What is Medication-Assisted Treatment?
Medication-assisted treatment, also known as MAT for short, is the use of medication as part of a broader treatment plan for substance use disorder (SUD). At first, it might sound odd that medications can be used to treat a condition that’s so often associated with factors like social, psychological, emotional, and even spiritual health.
As you’ll learn in this article, MAT is not a standalone treatment for SUD. However, as part of a holistic treatment plan, MAT fills a vital role that greatly increases the likelihood of success in sobriety and recovery from substance dependence.
What is treated with Medication-Assisted Treatment?
While there are many substances abused in our society, two common reasons that people seek treatment are for alcohol use disorder (AUD) and opioid use disorder (OUD). Alcohol and the class of opiates as a whole are two areas we have medications that play an effective role in treatment.
Why is Medication-Assisted Treatment Important?
The data on treatment with MAT and without is pretty clear. A wide variety of health outcomes are improved. Not only that, social and other life factors improve as well.
Individuals receiving MAT have increased survival. Think of decreased overdoses, decreased liver disease, etc. The reason is, MAT increases retention in treatment and therefore, an absence of use from the very substances that directly contribute to decreased survival in the first place.
Due to MAT’s effectiveness, it also comes as little surprise that individuals receiving MAT also experience less criminal activity, and increased ability to gain and maintain employment. With MAT, research also shows a decreased likelihood of contracting bloodborne infections such as HIV and hepatitis C.(1)
Medication-Assisted Treatment for Opioid Use Disorder
Suboxone is a widely used medication in OUD treatment. Suboxone is a brand name of the medication that actually contains two drugs, buprenorphine and naloxone. Let’s look at them one at a time.
Buprenorphine is what’s called a partial agonist. A little background will help explain what this means. The body has a number of different receptors throughout that bind, or respond to, opiates. The gut and brain are common places where these are found. Our body naturally produces opiate compounds called endorphins that bind to these receptors and activate them. They are part of our normal health and physiology. Opiates like morphine, and all the other commonly abused opiates, bind to these same receptors. When something binds and activates a receptor, it’s called an agonist. If it blocks the action, it’s called an antagonist.
This means that buprenorphine, being a partial agonist, is a partial activator. The reason this is important, is that since it has some activating properties, it can be used to replace dangerous street drugs like fentanyl or heroin, and this can usually be done without the need for a traditional detox. Buprenorphine also helps and can eliminate cravings, since the brain is now getting some opiate activity from the drug. Think of it like a band-aid for withdrawal and craving. This process of switching out an abused drug for buprenorphine is called an induction.
Due to the fact that buprenorphine can give some opiate effects, it has been abused by some by melting it and then injecting. This is where the second ingredient in Suboxone, naloxone, comes in. Anyone who’s been around opiates very long knows about naloxone. It’s the emergency overdose medication that has saved countless lives. Naloxone was put alongside buprenorphine to avoid its abuse. If someone injects Suboxone, the naloxone blocks its activity and the user doesn’t get high.
When used medically in its intended form, the buprenorphine still gets to the brain and does its intended job, without requiring escalating doses for the same effect.
Naltrexone is the opposite of buprenorphine and other opiates. It binds to opiate receptors but blocks the action. Naltrexone is an opiate antagonist. An easy way to think about it is, it essentially does the same thing as naloxone, but it sticks around longer before wearing off.
Naltrexone is used after detox to prevent relapse and help decrease physical cravings for opiates. Naltrexone is a bit like a security blanket against repeated relapse. Because it blocks the opiate receptors, if an opiate is used while on naltrexone, it doesn’t have the desired effect. Basically, the user doesn’t get high. As long as naltrexone is present in the system, it’s an effective protection against getting high and cycling back into dependence.
Methadone is the oldest FDA approved MAT for OUD. It is an agonist and because of this, is at risk for abuse and diversion (illegal resale). For this reason, methadone is distributed from specific “methadone clinics”, where the individuals go, usually daily, to receive their dose. As you can imagine, this can create difficulties. If you’re unable to show up for methadone administration, withdrawal could ensue and lead to relapse. Individuals are relatively bound to the location as long as they are under methadone treatment.
This being said, methadone is very effective at decreasing withdrawal and helping individuals become stable without the dangerous and continued dependence on illegal opiate sources.
Methadone is typically not the first option addiction medicine providers recommend, as the other MAT options mentioned have less risk and side effects, and can be more safely prescribed for home use. Medication-Assisted Treatment for Alcohol
Alcohol is metabolized/broken down in the liver. Disulfiram works in the liver so that the pathway that breaks down alcohol is interrupted. If alcohol is drunk while on disulfiram, middle products of the breakdown process build up and illness ensues. How sick one gets if they drink while taking disulfiram is relative to how much alcohol they drink.
Illness from drinking while on disulfiram is very unpleasant. Symptoms include(2) Flushing Sweating Throbbing Headache Increased Thirst Nausea and Severe Vomiting Blurred Vision Neck Pain Chest pain, Shortness of Breath Fast or Pounding Heartbeats; Fluttering in Chest; Confusion Weakness Spinning Sensation Light-headed Antabuse is an effective deterrent to drinking alcohol, while the individual works a program of counseling, groups, and other recovery support.
Naltrexone is also used for AUD. While naltrexone does not make the user ill if they drink alcohol, the typical experience is that alcohol craving is decreased. Alcohol also has a different “feel” while on naltrexone. Most notably, it lacks the euphoric feeling, which is another deterrent to drinking.
This medication is started once detox and abstinence has been achieved. Acamprosate is thought to support recovery success by helping to restore the balance of the calming and excitatory parts of the brain that can get altered with chronic alcohol abuse.
Is Medication-Assisted Treatment right for me?
In AUD and OUD, MAT is often an important component to the treatment plan. As you can tell from the information provided, medications are not themselves the solution. Establishing care with a MAT provider to discuss your options is important to make sure your individual needs and health history are being taken into account.
Establishing with a Personal Recovery Coach at Mindful Care is a great first step to begin your journey to recovery and build a personalized plan to help you meet your goals.
References: Substance Abuse and Mental Health Services Administration https://www.samhsa.gov/medication-assisted-treatment https://www.drugs.com/mtm/disulfiram.html