Medication-Assisted Treatment – Busting the Myths
When managing addiction, many people fear the judgement of others for their choices about treatment decisions. There are multiple ways to approach recovery. And medication-assisted treatment (MAT) is a viable and appropriate choice for some. You and your treatment team will decide which course of action is best for you. When talking with others you may experience negative feedback about your choices. Below are some facts from the research that support MAT.
Medication-Assisted Treatment (MAT)
The National Institute on Drug Abuse, the Centers for Disease Control and Prevention, and the World Health Organization all recognize medication-assisted treatment as the “gold standard” of opioid addiction treatment. And in September 2018, Surgeon General Jerome M. Adams issued a report calling for access to FDA-approved medications – along with behavioral interventions and support groups – as a component of treatment.
The Goal of MAT …
According to the Substance Abuse and Mental Health Services Association (SAMHSA) the ultimate goal of MAT is full recovery. This includes the ability to live a self-directed life. The MAT approach has been shown to:
- Improve patient outcomes
- Increase retention in treatment
- Decrease illicit opiate use and other criminal activity among people with substance use disorders
- Increase patients’ ability to gain and maintain employment
- Improve birth outcomes among women who have substance use disorders and are pregnant
Research also shows that these medications and therapies can contribute to lowering a person’s risk of contracting HIV or hepatitis C by reducing the potential for relapse.
Opioid Agonists: Methadone and Buprenorphine
The FDA has approved two opioid agonist drugs for opioid use disorder. And the FDA mandates that both (as well as a third option, naltrexone) be made available to patients.
Methadone ( Intensol and Methadose)
Methadone is an opioid agonist; meaning it activates opioid receptors in the brain. Methadone works like heroin and prescription opioids, but its long-acting properties reduce cravings and ease withdrawal symptoms without producing euphoria. It’s a less intense response as compared to heroin and other opioids.
The patient’s brain is “tricked” into believing it has received the expected dose of the drug. Although the patient experiences no withdrawal symptoms and no “high”, allowing them to function normally.
Buprenorphine (Buprenex, Subutex)
Buprenorphine is an opioid medication used to treat opioid use disorders (OUD). It is classified as a partial opioid agonist, meaning it has both agonistic (activating) and antagonistic (blocking) effects. Like methadone, buprenorphine activates opioid receptors but to a lesser degree when it attaches to opioid receptors. It also blocks other opioids, such as heroin or morphine, from attaching to the receptor. This limits their euphoria-producing abilities.
Thus, freedom from withdrawal symptoms and the absence of intoxication diminish the compulsive drug-seeking behaviors characteristic of addiction. Additionally, buprenorphine has a ceiling effect (saturation has been reached). Which makes it less likely to cause respiratory depression and other side effects associated with opioid agonists.
The potential for abuse is present with the pill form, but when used under close medical supervision, buprenorphine is safe and effective to treat opioid addiction. To eliminate the concerns about abuse, buprenorphine is available as an injectable, administered by a medical professional.
And for patients who are at risk of misusing buprenorphine, doctors can prescribe Suboxone ( administered daily by dissolving a film under the tongue or as a sublingual tablet), Zubsolv (sublingual – under the tongue – pill) and Bunavail (buccal film – in mouth). They all contain a combination of buprenorphine and naloxone.
Opioid Antagonists: Naloxone and Naltrexone
Naloxone (Narcan, Evzio)
Naloxone can immediately reverse the effects of an opioid overdose. After treatment, when a person’s tolerance is lower, the risk of overdose is greater. Because of this, a nasal spray formula of naloxone, Narcan, is an essential component to MAT. There is also an injectable Narcan which is often given at no charge. In the Grand Rapids area, the Red Project provides Naloxone and Naloxone training at no charge.
Naltrexone (VIVITROL, Revia)
Naltrexone is a non-addictive opiate antagonist that has helped many individuals remain drug-free during their initial recovery period. It can also be used as a treatment for alcohol addiction. Because it has been shown to reduce the reward or pleasure of drinking and craving induced by environmental stimuli. The drug is available in a daily pill or a monthly injection (VIVITROL).
The FDA recommends that treatment with MAT medications continue as long as necessary for a patient’s full recovery.
Additionally, SAMHSA mandates that all MAT programs include behavioral therapies and support programs, as well as regular drug testing.
Common MAT myths and beliefs
Myth #1: MAT replaces one addiction with another.
Sometimes patients and their families or friends wonder why doctors use drugs like buprenorphine or methadone to treat opioid addiction. Especially since these medicines are in the same family as heroin and prescription opioid pain medication. However, physician-prescribed buprenorphine and methadone are not just “substituting” one addiction for another.
Addiction treatment uses longer-acting and safer medications to help overcome more dangerous opioid addictions. Many studies have shown that maintenance treatment with long-acting opioids like methadone or buprenorphine helps keep patients healthier, reduces criminal activity, and helps prevent drug-related diseases like HIV/AIDs and hepatitis.
Patients who strongly object to using maintenance opioids for any reason may choose a different type of MAT. For example, naltrexone is not an opioid drug, and actually works by blocking the effects of opioids in the brain.
Myth #2: MAT is a bad moral choice. It is inferior to complete, unassisted abstinence.
Some of the negative stigma of MAT comes from different ways of understanding addiction. Some people with opioid use disorder and their communities view addiction as a moral and spiritual failing, not as a medical disease. In this view, medical treatment with methadone may seem like a “crutch,” or a weak moral choice. Because the patient is continuing to use an opioid on a daily basis.
Complete, unassisted abstinence is the most common treatment plan in this view of addiction. MAT’s ability to make addiction recovery easier and less painful may not be seen as a benefit, but may suggest that a patient “isn’t as serious” about quitting. MAT patients do not meet many 12-step programs’ definitions of abstinence because of their use of opioid medications. Individuals attending 12-step groups may be criticized as having “traded one drug for another” if they reveal that they are seeking treatment with buprenorphine or methadone. This is not always the case, and many AA and NA members understand the role of MAT in recovery.
Instead of understanding addiction as only a moral or spiritual failing, many medical professionals have begun to view opioid addiction as a medical disease. The disease of addiction can be caused by repeated exposure to a drug, coupled with genetic or environmental risk factors, leading to physical changes in the brain’s opioid receptors. In this view, addiction can be treated and managed with medication, much like other medical diseases.
Myth #3: MAT is not effective because it does not immediately end drug dependence.
MAT does not “cure” opioid use disorder or addiction. Addiction is a “chronic” (long-lasting) disease. Medical treatment for addiction can be compared to medical treatment for other common chronic diseases like diabetes or high blood pressure. Just as diabetes is not “cured” by the use of insulin, and people with high blood pressure often continue taking medications for many years. So, people with opioid addiction are not “cured” but instead well-managed by MAT.
Myth #4: “I’ve known a few people who could stop using opioids without help from any kind of medication. MAT is only for the weak. “
Though opioid abuse may begin with a series of poor judgments, addiction involves real, physical changes in the brain. While some people are eventually able to quit using opioids on their own, the majority of patients go though many dangerous cycles of relapse and recovery. MAT can make the recovery process much safer. And it has saved many lives by preventing death from overdose or dangerous behaviors associated with “street” drug use.
Federal law requires patients who receive treatment in an opioid treatment program (OTP) to receive medical, counseling, vocational, educational, and other assessment and treatment services, in addition to prescribed medication. The law allows MAT professionals to provide treatment and services in a range of settings. This includes hospitals, correctional facilities, offices, and remote clinics.
Studies have shown that people with opioid use disorders (OUD), as well as those dependent on other substances, achieve recovery with fewer relapses when MAT is part of their treatment program.
But despite the documented efficacy of opioid agonist therapy, skepticism and stigma persist among the general public and within the recovery community.
According to researchers from Oregon Health & Science University, “Frequently cited barriers to the use of agonist and antagonist medication include patients and families who request drug-free treatment, persistent expectations of abstinence as the only appropriate treatment outcome, staff resistance to the use of medications, and the cost of the medications; many addiction treatment centers, moreover, do not have prescribers on staff.”
But there’s no ignoring the facts.
In 2017 72,000 people lost their lives to drug overdoses. This is more than vehicular fatalities, gun violence and AIDS combined. The elimination of stigma towards MAT is necessary to prevent the senseless deaths that could be have been prevented through the health care system.
When asked in 2011 about the prejudice against patients based on their methadone dose, Dr. Robert G. Newman defended patients’ rights to treatment without discrimination. This statement from Treatment Improvement Protocol (TIP) 43, published by the Substance Abuse and Mental Health Services Administration, challenges the myth of “substitution.” The goal of MAT is harm reduction, as well as the stabilization of patients who would otherwise be unable to function without opioids. With supervised MAT programs, these people can be functional members of society, capable of making healthy decisions for their well-being. (Advanced Recovery Systems, 2019).
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. September 2018. Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. Retrieved 4/30/2019. https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf
Advanced Recovery Systems. 3/28/2019. Myths Fueling the Stigma of Medication-Assisted Treatment. Retrieved 4/30/2019. https://www.drugrehab.com/featured/the-myths-and-misconceptions-of-medication-assisted-treatment/
Providers Clinical Support System. 10/24/2017. Myths and Misconceptions: Medication-Assisted Treatment for Opioid Addiction. https://pcssnow.org/resource/myths-and-misconceptions-medication-assisted-treatment-for-opioid-addiction/
National Center for Biotechnology Information. 12/22/2017. Treatment and prevention of Opioid Use Disorder: Challenges and Opportunities. Retrieved 4/30/2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880741/
Substance Abuse and Mental Health Services Association. Last updated 05/07/2019. Medication-Assisted Treatment, Treatment, Buprenorphine. Retrieved 4/30/2019. https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine