Medication-assisted treatment (MAT) is an approach where counseling and behavioral therapies are used in conjunction with medicines for managing substance use disorders (SUDs) and preventing opioid overdose. Researches have established in the past that the combined use of medication and therapy can be useful in not only managing these disorders but also in sustaining recovery.
MAT is fundamentally used for treating addiction to opioids such as heroin and prescription pain relievers that have opiates. The medication functions towards normalizing brain chemistry, blocking the ecstatic effects of opioids and alcohol, alleviating physiological cravings, and regularizing bodily functions.
The medications prescribed in a MAT program are approved by the Food and Drug Administration (FDA), clinically significant, and customized according to an individual’s treatment requirements. It is important to remember that the medications used in MAT are not mixed with anxiety medications such as benzodiazepines (ex: Xanax or valium), as the combination can prove to be fatal.
Opioid treatment programs
People struggling with an opioid use disorder (OUD) are provided MAT through the opioid treatment programs (OTPs). Such programs provide a plethora of services aimed at reducing, eliminating, or preventing the use of illegal substances, probable criminal activity, and the dissemination of infectious disorders. Overall, OTPs help in improving the wellbeing and quality of life in people receiving addiction treatment. However, it is critical that OTPs first get certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved accrediting body. The certification process and standards for accreditation are supervised by the Division of Pharmacologic Therapies (DPT), a part of the SAMHSA Center for Substance Abuse Treatment (CSAT).
The federal law necessitates that patients receiving an OTP must get counseling, medical, educational, vocational, and other treatment services and assessments, in conjunction with the prescribed medication. The law permits MAT specialists to offer services and treatments in a variety of qualified practice settings including addiction treatment centers, hospitals, remote clinics, and doctor offices.
Counseling and behavioral therapies
According to the federal rule, patients receiving MAT must also undergo counseling comprising different types of behavioral therapies. These counseling sessions are mandated along with the vocational, medical, educational, and other treatment and assessment services. Experts believe that people struggling with substance abuse and mental illnesses could benefit from behavioral health services and treatments as strategies including counseling and other highly specialized psychotherapies intend to bring out a positive change in behavior, thought process, emotional processing, and the way a person sees and perceives situations.
Medicinal agents used for treating SUDs and mental health disorders can provide substantial relief to patients, making them receptive to the idea of exploring psychotherapies for recovery. For a majority of people, the best suited behavioral health strategy involves combining medication management with counseling. This must be started as early as possible to wield the best treatment outcomes. To successfully achieve this, a comprehensive evaluation and diagnosis should be carried out by a trained professional before the OTP is designed. It is important to understand that treatments do not work in isolation and each treatment must address a particular symptom or treatment goal need of a patient.
Medications used in MAT for opioid addiction
Addiction to alcohol and opioids can be treated using several medications approved by the FDA. However, a misconception associated with the use of MAT is that it replaces one drug with another. The medications administered as a part of the MAT protocol help greatly in relieving the withdrawal symptoms and psychological yearnings which pave the way for chemical impairments in the body. The MAT program delivers a controlled and safe level of medicine for overcoming the use of a drug. Even research has substantiated that when medications are administered at the recommended dose, incorporating the MAT protocol does not cause any adverse effect on an individual’s mental abilities, intelligence, employability, or physical functioning.
Only a SAMHSA-certified OTP can dispense medications used under the MAT program. Few medicines used in MAT belong to the category of controlled substances as they have an inherent risk of being misused. Medicines like methadone and buprenorphine are used for treating dependence and addiction as short-acting opioids like codeine, morphine, and heroin, in addition to semi-synthetic opioids like hydrocodone and oxycodone. On the other hand, naltrexone is used for controlling cravings and preventing a relapse.
- Methadone: A synthetic opiate pain reliever useful for treating narcotic addiction and dependence. It is a long-acting synthetic narcotic analgesic that is often prescribed as a substitute for heroin. When taken orally for a longer period of time, methadone helps in managing opioid addiction and sustaining recovery. Similar to heroin and morphine, methadone works on the opioid receptors in the brain, helps in minimizing withdrawal symptoms and stabilizing patients. Methadone deceits the human brain into believing that it is still getting its supply of the substance abused. Whereas in reality, the person does not get a high, there are no withdrawal symptoms, and the person might feel normal. Methadone is the only MAT drug that has been approved for treating pregnant or breastfeeding women.
- Buprenorphine: Buprenorphine was approved by the FDA in October 2002 for the reduction or cessation of addiction to heroin and pain relievers such as morphine. It is a recent addition to the field of MAT which is used in conjunction with behavioral therapies and counseling, and it is a part of a comprehensive patient-centric approach for the treatment of dependency on opioids. It is effective and safe when taken as prescribed. Buprenorphine has distinctive pharmacological properties that enable it to decrease a patient’s susceptibility to misuse a drug. Additionally, it reduces the physical dependence on opioids manifested in the form of cravings and withdrawal symptoms. In the case of an overdose, it increases the safety of an individual as buprenorphine is a partial opioid agonist that produces the same effects as those produced by the opioids. However, these effects are subtle in comparison to the ones produced by methadone and heroin. With each dose of buprenorphine, the opioid effects increase until one reaches a moderate dose when the effects stabilize even with further increase in the dosage. This is known as a ceiling effect and it greatly helps in lowering the potential for dependency, misuse, and side effects. Moreover, since buprenorphine is a long-acting agent, it is possible that a lot of patients may not have to take it on an everyday basis. Buprenorphine was the first drug approved for treating opioid addiction in a physician office which greatly increased treatment access. A qualified physician practicing in the U.S. can give buprenorphine in multiple settings, such as, in a health department, correctional facility, office, or a community hospital. Buprenorphine treatment can also be dispensed by the SAMHSA-certified OTPs.
- Naltrexone: After a complete detoxification process, naltrexone is used for preventing relapse in adult patients. Approved by the FDA, naltrexone exerts its action by blocking the opioid receptors, which is why it is also known as an opioid antagonist. It helps the user to not feel a high and prevents withdrawal after a recent opioid use. It is available orally or as an injection (Vivitrol®) to be taken once in a month administered by a doctor.
People on MAT programs may continue taking their medicines for several weeks, months, years, and even for a lifetime without worrying as these are quiet safe. However, if one wishes to discontinue the treatment, it is important that they have a word with their doctor before doing so.
Opioid overdose prevention medication
Naloxone is an FDA-approved injectable medicinal agent used for preventing an opioid overdose. It works by binding to opioid receptors and therefore can reverse and block the effects of other opioids, and it acts quickly to restore the normal respiration in a person whose breathing has slowed or stopped due to overdosing on heroin or prescription pain medications.
Though naloxone is an extremely safe medicine, it has the potential to cause a range of withdrawal symptoms, such as nausea, vomiting, diarrhea, stomach pain, fever, sweating, body aches, fast heart rate, throbbing heartbeats, increased blood pressure, nervousness, restlessness, irritability, goose bumps, shivering, etc. The withdrawal symptoms may be uncomfortable but are not life-threatening.
Medications used in MAT for alcohol addiction
Till date, three medications have received an approval from the FDA for the management of alcohol addiction:
- Naltrexone (Vivitrol® or ReVia®): Responsible for blocking opioid receptors that activate the reward effects of consuming alcohol and generate cravings for it. It has been found to be highly effective in preventing relapse in patients who indulge in excessive drinking. However, it is important to note that its effectiveness may also depend on the genetic variability of the patient.
- Acamprosate (Campral®): Found to be very effective in patients with a problem of excessive drinking, it helps an individual deal with the symptoms of long-lasting withdrawal including restlessness, anxiety, insomnia, feelings of unhappiness, and feeling unwell.
- Disulfiram (Antabuse®): The first FDA-approved oral drug used for the treatment of alcoholism. Alcohol gets converted into acetaldehyde through the action of an enzyme known as alcohol dehydrogenase, which, in turn gets converted into acetaldehyde with the action of an enzyme called acetaldehyde dehydrogenase. Disulfiram inhibits this conversion of acetaldehyde into acetic acid because of which the level of acetaldehyde builds up in the blood. This high level of acetaldehyde leads to the development of unpleasant symptoms such as palpitations, low blood pressure, chest pain, nausea, vertigo, thirst, flushing, headache, etc. These disagreeable side effects discourage alcoholics from consuming alcohol.
A fourth drug called Topiramate might also receive an FDA approval soon as it has shown some promising outcomes in large scale studies involving human beings.
Child safety and MAT medications
It is important to note and remember that if one is undergoing treatment under a MAT protocol and can keep these medicinal agents at home, then they must store them in a locked place inaccessible to children. Methadone is dispensed in a colored liquid form and it may be mistaken for a soft drink. Children who take MAT medications might overdose and potentially die.
MAT at Invictus Health Group
Substance abuse is a threat that has destroyed the life of many individuals. However, seeking substance abuse treatment at the right time can ensure long-term recovery. Invictus Health Group is a leading name in the drug and alcohol addiction industry. We work with certified medical teams and treatment centers across Southern California whom are available at all our partnering facilities, offering a research-backed addiction treatment that ensures safe withdrawal, complemented by medications and alternate therapies.
Our network of facilities pride themselves for being well-structured and safe for anyone battling substance abuse. Our network facilities administer the MAT protocol in a qualified practice setting, which means:
- Specialized cover for medical emergencies during hours when the patient’s practitioner’s practice is closed
- Provision of services related to the management of the case for patients including referrals and follow-up services especially for plans that offer or financially support services like behavioral, medical, housing, social, educational, employment, and other ancillary facilities
- Access to advanced health information tracking systems such as electronic health records (EHR)
- Treatment in accordance with the federal state law administered by practitioners registered with their state prescription drug monitoring program (PDMP)
- Acceptance of third-party payments for costs incurred in providing health services like federal health benefits, billing, credit, and collection procedures and policies
To learn more about how Invictus Health Group can help you or a loved one overcome their addiction to opioids or other forms of substances, get in touch with a treatment specialist by calling our 24/7 helpline 866-548-0190. You can also chat online with a representative for further assistance.