Medication-Assisted Treatment

Addiction is a chronic medical disease that can be treated as successfully as other chronic health conditions such as diabetes or hypertension.¹ In many cases, medically assisted treatment may be necessary to help patients safely detox from addictive substances and overcome unpleasant withdrawal symptoms. They also may be beneficial in the prevention of relapse and overdose.²

What Is Medication-Assisted Treatment?

Medication-assisted treatment (MAT) is an approach to treating substance use disorders that employs medicines in combination with behavioral counseling and other forms of therapy.1

There is a list of medications used in MAT that are approved by the Federal Drug Administration (FDA).3 Which medication will be used and in which dosage depends on the severity of a particular case, whether it is used to treat heroin addiction or other substance abuse, and other case-specific factors. It is therefore vital that medication is used exactly as prescribed.2

Parallel with taking medication, patients undergoing medication-assisted treatment for substance abuse also need to work on changing their perceptions, attitudes, emotions, and behaviors. This helps them cope with triggers that may have prompted them to abuse substances. By developing these skills, patients become able to lead healthy lives without addiction. There are many forms of behavioral therapy that have proven to be effective in substance abuse treatment.⁴ The choice of behavioral treatment will also depend on the treatment needs of a particular patient and accessibility of treatment facilities.

Medically assisted treatment may be used to treat opioid use disorders, which includes both illicit opioid drugs and prescription drugs. Additionally, MAT may also be part of alcohol addiction treatment.

How Effective Is Medication-Assisted Treatment?

There are several confirmed positive effects of MAT, including:

• Decreased opiate use and improved chance of patient survival.1
• Prevention of opiate overdose-related deaths.⁵
• Lower risk of infectious diseases such as HIV or hepatitis C.¹
• Less criminal activity.⁵
• Improved ability to gain and maintain employment.¹
• Improved birth outcomes in pregnant patients with substance use disorders.⁵

In addition, patients tend to stay in treatment longer when medication is used in substance abuse treatment compared to treatment options in which there is no medication that can help them stabilize. When trying to quit using drugs, a great number of people may experience very unpleasant withdrawal symptoms, which they cannot cope with, so they go back to using drugs and quit treatment. If medication is used to help manage withdrawal, then patients can detox more successfully and focus on other elements of therapy that would eventually result in long-term recovery. ⁵

What Medications Are Used In Medication-Assisted Treatment?

Medications Used for Opioid Use Disorders

• Methadone is an opioid agonist, which means that it activates the same nervous system receptors as heroin. In contrast to illegal drugs, it is safer and it does not cause either the sensation of euphoria or sedation, so the person is able to function normally.⁶ It helps people go through withdrawal and reduces cravings for opioids.⁷ Patients take their daily dose of methadone orally in the form of tablets (Dolophine) or oral concentrate (Methadose), which can be obtained only through approved programs.⁸
• Buprenorphine is a partial opioid agonist, which means that it activates opioid receptors but to a lesser extent than illicit opioids or methadone. Unlike methadone, it can be prescribed by physicians and is, therefore, a more accessible form of treatment.⁹ It comes in the form of sublingual tablets (Subutex, Suboxone, Zubsolv), sublingual film (Cassipa, Suboxone), buccal film (Bunavail), injections (Sublocade), and subdermal implants (Probuphine).³
• To prevent abuse of this medication, some of its forms also include a substance called naloxone. Since there is a risk that opioid treatment medications may get abused, if someone tries to abuse buprenorphine and inject it, naloxone will cause unpleasant withdrawal symptoms. As a result, patients will abstain from abusing this medication.¹⁰
• Naltrexone is an opioid antagonist, which means that it blocks the effects of addictive substances on the receptors of the nervous system, which reduces cravings. Unlike methadone and buprenorphine, there is no potential for its abuse or diversion. It is given to the patient once a month in the form of a slow-acting intramuscular injection called Vivitrol.¹¹
• Lofexidine is used in medically-assisted treatment for helping patients cope with unpleasant withdrawal symptoms. It is not used for long-term treatment but rather in a detox stage. It is used in the form of oral tablets called Lucemyra.¹²

Medications Used for Alcohol Use Disorders

• Acamprosate is used in medically assisted treatment of alcoholism to prevent relapse. It is not used in the stage of detox to mitigate withdrawal symptoms but is intended for people in recovery who are abstinent in order to maintain their abstinence.¹³ It comes in the form of oral tablets Campral.
• Disulfiram is used in medically assisted treatment of chronic alcoholism. It disrupts the metabolism of alcohol and discourages alcohol consumption because the patient experiences unpleasant effects when drinking alcohol.¹⁴ This medicine comes in the form of oral tablets Antabuse and is used once a day.
• Naltrexone is used in alcohol treatment for blocking the euphoric effects of alcohol, which results in reduced cravings and the amount of alcohol consumed. It helps patients stay sober after quitting alcohol. Treatment with this medication lasts for three to four months, during which period patients take one pill per day.¹¹