For patients struggling with addiction to opioids (oxycodone/Percocet, hydrocodone/Vicodin, Dilaudid, fentanyl, and heroin) Medication-Assisted Treatment (also known as MAT) is life-saving, evidence-based, and recommended treatment.
What Is Medication-Assisted Treatment (MAT)?
Medication for Addiction Treatment involves the use of Suboxone or similar medications in conjunction with therapy to address opioid use disorder (OUD).
How Does MAT Work?
People who use opioid every day become dependent on them. Their brain’s opioid receptors are used to being covered with opioids. If they are not able to get opioids and their receptors go “empty,” they will feel symptoms of withdrawal, such as body aches, nausea, diarrhea, and sweating.
People who use opioids every day also have cravings for them. They may think about opioids all day long. This can interfere with their ability to lead a normal life. They are often not able to work, take care of their kids, engage in normal social activities, or be responsible because their lives become consumed with getting their next dose of opioids.
People who use opioids every day are at risk for taking too many, resulting in overdose. This can lead to respiratory depression (meaning they cannot breathe) and ultimately death.
Evidence-based medicines such as buprenorphine treat opioid use disorder by binding to the brain’s opioid receptors and preventing withdrawal symptoms, cravings, and overdose.
People taking MAT appropriately should thus feel normal when they take their daily dose.
Evidence Behind MAT
MAT has been rigorously tested and is scientifically proven to be an effective treatment for people with OUD. Patients on MAT are much more likely to remain in recovery one year later as compared to those who are not on MAT.  Patients who are not on MAT are significantly more likely to overdose compared to those who remain on MAT. These medications work, and they save lives.
The three FDA-approved, evidence-based MAT medications include buprenorphine-naloxone (Suboxone), methadone, and naltrexone (Vivitrol).
Buprenorphine/Naloxone (Suboxone) & Buprenorphine (Subutex)
These are partial opioid agonists. This means that they partially bind to the brain’s opioid receptors, stimulating them enough to prevent withdrawal and cravings, but less so than full opioids like methadone which can increase a person’s risk of sedation or overdose.
Suboxone has a ceiling effect:  Taking too much should not make people feel “high” and very rarely leads to an overdose. Thus, Suboxone is considered as effective as methadone and potentially even safer.
This drug works as a full opioid agonist. Like oxycodone, heroin, and fentanyl, it fully stimulates the brain’s opioid receptors. When it binds to all the receptors, it blocks the other opioids so they cannot bind, preventing a relapse.
This is a monthly injection that is not an opioid. It works as an opioid antagonist (a “blocker”). This means that it binds to the brain’s opioid receptors and blocks them, so other opioids (like oxycodone, fentanyl, and heroin) will not work. It also prevents cravings from opioids.
Comparing Different MAT Options
|Buprenorphine/naloxone (Suboxone) & buprenorphine (Subutex)||Methadone||Naltrexone|
|How it works in the brain||Partially stimulates the brain’s opioid receptors||Fully stimulates the brain’s opioid receptors||Blocks the brain’s opioid receptors|
|How it helps with addiction to opioids||Prevents cravings, withdrawal symptoms, and overdose||Prevents cravings, withdrawal symptoms, and overdose||Prevents cravings and overdose|
|Safety profile||Very safe; has ceiling effect; very difficult to overdose||No ceiling effect; risk of overdose if too much is taken; requires regular heart monitoring||As an opioid blocker, does not stimulate the opioid receptors; very safe|
|Typical dose & formulation||12-16 mg buprenorphine/ day, taken sublingually: dissolves under tongue in ~15 minutes||60-120 mg/ day, taken orally: in liquid, powder, and diskette formulations||Vivitrol: long-acting version containing 380 mg injected monthly into the buttocks muscle; oral naltrexone: 50-100 mg taken daily as a pill|
|Where medication is obtained & taken||Prescription from a physician; can take at home||Must take at “methadone clinic,” which are highly regulated by federal & state accreditation; take under supervision||Does not require special license, can be provided in outpatient and specialty clinics|
|Amount of structure||Usually requires weekly appointments at first, patients doing well may be spaced out to monthly appointments||Usually requires daily visits; after months to years in recovery, patients meeting specific federal criteria can earn “take homes” and not have to come in as often||No associated regular structure; at minimum, patient receives monthly injection and programs decide how often the patient is required to attend appointments|
|Safe in pregnancy?||Yes, considered first-line treatment||Yes, considered first line treatment||Unknown, but thought to be overall slightly less effective than Suboxone or Methadone|
|Other perks?||Can be used to treat concurrent chronic pain||Long history supporting its use||Also used for patients with alcohol use disorder, so good choice for patients struggling with opioids and alcohol|
Barriers to Accessing MAT
Despite MAT’s effectiveness, patients with opioid dependence and OUD frequently experience multiple barriers to accessing MAT.
First, they must find a provider who will prescribe buprenorphine-naloxone or find a methadone clinic that is convenient to visit regularly. Once they find a provider, they may experience long wait times.
Patients often face logistical obstacles, such as time and transportation to attend appointments, difficulty getting prescriptions filled, and financial barriers to pay for MAT based on their insurance status and coverage.
Many may also face societal stigma from family and friends who are well-intentioned, but do not understand opioid use disorder. These loved ones may also view addiction as a curable disease rather than a lifelong disease that is often interspersed with periods of relapse. It can make it difficult for patients to pursue MAT when they feel judged or shamed by loved ones.
Patients treated with MAT should know that their health information is considered private and confidential by federal laws and regulations and will not be shared with family, friends, employers, or anyone else without the patient’s permission (unless required by a court order or for emergency purposes).
Talking to Your Doctor
Suboxone and other medications are evidence-based, FDA-approved medications to treat opioid use disorder. MAT is considered an essential part of recovery.
These medications can prevent cravings, withdrawal symptoms, overdose, and death. They make people with OUD feel normal and embrace lives in recovery where they can reconnect with their values and goals.
You can’t get MAT on your own. You need a doctor to prescribe Suboxone or another medication that is appropriate. Talk to your doctor about whether MAT is right for you.
It is important for patients to also address their mental health care needs. Medication isn’t enough on its own, as it is combined with therapy in MAT programs.
MAT & Telehealth
While there are many obstacles to obtaining MAT, it is important to navigate through these. One new innovation that supports increased access to MAT is the use of telehealth appointments. These allow patients to obtain buprenorphine-naloxone (Suboxone) entirely through phone and video formats, oftentimes without ever needing to step into a doctor’s office.
Bicycle Health is a telehealth company that provides buprenorphine-naloxone (Suboxone) to patients across the country. Patients can get started on MAT quickly and receive support for their opioid use disorder without ever having to leave their homes. To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.
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 ... Read More
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