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What is Medication-Assisted Treatment (MAT)?
Medication-Assisted Treatment uses FDA approved medications in conjunction with evidence-based therapies to treat substance use disorders (SUDs). This treatment approach is used for opioid and alcohol addictions. Combining medications and behavioral therapies provides a "whole patient" approach to managing substance use disorders.
“Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery.”- Substance Abuse & Mental Health Services Administration
How Does MAT Work?
MAT is mainly used to treat opioid addictions such as heroin and prescription pain medications containing opiates. The prescribed medication works to block the euphoric effects of drugs, reduce cravings, and normalize brain chemistry and body functions as the body goes through withdrawal and stabilizes.
The Food and Drug Administration (FDA) has approved all medications used in MAT. Treatment programs are clinically driven and personalized to meet each individual's needs.
The use of medication-assisted treatment in treating drug and alcohol use disorders (AUD) can help to:
- Prevent relapse
- Block the euphoric reaction of substances
- Alleviate withdrawal symptoms
- Reduce cravings
- Help facilitate behavioral therapy
- Allow patients to focus on obligations and responsibilities during recovery
MAT is a comprehensive and individualized treatment option that increases the chances of successful recovery. Long-term benefits of MAT include:
- Improving patient survival rates
- Increasing treatment retention
- Decreasing illicit opioid use and criminal activity among those with a SUD
- Increasing patient employability
- Improving birth outcomes in women with SUDs
- Reducing the risk for HIV and hepatitis C
Types of Substance Addictions MAT Treats
MAT is currently approved to treat opioid use disorder and alcohol use disorder. Medication-assisted therapy for stimulant use disorder is still under development.
Tobacco use disorder can also be treated with MAT. Nicotine patches, gum, lozenges, and prescription medications can help people overcome their tobacco addictions.
What Medications Are Used in Medication-Assisted Treatment?
There following medications have been approved by the FDA to be used in MAT:
- Methadone (Dolophine, Methadose)
- Buprenorphine (Subutex)
- Naltrexone (Vivitrol, Revia)
- Naloxone (Narcan)
- Disulfiram (Antabuse)
- Acamprosate (Campral)
Off-Label Medications Used to Treat Drug Addiction
In some cases a doctor may prescribe a medication that is not approved by the FDA to treat substance use disorders in MAT. This is known as “off-label use.” The following drugs may be prescribed “off-label” by a treatment provider:
Antipsychotics treat psychosis rooted in mental illness, as opposed to psychosis caused by substance use. However, they are still effective in managing alcohol and drug use linked to mental illness.
These medications include:
- First-generation antipsychotics including Chlorpromazine (Thorazine), Haloperidol (Haldol), Loxapine (Loxitane), Molindone (Moban), and Perphenazine (Trilafon)
- Second-generation antipsychotics including Clozapine (Clozaril), Olanzapine (Zyprexa), Risperidone (Risperdal) and Quetiapine (Seroquel)
- Third-generation antipsychotics including Aripiprazole (Abilify), Brexpiprazole (Rexulti), and Cariprazine (Vraylar)
Anticonvulsant medications, including topiramate and gabapentin, have shown promising results in treating alcohol use disorder. However, they are not FDA approved.
Beta-blockers are primarily used to prevent heart attacks, angina, and migraines. They also get used off-label for several uses, including drug and alcohol rehabilitation with co-occurring disorders. They work to prevent neurotransmitters from attaching to beta receptors on nerves, which reduces anxiety.
Clonidine is an anti-hypertensive medication. It blocks chemicals in the brain that trigger sympathetic nervous system activity. Sometimes it can treat opioid dependence by reducing the symptoms of detoxification. Clonidine also reduces anxiety and might shorten the time it takes to detox. It does not cure addiction, but it makes relapse less likely during the detoxification phase.
Medication-Assisted Therapy and Opioid Addiction
The medications used in MAT do not cure opiate dependence. They assist the patient in maintaining abstinence from opioids. Some medications block the withdrawal symptoms during opioid addiction treatment, while others focus on preventing the euphoric effects of opioid use.
Under federal law, opioid treatment programs require patients who receive MAT to receive medical, counseling, vocational, educational, and other assessment and treatment services.
The following medications may be used in the treatment of opioid use disorder:
Methadone is one of the most commonly prescribed medications used in the treatment of opioid dependence. It is a full opioid agonist, which means it activates the opioid receptors in the brain. This alleviates cravings and withdrawal symptoms and blunts the effects of opioids.
Methadone should only be used under a doctor's direct supervision. It is the only drug approved for pregnant or breastfeeding women using MAT.
Buprenorphine is a partial opioid agonist. It produces effects similar to other opioids. However, the effects are much weaker. People are unlikely to abuse buprenorphine because of its “ceiling effect,” which means more doses don’t trigger additional side effects. Like methadone, buprenorphine can reduce opioid cravings, withdrawal symptoms, and effects of other opioids.
Naltrexone (Vivitrol, Revia)
Naltrexone works differently than methadone and buprenorphine because it is an opioid antagonist. This means it blocks the effects of drugs. If someone relapses while taking naltrexone, they will not experience the euphoria that they did in the past. Naltrexone is also used to treat alcohol use disorder.
Naloxone is used to treat someone who has overdosed on heroin, morphine, oxycodone and other types of opioids. Some states allow people who know someone with an opioid use disorder to carry naloxone in injectable form in case of overdose. There is also a nasal spray version that can be used without any special training.
Naloxone works by blocking the effects of opioids and heroin. These drugs slow a person’s breathing, and when someone overdoses, their breathing can stop. When naloxone is administered soon enough after an overdose, it counters the effects and can save someone’s life.
Naloxone also puts a person into withdrawal, which can trigger vomiting, shaking, and sweating. Naloxone is effective even if opioids are misused at the same time as other sedatives or stimulants. However, it cannot treat overdoses of benzodiazepines or stimulant overdoses involving cocaine and amphetamines.
Medication-Assisted Therapy and Alcohol Addiction
Alcohol use disorder can be treated with MAT as well. These medications do not cure alcohol use disorder. However, they can be very effective at assisting in recovery by controlling cravings and blocking the euphoric effects of alcohol.
Medications used for alcohol use disorder include:
Disulfiram treats chronic alcoholism. It changes the way your body metabolizes alcohol. It creates an adverse physiological reaction to acetaldehyde, which is a chemical in alcohol. If you drink alcohol while taking disulfiram, it will trigger a headache, nausea, and possibly vomiting. It is most effective in people who have already gone through detoxification or are in the first stages of abstinence.
Acamprosate is for people who have already stopped drinking and want to continue sobriety. It does not prevent withdrawal symptoms just after you stop drinking. It gets prescribed five days after abstinence begins and is fully effective in another five to eight days.
Naltrexone blocks the euphoric effects of alcohol. It helps people reduce their drinking behaviors and increases their motivation to stay in treatment and their ability to avoid relapses.
How Strong Is the Evidence behind MAT?
The outcomes are much better when you undergo medication-assisted treatment than if you don't. It significantly decreases the risk of relapse, and it is also effective in preventing infectious diseases like HIV.
MAT has also been shown to be effective in preventing overdoses. For example, one study found that deaths from opioid overdoses reduced as treatment with buprenorphine became more popular in Baltimore.8 Buprenorphine is one of the three drugs often used for MAT.
However, while there is plenty of evidence supporting the success and efficacy of MAT, there are still gaps in the scientific literature that must be addressed. MAT is also not approved or recommended to treat every addiction.
Common Questions & Concerns
Am I sober if I’m using MAT?
Yes, medications used in MAT help patients avoid relapse and manage their addiction. They are no different than using medication to control blood pressure, diabetes, or any other chronic condition. MAT medications are safe, controlled, and effective, and do not trigger highs or euphoria like the drugs associated with addiction.
Can I be a member of Alcoholics Anonymous or Narcotics Anonymous if I’m using MAT?
How Much Does MAT Cost?
Medication-Assisted Treatment costs vary greatly from program to program, depending on which drug is administered and other factors.
-Methadone treatment costs about $126.00 per week or between $4000 and $7000 per year.
-Buprenorphine given to stable patients is approximately $115 per week or just under $600 per year.
-Naltrexone is approximately $1200 per month or $14,100 per year.
Does Insurance Cover MAT?
Sometimes. Treatment coverage for substance use disorders (SUD) became more widely available following the passage of the Affordable Care Act. The Mental Health Parity and Addiction Equity Act of 2008 also requires insurance providers to offer the same level of benefits for mental and/or substance use treatment as they do for medical and surgical care.
Does Medicaid Cover MAT?
Medicaid programs and what they cover vary from state to state. For example, most state Medicaid plans cover Methadone treatment. Arkansas, Idaho, Kansas, Kentucky, Louisiana, Nebraska, North Dakota, South Carolina, Tennessee, and Wyoming do not. Most states cover suboxone treatment, but there are specific requirements regarding amounts and administration. The best way to determine what financial support is available is to contact a specific state’s Medicaid office.
How Effective is Medication-Assisted Treatment?
MAT is effective for helping people overcome substance abuse disorders. It is an evidence-based form of treatment, which means there is research proving its effectiveness. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT is “clinically effective” and significantly reduces the need for inpatient detoxification.
Many healthcare professionals believe MAT is underused due, in part, to the misconceptions about substituting one drug for another. Patients also have concerns about using drugs in their recovery from addiction. More training and education is needed to change opinions toward MAT in the addiction community.