Substance addiction is having a major impact on public health in the United States. More than 2.1 million people in the country are addicted to opioids, according to a by the U.S. Department of Health and Human Services. In the current U.S. national opioid addiction crisis, every day an astounding average of one in every 130 U.S. Americans dies from opioid overdose, per a report, by the Centers for Disease Control. Approximately 68% of deaths from drug overdose involve opioids (2017). That's an increase of 600% since 1999. Alcohol-related deaths total an additional 88,000 each year. Addiction treatment centers throughout the country provide wide-ranging recovery programs, including everything from periodic group discussion therapy to intensive in-patient care.
What is Medication Assisted Treatment (MAT)
Medication-assisted treatment (MAT) is a strategy of addiction care that involves using medication as part of a comprehensive recovery program. Use of MAT has been determined to help improve safety and effectiveness of the overall recovery process. Various alcohol and drug rehab medications are used for purposes including easing symptoms during detox, helping help reduce cravings for the addictive substance during the recovery program following detox, increase patient safety, reduce risk of overdose, and help prevent relapse.
MAT for Drug and Alcohol Addiction
MAT For Drug Addiction — The above alarming statistics clearly signal the need for recovering addicts to receive the most effective possible treatment. Compared with non-medication assisted treatment, MAT for opioid addiction has shown significant results. MAT is used to help relieve symptoms of withdrawal during detox, and afterward to help manage strong cravings and reduce risk of relapse during the recovery process. Certain medications are also used to interact with opioid receptors in order to prevent the high effects of the addictive drug. Others are used in emergency treatment, to counteract the potentially life-threatening effects of opioid overdose.
MAT For Alcohol addiction — The often very difficult process of recovering from alcohol addiction can be made safer and easier for many people by incorporating MAT into the recovery program. Appropriate medication can help reduce the strong cravings that can trigger a sense of compulsion to use alcohol. When used in combination with counseling and other forms of treatment, MAT has shown to lead to better outcomes for recovering alcoholics than programs that do not utilize the more comprehensive approach of including MAT.
How Does MAT Work?
MAT is especially helpful for patient's struggling to overcome dependency on physically addictive substances, like opioids or alcohol. MAT combines use of medication with other forms of drug or alcohol addiction treatment, such as behavioral therapies, family therapy, individual counseling, job counseling, support groups and others. Quality MAT is individualized to meet each patient's unique needs. Medication-assisted treatment for opioid addiction or alcohol addiction can be helpful for:
Stopping the addictive drug from interfacing with receptors, preventing a high sensation.
Relieving symptoms of withdrawal during detox.
Reducing cravings during recovery.
Providing a reliable and effective alternative to the addictive drug.
Provide the user a sense of greater stability during recovery.
MAT is used as one component of a more comprehensive addiction recovery program. It's not employed as a stand-alone treatment. A well-structured, individualized comprehensive recovery program must be used in combination with MAT. Using medication in drug addiction treatment can help people focus on learning the underlying contributors to their addiction, without the intense distraction of physical discomfort or cravings that can complicate the struggle to move beyond habitual drug abuse.
Opioid Addiction Medications
It is the extremely addictive property of opioid drugs that makes recovery for users so difficult. Using MAT can serve to remove many of the obstacles to sustainable recovery. Different addiction treatment medications are used to accomplish different treatment objectives:
One of the long most prescribed MATs is methadone. This treatment is used to help prevent symptoms of opioid withdrawal, and then to help control cravings for the addictive drug. Administering a mild dosage of medication, as part of an overall recovery program that is carefully tailored to each individual's needs, can help the patient through the more difficult phases of the rehab process. This medication is usually administered once daily, and a dose typically lasts from four to eight hours. Methadone can be used in the form of liquid, pill, or wafer tablet.
Because methadone is an opioid, using it for MAT does carry the potential for the abuse of the drug. It must only be administered in an appropriate addiction treatment environment , by qualified professionals. Because methadone is addictive, treatment with this drug should be continued for at least 12 months, in order to permit gradual removal of it from the treatment program and avoid onset of withdrawal symptoms from discontinuing its use too rapidly.
To help minimize the sense of craving for opioids that often occurs during recovery, buprenorphine provides another effective option. The treatment benefits of buprenorphine are similar to those of methadone, but the chemical action of buprenorphine is different than that of methadone. Unlike methadone, buprenorphine is a partial opioid agonist. As such, it generates a much milder level of the euphoric effects that other opioid drugs produce, and the effects wear off rather quickly, compared to other drugs, even when used in higher dosages. Due to this maximum possible effect, or "ceiling effect" of buprenorphine and its relatively longer lasting effects, drug treatment professionals have found it a relatively safe alternative to drugs that do not offer its reduced potential for misuse.
Buprenorphine doses are usually started between 12 to 24 hours after the last time the addicted person used drugs and has entered a recovery program. Buprenorphine is manufactured in four forms. Each has its particular effect, purpose and method of delivery:
Injectable Buprenorphine — This application of buprenorphine provides the same benefits as the tablet or other forms of the drug, but doses are administered by subcutaneous monthly injections. This delivery method minimizes the risk of misuse or abuse of the drug, and it eliminates the need for the frequent dosing that is necessary with other methods of administering buprenorphine. Injections can begin only after detox is completed, after the individual has been mentally evaluated and determined to be an appropriate candidate for MAT with injectable buprenorphine, and after 3 to 7 days from the start of drug addiction recovery treatment.
Suboxone — By combining naloxone and buprenorphine, suboxone is produced. This widely used addiction treatment medication is typically administered in tablet form. Suboxone is a partial opioid agonist. Its naloxone component is a full opioid antagonist, blocking opioid receptors, and thereby preventing the effects of opioids in the body. This property of suboxone makes this drug less likely to be abused by patients. Consuming suboxone in excessive amounts can cause strong symptoms of opioid withdrawal.
Subutex — Subutex contains only buprenorphine. A frequently used MAT option, subutex is administered as a sublingual tablet. When used in inappropriate dosages or injected, Subutex does present higher potential for abuse than other addiction treatment medications. Therefore, treatment with subutex must be carefully managed, to ensure against use of excessive amounts.
Probuphine — For low doses of buprenorphine, probuphine is administered by an implant that delivers the drug into the body continuously, throughout a six-month period. This approach to administering buprenorphine makes probuphine a more efficient and convenient option for managing MAT than other forms of buprenorphine, such as suboxone and subutex. This delivery method also minimizes potential for the drug to be abused. If the implant is removed or moved from the insertion location, there does exist the potential for misuse or unintended exposure to inappropriate dosage of the drug.
Naltrexone works differently than other medications used for medication-assisted opioid (and alcohol) addiction treatment. It suppresses cravings, as do the majority of medications used in treatment of opioid addiction. But, naltrexone blocks opioids by binding to opioid receptors, whereas buprenorphine and methadone work by activating the receptors. This blocking interaction helps recovering addicts by suppressing opioid cravings that can increase risk of relapse. Naltrexone also prevents an opioid user's feeling of being high, which removes the incentive to use opioids for that purpose. The drug presents relatively few of the risks that other opioid treatment medications carry.
The recovering addict must have completed detox from opioids, including from any other opioid addiction treatment medications, at least 7 to 10 days prior to beginning use of naltrexone for MAT. Naltrexone can be administered by injection, extended release injection (Vivitrol), or in pill form (Deparde, ReVia).
Naloxone – For Overdose Emergency
Accidental overdose can occur from overuse of an opioid in attempt to get high, or from combining opioid treatment medications with other drugs, or from accidental exposure. Therefore, individuals prescribed MAT for recovery from opioid addiction must also have emergency access to a drug that can reverse the dangerous effects of overdose and stabilize the victim. Naloxone is used in cases of emergency, to reverse the potentially fatal effects of an opioid overdose.
Naloxone is a synthetic opioid antagonist. This medication is administered either by subcutaneous injection, injection into the muscle or by an intranasal spray called Narcan. Naloxone binds with opioid receptors, blocking opioids from activating the receptors. This temporary chemical intervention reverses life-threatening respiratory effects, to allow emergency professionals necessary time to perform further examination and treatment. Naloxone is also frequently prescribed for recovering addicts, especially when the patient is prescribed MAT medications that present appreciable risk of overdosing.
Alcohol Addiction Medication
Detox from alcohol can cause severe withdrawal symptoms, including seizures and delirium tremens (DT). MAT can help make the difficult process of recovery from alcohol addiction much safer and easier. Addiction treatment medication can reduce alcohol cravings. According to the National Institute of Health, when used in combination with other forms of treatment, including individual, group and family therapies, as well as other evidence-based addiction treatment options, MAT drugs such as disulfiram, acamprosate, and naltrexone can improve outcomes of treatment for alcoholism.
Disulfiram is used in MAT for patients, following the completion of detox and in the early phases of treatment. Disulfiram is administered as a daily tablet. The drug has been shown to help recovering alcoholics, by causing uncomfortable effects when the individual consumes alcohol, even in a small amount. The onset of these effects can occur at around ten minutes or so after the individual consumes alcohol and can last for more than an hour. Due to risks associated with the effects of disulfiram, not all treatment centers opt to utilize the drug in MAT. Some side effects that ingesting alcohol while disulfiram is in the body can cause include:
Naltrexone, as previously described, is a drug used to inhibit the feeling of being high or intoxicated that incentivizes people to consume alcohol (or use opioids). By helping to reduce the effect of intoxication, naltrexone can help recovering alcoholics avoid relapse and continue toward success in their addiction recovery programs. This medication is most effective in MAT that is combined with other forms of treatment, such as counseling, behavioral, group and family therapy in a well-structured alcohol addiction recovery program.
Naltrexone is usually administered in tablet form (Depade, ReVia). It can also be injected (Vivitrol).
As part of a comprehensive alcohol addiction treatment program, acamprosate can be used to relieve anxiety, insomnia and cravings for alcohol and help make avoiding relapse less challenging for many recovering alcoholics. Similarly to other MAT drugs, like naltrexone and disulfiram (both described above), administering acamprosate can begin following the detox phase of recovery – usually about five days after discontinuing alcohol use. Acamprosate can typically be expected to reach its full level of effectiveness between 5 to 8 days after starting use.
Acamprosate is available as tablets, which are administered three times each day. Acamprosate has been found very useful in alcohol addiction treatment, although there remains some question of how the chemical action of the medication works to generate its effects.
Weighing the Positives and Negatives of MAT
The objective of MAT is to help minimize the risks presented during addiction recovery. Medication-assisted treatment has been found to reduce instances of drug misuse and abuse for people during the process of opioid and alcohol addiction treatment. MAT can also help minimize the potential for overdose or relapse during treatment and can increase individual's likelihood of success in their recovery program.
MAT has been found especially helpful to people suffering from co-occurring conditions, such as drug addiction and mental illness. In fact, people with long-term depressive disorder have been found to experience significantly higher rates of recovery progress from use of MAT than patients receiving MAT who do not have the same mental health history.
Medically-assisted treatment for drug and alcohol addictions have not proven to have adverse impacts on patients' cognitive functioning, physical abilities, ability to perform at their jobs. MAT has been found to provide significant benefits to people going through the mentally and physically challenging process of addiction recovery, including:
Easing withdrawal symptoms.
Reducing risk of relapse.
Reducing risk of death due to overdose.
Making recovery more stable and manageable.
Minimizes distraction, allowing individuals to focus fully on recovery
Increasing recovering addicts' success in obtaining and keeping employment.
Reducing addiction-related criminal activity.
Improving outcomes for recovering addicts who are pregnant.
Medication-assisted treatment for opioid or alcohol addiction offers important benefits for people going through the difficult process of recovery. However, this method of treatment also presents concerns that must be weighed in decisions to use MAT, including:
Only effective as part of more comprehensive treatment.
Requires drug administration by licensed professionals.
Typically requires daily use.
Require diligent monitoring to prevent abuse.
Can cause or compound medical problems.
May lead to feeling of being stigmatized for using the drug.
Treatment for opioid and alcohol use disorder is most effective when the recovery program is individualized to meet the addict's personal needs. For some individuals, abstinence works well. For others, medication-assisted treatment can help prevent relapse and significantly improve likelihood of success in the recovery program. The National Institute on Drug Abuse (NIDA) has indicated that utilization of MAT is an effective course of addiction treatment in combination with other therapies.
MAT has proven to be among the most effective of evidence-based addiction treatment methods. The NIDA advises that recovering addicts' ability to sustain commitment to treatment and to avoid illicit drug use can be significantly increased by including MAT as part of a more comprehensive recovery program. Studies have also found that use of MAT has contributed to a decrease in addicts' deaths due to overdose and in overall numbers of deaths related to opioid abuse.