Medication-Assisted Treatment for Opioid Addiction

Medication-assisted treatment for opioid addiction is the most effective approach to treating opioid use disorders (OUD).¹ Opioids are a class of drugs that interact with the opioid receptors of the nervous system and reduce the feeling of pain. There are several subcategories of opioids:²

• Natural substances obtained from the poppy plant, such as heroin, morphine, and codeine. These natural opioids, whether legal or illegal, are often referred to as opiates.
• Synthetic prescription drugs such as methadone, which is used in addiction treatment, and opioid analgesics such as tramadol and fentanyl.
• Semi-synthetic prescription opioid drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone.

As a result of the partial overlap in the use of the word opioids and opiates, the term medication-assisted treatment for opiate addiction are also present in literature, as well as the abbreviation MAT opioid treatment. MAT as an approach is also used for treating alcohol use disorder, but the medicines that are prescribed for alcohol treatment are not the same as for opioid treatment.

The Importance of MAT Opioid Treatment

This kind of treatment involves medications in combination with behavioral counseling, the aim of which is to help the patient both physically and psychologically. Including medications in treatment may have a positive impact on how long the patient stays in treatment.  This may improve chances of recovery and reduces risks related to OUD, the most prominent ones being overdose death, infectious disease transmission (HIV and hepatitis C), and criminal activity.³

Despite these proven benefits, opioid addiction treatment medications are still underused, especially among some private treatment programs. On the other hand, opioid overdose still kills more people in the U.S. than car crashes.⁴

Regarding the number of people suffering from OUD, the statistics of the Substance Abuse and Mental Health Service Administration from 2017 showed that 11.1 million people misused prescription opioid drugs, while 886,000 people used heroin. In order to address this major public health concern, U.S. health authorities have placed a high priority on expanding access to medication-assisted treatment for opioid addiction and improving treatment capacities.³

How Does Medication-Assisted Treatment for Opioid Addiction Work?

Medication-assisted treatment consists of using medications in conjunction with behavioral therapy. The functions of medication in MAT opioid treatment are the following:⁵

• Reducing substance use
• Preventing overdose
• Alleviating unpleasant withdrawal symptoms
• Preventing relapse
• Maintaining abstinence

Taking medications is not treatment for opioid addiction in itself, but helps patients regain the biochemical balance in the body which was disrupted by opioid drugs. When patients are physically and psychologically stable, they can work on perceptions, emotions, thoughts, and behaviors and make changes in order to lead a healthy life without addiction.⁶ There are various forms of behavioral therapy, group and individual, proven to be effective in substance use treatment.⁷

Which form of behavioral therapy will be selected depends on the particular case. The same applies to the choice of appropriate medication, and whether outpatient treatment is possible or inpatient treatment is a more recommendable option.⁸ Medication-assisted treatment for opioid addiction is not a “one size fits all” solution: it is always individually tailored to meet the treatment needs of a particular patient.⁹

Which Medicines Are Used?

The opioid addiction treatment medication approved by the Federal Drug Administration (FDA) for treating OUD are methadone, buprenorphine, and naltrexone.¹⁰

Methadone

Methadone is a long-acting opioid agonist, which means that it activates the same receptors in the brain as opioids, which reduces drug cravings and blocks the effects of opioid drugs, like heroin. It is used for treating withdrawal symptoms and maintaining abstinence.⁴

Methadone comes in several forms: liquid concentrate, tablet, oral solution of powder, and dispersible tablet. It is taken orally once a day and the dosage and the length of treatment will vary significantly, depending on the particular case. A patient may be treated with methadone as long as medically necessary.⁴ Some research suggests that treatment should not be shorter than three months to ensure substantial improvement.⁵

Buprenorphine

Buprenorphine is a partial opioid agonist that tightly binds to opioid receptors and prevents other opioids from binding to the same receptors. The result is that the strong effects of opioid drugs such as euphoria or respiratory depression are blocked.⁴

The potential for its misuse is very low and to prevent misuse of this treatment drug even further, a substance called naloxone was added to certain products that contain buprenorphine.⁵

Naloxone

Naloxone functions as a deterrent, so if a patient tries to abuse the treatment drug and not use it as prescribed, they will experience unpleasant withdrawal symptoms.⁵ Buprenorphine comes in the form of sublingual tablets, sublingual or buccal film, injections, and implants for subdermal administration.¹⁰

Naltrexone

Naltrexone is a long-acting opioid antagonist, which means that it blocks the effects that opioids, like oxycodone, produce when they bind to opioid receptors. It is not used in the stage of detoxification to manage withdrawal, but rather after this stage for the purpose of reducing opioid cravings. In order to start naltrexone treatment, the patient needs to be abstinent for at least seven days.⁴ It comes in the form of an extended-release intramuscular injection that is administered once a month.¹¹

Naloxone

In some cases, medication-assisted treatment for opioid addiction may start by trying to save the person from an opioid overdose. The medicine used for this purpose is called naloxone. It is an opioid antagonist used to reverse the effects of an overdose. This medication is administered in the form of a nasal spray or injections (intravenous, intramuscular, and subcutaneous). It is typically administered by first responders and has a temporary effect. After being given naloxone, the patient needs to get further medical care as soon as possible.¹²

Additional Medications

In addition to the medications used specifically for opioid addiction treatment, there are also some ancillary medications, including some over-the-counter remedies, that are not intended for treating addiction but are used as help in mitigating some of the withdrawal symptoms:¹³

• Clonidine for anxiety, irritability, and sweating
• Diphenhydramine or trazodone for insomnia
• Nonsteroidal anti-inflammatory drugs for pain management
• Ondansetron and metoclopramide for nausea
• Loperamide for diarrhea

 

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