Medication-assisted treatment (MAT) helps people with addiction to drugs or alcohol achieve sobriety and maintain recovery. Addiction is a chronic disease that can be treated effectively with medication, counseling and peer support. When used during addiction treatment, MAT can decrease discomfort, prevent dangerous symptoms and help with cravings.
How Medication-Assisted Treatment Works
Most importantly, Medication-Assisted Treatment (MAT) is the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.
Presently, there are medications to help treat patients with alcohol use disorder and opioid use disorder. However, there are other medications that are helpful in the treatment of the anxiety, depression or physical withdrawal symptoms that can occur during detoxification from other substances.
Medication-Assisted Treatment for Alcohol Misuse
For patients with alcohol use disorders, there are a few MAT options. Two medications, acamprosate and naltrexone, can help suppress the urge to drink. Naltrexone has also been shown to decrease the euphoria that some people experience after drinking, reducing the number of drinks consumed if a patient in recovery relapses. Both of these medications can be administered in pill form, and naltrexone is also available in a once-monthly shot. Another pill available is disulfiram, also known as Antabuse, which does not affect the urge to drink but causes very unpleasant symptoms if a patient drinks alcohol. Those symptoms include headache, nausea, vomiting, skin flushing and sweats, chest discomfort, and anxiety.
Medication-Assisted Treatment for Opioid Misuse
For opioid dependent patients, treatment can be undertaken with agonist or antagonist medication. Opioid agonists are those that stimulate opioid receptors in the brain while antagonists block those receptors. Drugs like heroin, fentanyl, oxycodone, and others act in the brain by stimulating opioid receptors. Over time, higher and higher doses of the patient’s drug of choice is needed to get the same effect. When these short-acting drugs wear off, the patient experiences withdrawal and cravings to use again.
Specifically, the antagonist medication used for opioid-dependent patients is naltrexone. This blocks the opioid receptors in the brain, making opioids ineffective. If a patient relapses on an opioid drug, no effect is felt. It is important to know that naltrexone does not improve opioid withdrawal symptoms like agonist medications. The injectable form of naltrexone is usually preferred over the pill form for opioid use disorder.
And, two different agonist medications can be used to treat opioid use disorder. The first is methadone, which must be administered in a qualified methadone clinic, usually on a daily basis. When dosed correctly, methadone does not cause euphoria or a “high” and suppresses the urge to use other opioids. The other agonist medication is buprenorphine, which goes by several brand names including Suboxone and Zubsolv. It is considered a partial agonist, meaning it partially stimulates opioid receptors. Because of this, buprenorphine is thought to have a “ceiling effect” which means above a certain dose, it will have no greater effect. This is important as it makes it difficult for an opioid-dependent patient to experience euphoria or to overdose on buprenorphine. However, in combination with other medications that can cause sedation such as benzodiazepines, especially alprazolam (Xanax), overdose can occur.
Common Misconceptions about Medication-Assisted Treatment
When considering Medication-assisted treatment, the word “assisted” is important because medication helps, rather than replaces, other forms of addiction treatment.
For instance, a common misconception about MAT — even among health care workers and people in recovery — is that MAT replaces drugs with other drugs. However, opioid agonists “normalize” the brain chemistry of an opioid-dependent patient. Patients are not “high” and are not sedated. Rather, patients can feel like themselves again. It is important to take medication as prescribed and not miss a dose as withdrawal symptoms can occur. And that “withdrawal” from a medication does not mean the patient is “addicted” to the medication. If that were true, patients would also be considered “addicted” to their medication for other illnesses like high blood pressure, diabetes, or dozens of other chronic diseases that can become symptomatic when stopping prescribed medications.
Medication-Assisted Treatment Is Effective
In conclusion, more people on MAT stay clean and sober than those who do not engage in MAT. MAT enables more people to stay involved in treatment. The results include healthier relationships, secure employment, self-sufficiency, less criminal activity, and less exposure to dangerous illnesses such as Hepatitis and HIV.
For example, Valley Hope encourages patients in treatment to meet with our medical providers to decide whether MAT is right for them, and provides medically-monitored detox to help ease withdrawal in a safe, supportive environment.
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By Dr. Jon Siebert, Medical Director, Valley Hope
Dr. Jon Siebert has spent more than 18 years in medicine. He is board certified in family practice, as well as addiction medicine by the American Board of Addiction Medicine. Dr. Siebert earned his Bachelor of Science in biology from Kansas State University and a medical degree from the University of Kansas School of Medicine.