From opioid misuse to increased opioid-use related overdoses to the rising incidence of newborns experiencing opioid withdrawal symptoms, the devastating consequences of the opioid epidemic continue to increase. With such consequences arises conversations regarding the appropriate treatment of Opioid Use Disorder, often evoking debates whether traditional total-abstinence or harm-reduction approaches are most efficacious. If one were to research Medication-Assisted treatment, they would likely find a number of opinions. That’s not what I’m here to do; today, I want to present you with some facts regarding what MAT is and the various forms of MAT programs available.
According to the United States Department of Health and Human Services, Substance Use and Health Services Administration, and The Center for Substance Use Treatment, MAT is defined as “the use of medication, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders” and is an evidence-based form of treatment. MAT can be used for persons experiencing Alcohol Use Disorder, Tobacco Use Disorder, and Opiate Use Disorder and can be used to treat the acute withdrawal symptoms associated with detoxification and for long-term recovery.
Types of MAT Programs
MAT for Opioid Use Disorder falls into three categories: antagonist, partial agonist, and full agonist.
Antagonist forms of MAT include naltrexone tablets or Vivitrol injections and were initially approved for maintenance therapy in 1984. The antagonist works by binding to the mu opiate receptors to displace opiates from affected receptors and blocking the effects. According to SAMHSA, antagonist therapy has a 20% retention rate after one year of treatment. Initiation to antagonist therapy requires a person to maintain abstinence from short-acting opioids for seven days and from long-acting opioids for at least ten days.
Partial agonist forms of MAT include Suboxone, Zubsolv, and Probuphine and was granted approval for office-based treatment of Opioid Use Disorder via the Drug Addiction Treatment Act of 2000. This form of therapy does not fully activate the mu receptors, resulting in a ceiling effect: the dose peaks at 32-40 mg, then becomes fully antagonistic and can shut down opiate receptors completely. This form of therapy has a longer half-life (37 hours) and comes with a decreased risk of respiratory depression when compared with full opioid agonists. SAMHSA estimates a 60% retention rate after one year of treatment.
Lastly, full opioid agonist forms of MAT include Methadone/Methadose. Methadone was originally approved for analgesic uses in 1947, began to show efficacy in the treatment of Opioid Use Disorders in the mid-60s, and was approved for treatment in 1972. This form of treatment produces a range of mu agonist effects similar to that of a short-acting opioid, also has a longer half-life (28 hours) and when prescribed inadequate doss can suppress withdrawal symptoms and cravings for 24-36 hours. This has been considered the “gold standard” for opioid use disorder replacement therapy and also has been shown to have a 60% retention rate after one year of treatment.
In conclusion, there are numerous studies and data available that support MAT use and show that recovery success increases substantially when MAT is incorporated. Some of those successes include: 80% of persons receiving MAT maintained continued sobriety after one year, 50% after three to five years; 75% decrease in crime rates; $7-12 savings for every $1 spent; and decreased psychiatric, family/social, medical, and vocational problems.