Medication-Assisted Treatment:

2019 Guide to the Most Effective Treatment

What is Medication-Assisted Treatment (MAT)?

Medication assisted treatment (MAT) is a modern approach to treating addiction. MAT aims at ensuring a successful and effective recovery from opioids and alcoholism.​​​1 Every 20 minutes, a person dies because of opioid-overdose. ​​​2 88,000 Americans died in 2017 because of alcohol-related problems. ​​​3 Heroin overdoses deaths increased by 286% in 2013, compared with 2002. ​​​4 More than 28,000 Americans died in 2014 because of opioid overdosing. ​​​6 More than 70,200 Americans died in 2017 because of overdose. ​​​7

Medication assisted treatment cures both opioid disorder and alcoholism by combining two types of treatment:

FDA-approved medications

Counseling and behavioral therapy

MAT & First-Line Treatment

MAT is a first-line treatment for both opioid-use disorder and alcohol -use disorder is recommended by: ​​​5

American Academy of Addiction Psychiatry

American Medical Association

The National Institute on Drug Abuse

Substance Abuse and Mental Health Services Administration

National Institute on Alcohol Abuse and Alcoholism

Centers for Disease Control and Prevention

What Makes MAT a Vital Treatment?

The high need for medication-assisted treatment (MAT) comes from conventional treatments inability to end drug use for many people. Rates of relapse and continually rising rates of substance abuse and overdose show the importance of finding a complete treatment that will allow people to move on from substance addiction. In 2015, deaths resulting from drug overdose increased by: 198% in urban area, and 325% in rural areas, compared to 1999. ​​​8 Within 15 years from now, overdoses, fatalities, and medical costs related to opioids are estimated to increase by ten times. 9 Different studies have shown that the treatment of opioid-use disorder via detoxification alone is associated with an 80% relapse rate. 8

So What Works?

According to the American Society of Addiction Medicine, MAT is the most effective approach to treat opioid use disorder. Compared to both medications alone and psychotherapy alone, MAT was found to be more effective. ​​​10 IHS Markit predicts that If MAT is considered and implemented more over the upcoming 15 years, that is estimated to result in:

Preventing 805,000 deaths

Preventing 6.1 million opioid-overdoses

Preventing $645 billion loss in the healthcare sector

If a pregnant woman is abusing opioids, the baby is at risk of neonatal abstinence syndrome. MAT effectively decreases the risk of this syndrome in babies through a couple of ways:

Decreasing how long a baby needs to stay at the hospital

Reducing the duration and severity of symptoms

Benefits and Advantages of MAT

MAT is customized to meet each individual patient’s needs, addressing symptoms and severity of withdrawal. MAT ensures successful recovery from opioid use disorder and alcoholism by:

Helping to sustain long-term recovery

Decreasing and preventing withdrawal symptoms

Reducing the risk of relapse

Improving quality of life

Eliminating the need for hospitalization

Helping patients to healthily handle anger, anxiety, and substance abuse

Reducing criminal activity related to both opioid-use disorder and alcohol-use disorder

Decreasing cravings for opioids or alcohol

Reducing illicit drug use

Reducing the likelihood of overdosing

Increasing retention in treatment

Helping those who resist medications

Reducing the risk of transmitting infectious diseases via injections, such as hepatitis C and HIV

MAT Misconceptions

Myth: MAT Just Changes What You’re Addicted to

One of the most common misconceptions about MAT is that MAT doesn’t cure opioid-use disorder or alcohol-use disorder. Some mistakenly think that MAT just changes the substance you are abusing.

MAT effectively treats substance-use disorders, including opioids, alcohol, and smoking as well. Research provides clear evidence that supports both: the highest effectiveness of MAT in treatment, and the recovery-sustainability.

Myth: MAT’s effectiveness doesn’t last long-term

It does. Research shows that MAT has the longest-term effectiveness, in case: Patients stick to MAT for 1 to 2 years at least.31, 14

Myth: MAT is only for severe conditions of substance-use disorders

Being the most-effective treatment doesn’t mean that MAT is only for severe conditions. MAT includes different treatment options and plans that are meant to be tailored and customized to meet the needs of each patient. ​​​14

Myth: MAT is Difficult and Risky

No, that is not true. MAT improves the quality of life since the first moment of the treatment-course. What is actually risky is detoxification without MAT. In a comparison between detoxification alone and MAT:​​​14

  • The major risk of detoxification alone is respiratory depression, which can be fatal.
  • The major risk of MAT is just some medication side effects, which is completely safe and manageable.

Myth: MAT Isn’t Covered By Insurance

Medicaid FFS programs cover Methadone — The main medication included in MAT — in 31 states. The same applies to buprenorphine, but with a prior authorization form. Furthermore, the injections of Naltrexone are covered by Medicaid PDL in over 60% of the states. ​​​14

Myth: Recovery from Addiction to Opioids and
Alcohol is Rare

Some misconceptions are harmful, such as thinking that opioids treatment is impossible or rare. The same with alcohol-use disorder. That is not true.

What makes some think so is just the high mortality rate of heroin users as well as the continually increasing number of alcohol addicts in the U.S. Actually; the majority of these people do not seek help. People can recover from opioid-use disorder as well as alcohol-use disorder safely and successfully via MAT’s specifically-prepared programs.

Understanding Opioid and Alcohol Use Disorders

What is Opioid Use Disorder?

Opioid use-disorder results from the frequent administration of opioids. That includes both illicit and prescribed opioids. Opioid Use Disorder affects certain parts of the brain. These parts are responsible for memory-efficiency, feeling motivated and rewarded.

Examples of the drugs that cause opioid use disorder:

  • Hydrocodone
  • Oxycodone
  • Heroin

More than 2.5 million Americans suffer from opioid-use disorder.​​​15
In 2013, 1.9 million Americans suffered from a substance-use disorder, including prescription pain killers.​​​16

Heroin use in young adults increased by more than 100% within the last decade.​​​17
$504 billion in economic losses in 2015 because of opioid abuse.​​​18

The percentage of people in the U.S who die because of heroin overdose has risen since 2002 at 57% in 2009, equating to an increase from 0.7 deaths per 100,000 people to 1.1 deaths per 100,000 people, and at 285.7% in 2013, equating to rise to 2.7 deaths per 100,000 people.​​​19

What Causes Opioid Use Disorder?

The drug effects mimic the brain’s reward system, resulting in behaviors to get more of the drug. The misuse of prescription pain killers is the leading factor that accounts for the majority of opioid-use disorder. 80% of heroin users in the U.S. have misused prescription opioids before heroin use.20 21% to 29% of Americans misuse the opioids prescribed for them 21 11.5 million Americans misused prescription opioids in 2015.22

What is Alcohol Use Disorder?

Alcohol use disorder results from the long-term, heavy use of alcohol. Alcohol use disorder is also known as alcohol abuse or alcoholism. 88,000 Americans die annually because of alcohol-related problems.​​​3 22,246 Americans died in 2017 because of liver disease due to alcohol use.​​​23 15.1 million Americans suffered from alcoholism in 2015.​​​24 623,000 young Americans (aged 12 to 17 years) suffered from alcoholism in 2015.​​​24 25.1% of the adults in the U.S. are heavy alcoholics. 9,967 Americans died in 2014 because of alcohol-related driving accidents. The misuse of alcohol cost the U.S. $249 billion in 2010.

The percentage of people in the U.S who die because of alcohol-related problems has risen since 1999 at 14.28% in 2009, equating to rise from 7 per 100,000 population to 8 per 100,000 population, and at 57% in 2017, equating to rise to 11 deaths per 100,000 population.​​​25

Symptoms: Opioid Use Disorder and Alcohol Use Disorder

Symptoms can differ, depending upon the substance being abused as well as the frequency of abuse. However, these seven symptoms you are likely to experience in all cases of opioid or alcohol use disorder.

The continuing need to take more and more opioids or alcohol. This is due to the body building tolerance to substances.

Taking opioids or alcohol for a long time.

Cravings to take opioids or alcohol. Some often describe this urge, saying, “I just want to take this substance right NOW.”

Failing to quit this substance; in spite of many attempts.

Experiencing withdrawal symptoms whenever you try to quit.

Missing some of the daily events or activities that you are committed to.

Different health problems. For example, if you are using heroin, you will likely experience these symptoms:

  • Dry mouth
  • Feeling like your body/legs/or arms are heavy
  • Your skin flushes and gets warm & itching
  • Nausea and vomiting
  • Confusion & drowsiness & clumsiness
  • Low libido or sex drive
  • Unable to identify whether you are conscious or semiconscious

How Can MAT Cure the Use-Disorders of Opioids and Alcohol?

Step One: Develop a Treatment plan

The first and foremost step of MAT is ensuring complete freedom from withdrawal symptoms of both opioids and alcohol. Then, it becomes easier to go through a treatment program. Individual treatment plans take into account past substance abuse as well as outlining individual therapies. Cognitive-behavioral therapy is frequently used to address substance use disorders.

Cognitive Behavioral Therapy: Higher Successful Treatment Rate

Cognitive-behavioral therapy is also known as psychosocial treatment. Cognitive-behavioral therapy helps to get rid of the root causes that led to opioid or alcohol abuse. That is how MAT ensures patients don’t relapse throughout the treatment program and after.

Here is how cognitive behavioral therapy works:

Assessing the patient’s psychological status. For example, social life, and the tendency to loneliness.

Developing a treatment plan that takes into consideration the patient’s needs, such as the lack of motivation.

Improving the patient’s behavior related to substance abuse. For example, sadness, depression, and the unhealthy ways a person may be considering to feel his or her life is rewarding.

Encouraging patients to continue abstaining opioids.

Providing tangible rewards when a patient can quit opioids or alcohol.

Individual counseling – Your doctor will spend enough time listening to all your concerns in regards to your life, addiction, and MAT therapy as well.

Group counseling, which helps patients be able to communicate and immerse in life normally once again.

Increasing the patient’s acceptance of the prescribed medications.

Family therapy, in some cases, through a family support system.

Other treatment approaches may also be included whenever needed. For example, mutual help programs.

Including other healthcare professionals whenever needed. For example:

  • Psychiatrist
  • Psychologist
  • Professional counselor

Step Two: Take Approved Medications

The medications included in MAT are approved by the Food and Drug Administration (FDA) for:

  • The management of opioid dependence & alcohol dependence
  • Opioid treatment & Alcohol treatment
  • Relapse prevention

Medications for The Treatment Of Opioid Use Disorder

Methadone: available in brands like Dolophine® & Methadose®

Methadone completely occupies the same brain receptors that heroin and opioids target. That is how methadone displaces heroin and other opioids.​​​26

Methadone has a longer duration of action than other opioids, equating to 24 to 36 hours. In other words, every time you take methadone, methadone will ENTIRELY displace opioids for 24 to 36 hours. Consequently, methadone will stabilize your health-status.

That way, methadone:

  • Lessens the withdrawal effects of opioids
  • Decreases the urge to take heroin or other opioids
  • Replaces and prevents the euphoric effect of the opioids you are abusing. So, even if you take opioids once again during the treatment-duration, you won’t achieve the desirable effects you were used to

Buprenorphine: available in brands like Bunavail®, Cassipa®, and Subutex®

Buprenorphine partially occupies the same brain receptors that opioids target. The main advantage buprenorphine has over methadone is: Buprenorphine doesn’t necessarily require to be taken at a clinic. Therefore, buprenorphine is convenient for those who prefer not to stay for a long time in a hospital or a clinic. Furthermore, Buprenorphine decreases the risk you may experience following an overdose of opioids.​​​27

According to a study conducted in Baltimore and ended in 2009, buprenorphine decreased the deaths of heroin overdose by 37%. As buprenorphine also has a long duration of action, you don’t need to take buprenorphine daily.

Ceiling Effect and Dependence

The ceiling effect of buprenorphine is another advantage. The ceiling effect means that: The effectiveness of buprenorphine continues to rise with the doses you are taking of buprenorphine to a certain level. Then, it becomes steady. In other words, you won’t be at risk of buprenorphine dependence or addiction.

Naltrexone: available in brands like ReVia® pills & Vivitrol® injections

The difference between naltrexone and the previous medications is: Naltrexone blocks the brain receptors targeted by opioids. Therefore, even if you re-take opioids, naltrexone will prevent the medication from working, blocking the effects that result in opioid-dependence.​​​28 Naltrexone does not cause euphoria, putting it at a low risk of abuse.

Naloxone:

Naloxone also blocks the same brain receptors that heroin and opioids target. Naloxone is prescribed in the following cases:29

Overdose

Taking opioids for a long time to manage chronic pain

Opioid poisoning

In cases of emergencies, you may be given naloxone injections intravenously every 2 to 3 minutes

If you are at risk of misusing buprenorphine, you will likely be given both naloxone and buprenorphine altogether

Medications for Alcohol Use Disorder Treatment

Naltrexone: available in brands like ReVia® pills

Naltrexone blocks the effects of alcohol on the brain. Therefore, Naltrexone:

Prevents the release of a hormone called dopamine

Decreases the rewarding feeling alcohol causes

Decreases your cravings to drink alcohol while in MAT-treatment

Prevent relapse

In cases of successful alcohol abstinence without staying at a hospital or a recovery-center, naltrexone injections may be given to help sustain abstinence.

Acamprosate: Available in brands like Campral® pills

Acamprosate helps to treat alcohol use disorder by:

Decreasing cravings to alcohol

Preventing the effects of alcohol

Treating ongoing alcohol withdrawal symptoms, such as:

  • Insomnia
  • Anxiety
  • Restlessness
  • Dysphoria

Disulfiram: Available in brands like Antabuse® pills

Disulfiram prevents the breakdown of alcohol. By doing this, disulfram:

Prevents the effects of alcohol

Discourages alcohol use

When alcohol is taken while disulfiram is in the body, unpleasant side effects like nausea, hot flashes occur.
How to prevent these side effects? Do not drink alcohol during the duration of treatment.

Addiction to Only One Substance is Rare

It was found that if a person is addicted to a certain substance, they are much more likely to abuse other substances as well. More than 90% of people with an addiction to heroin are also addicted to other substances, such as alcohol, marijuana, or cocaine. 30

People who abuse prescription opioid painkillers have the highest likelihood of using heroin, with a 40-times high risk. A person who abuses cocaine is 15 times more likely to use heroin. Marijuana use indicates a 3-times greater risk of using heroin, and alcohol shows a 2-times higher likelihood.

How Long Does MAT Last?

Generally, the longer you stick to your MAT-program, the better outcomes you will get. In terms of methadone, a twelve-month duration is a must to maintain therapeutic effectiveness. 31
MAT typically ends when:

  • Opioid use has not happened for an extended time
  • There is substantially diminished cravings for opioids and alcohol
  • There is enough community support help to sustain recovery

How to track the progress and success of MAT?

There are signs you can watch for to track the overall improvement while you are on MAT. 32

Attention to Health and Quality of Life will Increase

As health becomes a priority during recovery, sticking to prescribed medications is one sign of recovery. Engaging in health services by regularly seeing your doctor for health problems and being open and honest regarding symptoms are also signs of making physical health a priority.

Overall Health will Improve

As recovery continues, less anxiety and irritability will occur and your quality of sleep will improve. Overall, you may find an improvement in your mood. Medications and cognitive therapy can assist you with problems like depression and anger.

Improved Social Experience

Not only will you feel much happier, but you will find yourself spending more time with loved ones, like friends and family than you did before. Medication-assisted treatment also enables more engagement in social events and activities.

Changes in Work

Whether you are a student, employed or unemployed, you will notice that you will feel more committed to attending your classes and duties, workplace, or other responsibilities. Medication-assisted treatment has been found to enable people to better maintain a job and housing as well.

Legal Changes

If you have previously experienced legal problems related to your alcohol or opioid use, these problems will decrease.

Does MAT Cause Side Effects?

Yes, sometimes, just like any medication, MAT may cause temporary side effects. Your doctors will do their best to help you prevent and overcome side effects before they occur. While on medication-assisted treatment, you may experience one or more of these following side effects:

Nausea and vomiting

Constipation

Diarrhea

Abdominal pain

Muscle aches and muscle cramps

General body aches

Fever, chills, and/or goosebumps

Insomnia

Distress

Feeling nervous & restlessness

Dizziness, fatigue, and weakness

Sneezing and runny nose; without a cold

Finding Medication-Assisted Treatment

As MAT is an advanced treatment-approach, it can still be challenging for people to find a recovery center that provides MAT. 33 The insurance coverage for MAT is still limited. Some medication and behavioral therapies may not be covered in all insurance programs. There also remains a lack of medical professionals qualified to administer MAT as well as the medication buprenorphine.

Only 50% of the treatment-programs provided by the private sector provide MAT.In some states, treatment services related to MAT are only covered for a specific duration.

Where do I go from here?

Seeking professional help should be the first and foremost step to opioid treatment or to help a loved one struggling with the alcohol-use disorder. Recognizing that both these cases are treatable is also an important step to get the help you need as soon as possible.

The quicker you seek help, the fewer effects these harmful problems will cause you, and thus the quicker you will recover.


Resources

  1. https://www.samhsa.gov/medication-assisted-treatment/treatment
  2. https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2016/11/medication-assisted-treatment-improves-outcomes-for-patients-with-opioid-use-disorder
  3. https://www.niaaa.nih.gov/alcohol-facts-and-statistics
  4. https://www.cdc.gov/vitalsigns/heroin/infographic.html#graphic
  5. https://www.thenationalcouncil.org/wp-content/uploads/2016/10/MF_1_30.pdf
  6. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm
  7. https://ihsmarkit.com/research-analysis/improving-access-medicationassisted-treatment-opioid-use.html
  8. https://www.ruralhealthinfo.org/rural-monitor/medication-assisted-treatment/
  9. https://ihsmarkit.com/research-analysis/improving-access-medicationassisted-treatment-opioid-use.html
  10. https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf?sfvrsn=24
  11. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction
  12. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm
  13. https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(17)30482-8/fulltext
  14. https://www.thenationalcouncil.org/wp-content/uploads/2016/10/MF_1_30.pdf
  15. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction
  16. https://www.drugabuse.gov/publications/drugfacts/nationwide-trends
  17. https://www.cdc.gov/vitalsigns/heroin/
  18. https://ihsmarkit.com/research-analysis/improving-access-medicationassisted-treatment-opioid-use.html
  19. https://www.cdc.gov/vitalsigns/heroin/infographic.html#graphic
  20. https://www.hhs.gov/opioids/
  21. https://www.ncbi.nlm.nih.gov/pubmed/25785523
  22. https://www.nbcnewyork.com/news/local/Americas-Deadly-Opioid-Epidemic-By-the-Numbers-458709663.html
  23. https://www.cdc.gov/nchs/fastats/alcohol.htm
  24. https://www.niaaa.nih.gov/alcohol-facts-and-statistics
  25. https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf
  26. https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone
  27. https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
  28. https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone
  29. https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone
  30. https://www.cdc.gov/vitalsigns/heroin/
  31. https://www.thenationalcouncil.org/wp-content/uploads/2016/10/FINAL-MAT-PowerPoint.pptx
  32. https://store.samhsa.gov/system/files/sma15-4907.pdf
  33. https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2017/02/the-case-for-medication-assisted-treatment