Medication Management and Medication-Assisted Treatment (MAT)
The term “continuum of care” is defined as the delivery of care over a period of time. For treatment centers, a full continuum of care is best practice, as it logistically simplifies transitions and tracks patients through all levels of treatment. This means connecting individuals to the various parts of the continuum, based on the assessed needs, at any given point in their recovery process. It also means interfacing with the community to educate about prevention, connecting individuals to the appropriate level of care when treatment is needed, and providing or connecting individuals/family with long-term recovery management.
At Sanford, we recognize the importance of a long-term continuum of treatment programs, classes and resources. Successful treatment of substance use disorders typically requires continual evaluation and adjustments, similar to the approach taken for other chronic diseases.
In response to the nation’s opioid addiction epidemic, medication-assisted treatment (MAT) protocols have been developed to serve as an adjunct to evidence based addiction treatment. Our MAT program also incorporates 12-step methodology, whole-body wellness and the vital role of the family in its approach to treatment. MAT helps patients get through the discomfort of opioid withdrawal and it helps to reduce drug cravings. MAT is primarily used for the treatment of addiction to opioids, and alcohol. The prescribed medication normalizes brain chemistry, blocks the euphoric effects of alcohol and opioids, and relieves physiological cravings.
Addiction is a chronic brain disease. A patient who is prescribed medication under the advice of Sanford medical staff is like any other patient who takes medication to treat a disease. Recovery from addiction is a process and the medications give our patients time to work on recovery without unnecessary discomfort.
MAT Program Description
The Sanford MAT program combines psychosocial/behavioral therapy and pharmacotherapy to treat alcohol and/or opioid use disorders. At Sanford, our clinical team works alongside our medical team and both clinical and medical practicioners specialize in addiction treatment.
- MAT includes group, individual, and family therapy along with medical services and medication management. Research has consistently demonstrated that medication, in conjunction with evidence-based behavioral therapies, increases an individual’s success in maintaining recovery. All medications prescribed in our care are approved by the Food and Drug Administration (FDA).
- Individuals enrolled in the MAT program may participate at various levels of care within Sanford. Patients who participate at the Intensive Outpatient Program level of care or higher are considered eligible for participation in MAT services, unless contraindicated by medical or clinical reasons.
- We offer a variety of convenient group therapy sessions, so patients can choose from programs that address their specific challenges. All MAT staff participate in continuing education to ensure that the medical and clinical care provided at Sanford is comprehensive, individualized, effective, and evidence based.
- Federal Law requires patients who receive MAT as an opioid treatment program to receive medical, counseling, vocational, educational and other assessment and treatment services, in addition to prescribed medication. 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.
I see people in so much pain. Our patients worry about their physical health as a result of their substance use. Also, there are psychiatric issues that accompany substance use disorders. Most of our patients have co-occurring intrusive thoughts, anxiety, depression. They self medicate. Our patients look for a psychiatric evaluation, and long-term medical and psychiatric care. We want to provide medical services, residential and outpatient MAT for opioid use and cravings. And our goal to to stop the pain.Dr. Gilbert Masterson, Sanford Behavioral Health, Chief Medical Officer
Medical Services Provided
Our Medical services are led by Gilbert Masterson, M. D. with 24 hour/day support for all residential patients. All levels of care include on-site supervision by medical doctors with specialties in psychiatry and/or addictionology, advance practice providers, registered nurses and registered dietitians.
- Screening & orientation to treatment
- Multidisciplinary (medical and clinical) diagnostic assessments and exams
- Follow-up medical exams
- Nursing assessments
- Medication administration
- Group therapy meetings
- Weekly individual and/or family therapy sessions
- Drug testing & breathalyzer tests
- Structured daily check-in with staff
- Client advocacy
- Crisis safety planning (when necessary)
- Family psychoeducation sessions & support groups
- Aftercare/continuing care planning & referrals
- Treatment planning
- Case management services
Clinical assessments are completed at the start of treatment by master’s level clinicians. Assessments identify appropriate level of care, current physical and mental health symptoms, problems in life areas, medical/mental health treatment history, substance use history, family dynamics, trauma history, presence of risk to self or others, and more.
Medical exams are performed by a Medical Director (MD) or Nurse Practitioner (NP). Initial exams include a urinalysis and appropriate laboratory testing. Follow-up exams are performed for continual evaluation and management of symptoms and medication and are performed by an MD or NP. The frequency of these exams are dependent on the patient’s individual medical needs, determined by Sanford. Weekly medical visits are usually required in early treatment until further stabilization.
Nursing assessments are completed at the Intensive Outpatient and Outpatient level of care to pre-screen and determine if medication assisted treatment is appropriate. Nursing assessments are performed by a Registered Nurse (RN).
Medications used for medication assisted treatment can be prescribed to be taken orally or by injection. Injections are administered monthly. patients are observed in office after their first administration until they are cleared to be released.
Group therapy sessions are facilitated by a master’s level clinician and sessions incorporate evidence-based modalities and curricula. This includes: Motivational Interviewing, CBT, DBT, Matrix Model, 12-Step Facilitation, Living in Balance, Connections, Mindfulness-Based Relapse Prevention, A New Direction, Seeking Safety, Mindfulness-Based Stress Reduction, and more.
Individual therapy sessions, performed by a master’s level clinician, include treatment planning, assessing and promoting progression through stages of change, recovery support education (12 step meetings, SMART recovery, Refuge Recovery, Celebrate Recovery, recovery coaches, sober living resources), crisis safety plan development (when necessary), and aiding in development of a detailed relapse prevention plan prior to discharge. Clinicians use evidence-based techniques and best practices.
Randomized drug screening is part of the therapeutic process and it serves as an accountability measure, promoting the maintenance of sobriety. All testing is done in a private and respectful manner and all results are shared privately with the patient. Drug testing provides opportunities for appropriate medical and therapeutic intervention. In accordance with Michigan licensing requirements, urine samples will be tested within 72 hours of being collected.
Family therapy and family psychoeducation sessions are provided weekly by master’s level clinicians. We work with all different family structures, non-traditional families, and client’s loved ones and support people who are not “technically” family.
Case Management services are an integral part of treatment at Sanford. These services include: planning and coordinating health care, SUD treatment and social services; assisting with applications and criminal justice involvement proceedings; engaging in advocacy on behalf of individual clients; and more.
Medications Used for MAT
Naloxone, Buprenorphine, Suboxone, Naltrexone, Vivitrol
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 FDA has approved, and Sanford prescribes, the following medications for MAT:
Naloxone (Narcan, Evzio)
Naloxone is a medication used to block the effects of opioids and decreased breathing in an opioid overdose. Naloxone can immediately reverse the effects of an opioid overdose. The effects of naloxone last about half an hour to an hour. Multiple doses may be administered, as the active duration of opioids is greater than that of naloxone.
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.
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. 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 and physical dependence abilities.
When coupled with therapy, buprenorphine may also lower the potential for opioid misuse, allow for a ceiling on the effects of opioids and provide a relatively mild withdrawal profile.
At the appropriate dose buprenorphine treatment may:
- Suppress symptoms of opioid withdrawal
- Decrease cravings
- Reduce illicit opioid use
- Block the effects of other opioids
- And help patients stay in treatment
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 misuse 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.
Buprenorphine and Naloxone (Suboxone)
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.
Naltrexone (VIVITROL, Revia)
Naltrexone is a medication that has been approved by the Food and Drug Administration (FDA) to treat opioid use disorders and alcohol use disorders, in pill form or as an injectable. The pill form of naltrexone (Revia, Depade) can be taken once per day. The injectable extended-release form (VIVITROL) is administered intramuscular once a month.
Naltrexone is a non-addictive opiate antagonist. This means naltrexone blocks the effects of opioid medication. Because of this, naltrexone has helped many individuals remain drug-free during their initial recovery period. Naltrexone can also be used as a treatment for alcohol addiction, by reducing the urge to drink alcohol. It has been shown to lower the reward or pleasure of drinking and the craving induced by environmental stimuli.
Naltrexone blocks the elated and sedative effects of opioids. It works differently in the body than buprenorphine. Buprenorphine activates opioid receptors in the body to suppress cravings. Naltrexone binds and blocks opioid receptors to reduce opioid cravings. In the event of a relapse, naltrexone prevents the effects of “getting high”.
The Substance Abuse and Mental Health Services Association (SAMHSA), says 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
- Reduce cravings
- 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.