article: Effective Management of Opioid Withdrawal Symptoms: A Gateway to Opioid Dependence Treatment. The American Journal on Addictions. https://pubmed.ncbi.nlm.nih.gov/30701615/. February 2019. Accessed July 2022.     
  6. Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings. Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK402352/. December 2016. Accessed July 2022.     
  7. Pharmacology in the Treatment of Addiction: Methadone. Journal of Addictive Diseases. https://pubmed.ncbi.nlm.nih.gov/20407977/. April 2012. Accessed July 2022.     
  8. Effect of Buprenorphine Dose on Treatment Outcome. Journal of Addictive Diseases. https://www.mcstap.com/docs/Effect%20of%20Buprenorphine%20Dose%20on%20Treatment%20Outcome.pdf. December 2011. Accessed July 2022.     
  9. Buprenorphine: A Review of Its Pharmacological Properties and Therapeutic Efficacy. Drugs. https://link.springer.com/article/10.2165/00003495-197917020-00001. October 2012. Accessed July 2022.     
  10. A Review of Opioid Dependence Treatment: Pharmacological and Psychosocial Interventions to Treat Opioid Addiction. Clinical Psychology Review. https://pubmed.ncbi.nlm.nih.gov/19926374/. March 2010. Accessed July 2022.     
  11. National Opioid Epidemic. amfAR Opioid & Health Indicators Database. https://opioid.amfar.org/indicator/SMAT_fac. Accessed July 2022.     
  12. Long-Term Follow-Up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields ‘Cause for Optimism’. National Institute on Drug Abuse. https://archives.drugabuse.gov/news-events/nida-notes/2015/11/long-term-follow-up-medication-assisted-treatment-addiction-to-pain-relievers-yields-cause-optimism. November 2015. Accessed July 2022.     
  13. The Prescription Opioid Addiction Treatment Study: What We Learned. Drug and Alcohol Dependence. https://www.sciencedirect.com/science/article/pii/S0376871617300029. April 2017. Accessed July 2022.     
  14. Methadone Maintenance vs. 180-Day Psychosocially Enriched Detoxification for Treatment of Opioid Dependence: A Randomized Controlled Study. JAMA. https://pubmed.ncbi.nlm.nih.gov/10714729/. March 2000. Accessed July 2022.     
  15. 1-Year Retention and Social Function After Buprenorphine-Assisted Relapse Prevention Treatment for Heroin Dependence in Sweden: A Randomised Placebo-Controlled Trial. Lancet. https://pubmed.ncbi.nlm.nih.gov/12606177/. February 2003. Accessed July 2022.     
  16. Analysis of 12 Years of Treatment Demands in the Region of Charleroi: A Trend Towards More Poly-Drug Use. Academia. https://www.academia.edu/32276179/Analysis_of_12_years_of_treatment_demands_in_the_region_of_Charleroi_A_trend_towards_more_poly_drug_use. 2012. Accessed July 2022.     
  17. Perceived Relapse Risk and Desire for Medication Assisted Treatment Among Persons Seeking Inpatient Opiate Detoxification. Journal of Substance Abuse Treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874241/. June 2013. Accessed July 2022.

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