Over the past 30 years Medication Assisted Treatment has grown in popularity within the field of addiction treatment. While there are many non-medication based therapeutic modalities like CBT, DBT or ACT, there are now just as many medication based therapies for treating the disease of addiction. Medications for treating addiction and alcoholism have come a long way since the deterrent types like Antabuse which caused people to become ill if they drank alcohol. Today’s medications work in a way that is far more favorable to the patient. In this post we will cover the array of Medication Assisted Treatment, or MAT, medications and their indications.
Medication Assisted Treatment: Methadone
The first medication to become with widespread use for treating opioid addiction is Methadone. Methadone is a synthetic opioid developed by the Germans in the mid 1940s. It was first used as an opioid addiction treatment medication in the US in 1947. Methadone is long acting and is available in pill, liquid and sublingual tablet form.
Methadone is both an opioid agonist which bonds neatly with opioid receptors in the brain and an antagonist which blocks opioid receptors. These details make methadone uniquely useful for alleviating withdrawal symptoms during short term use in detox programs and for long term use in opioid maintenance programs.
According to various SAMHSA medical studies Methadone is the most effective of maintenance drugs. This is because there are significantly less overdose deaths associated with people that utilize methadone as a maintenance drug compared to any other maintenance medications. Additionally, since methadone dispensing is so closely monitored through DEA licensed and registered Methadone clinics, diversion rates are significantly lower than any other opioid treatment medications.
Medication Assisted Treatment: Buprenorphine
The next medication now commonly used in Medication Assisted Treatment programs is Buprenorphine. Buprenorphine is an opioid medication used to treat opioid use disorder (OUD), acute pain, and chronic pain. Buprenorphine is an opioid partial agonist. It produces effects such as euphoria or respiratory depression at low to moderate doses. With buprenorphine, however, these effects are weaker than full opioid agonists such as methadone and heroin.
Buprenorphine is available under several brand names including Suboxone, Subutex and Sublocade. Suboxone is a combination of the opioid agonist buprenorphine and the opioid blocker naltrexone and is available as a sublingual film, tablet or pill. Subutex is buprenorphine without the naltrexone and is available as a sublingual tablet. Sublocade is a long acting subcutaneous shot that contains both buprenorphine and naltrexone.
Buprenorphine was revolutionary in its widespread accessibility to opioid addicts since it can be prescribed by any registered physician or general practitioner. Patients seeking treatment for opioid use disorder can simply go to their family doctor to get prescribed the medication rather than having to go to a daily clinic like with Methadone maintenance programs. Buprenorphine products are available in almost any pharmacy and are usually prescribed in month supply quantities.
While the accessibility of buprenorphine products is high, so is the rate of diversion. It is very successful in treating opioid use disorder, but according to SAMHSA research it comes in second place in regard to opioid overdose death prevention compared to Methadone.
Medication Assisted Treatment: Naltrexone
The next medication with popular use in Medication Assisted Treatment programs is Naltrexone. Naltrexone, sold under the brand name Revia among others, is a medication primarily used to manage alcohol use or opioid use disorder by reducing cravings and feelings of euphoria associated with substance use disorder. Naltrexone was first made in 1965 and approved for medical use by 1984.
Naltrexone is not an opioid, is not addictive, and does not cause withdrawal symptoms with stop of use. Naltrexone blocks the euphoric and sedative effects of opioids such as heroin, morphine, and codeine. Naltrexone binds and blocks opioid receptors and reduces and suppresses opioid cravings. There is no abuse and diversion potential with naltrexone.
When Naltrexone is used for Opioid Use Disorder the patient must be detoxed otherwise there runs a risk of precipitated withdrawal which is a sudden peaking of extreme withdrawal symptoms. Naltrexone is often combined with Buprenorphine to be used in opioid maintenance programs.
When Naltrexone is used for the treatment of alcohol dependency it is commonly given as a shot under the brand name Vivitrol. Vivitrol has been best studied as a treatment for alcoholism. Vivitrol has been shown to decrease the quantity and frequency of ethanol consumption by reducing the dopamine release from the brain after consuming alcohol. Its overall benefit has been described as “modest”.
Medication Assisted Treatment saves lives and the proof is in the ongoing research being conducted in the field of addiction medicine. There is however controversy among the recovery and 12 step communities. Recovering addicts and alcoholics who are members of 12 step fellowship believe that abstinence is the only way to truly recover. Patients of Medication Assisted Treatment programs as such experience difficulty in finding a recovery community and experiencing the therapeutic value contained therein. Because of these challenges there are now in some cities fellowships or support groups for people using MAT.
In closing, Medication Assisted Treatment patients may use medications for various durations depending on the recommendations of a doctor or depending on their personal preference. MAT is not to be used without any other supports. It is recommended that people in MAT programs also participate in some kind of therapy or outpatient counseling program. Some people use MAT as a transition from active addiction to a point where they have greater stability in their life. At a point of greater stability, they may then choose to step down from their medication to a point of abstinence. Each person’s journey of recovery is unique to them and should be respected accordingly. If one chooses to go the route of an MAT program, they should not be ashamed for they are making healthy choices towards living a better way of life.
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