Medication Managed Treatment
Medication-Assisted Treatment (MAT)
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 is also available for other drug or alcohol addictions. Sanford’s MAT always incorporates group and individual therapy, 12-step methodology, whole-body wellness and the vital role of the family in its approach to treatment. MAT helps clients get through the discomfort of opioid withdrawal and it also helps to reduce drug and alcohol cravings.
Addiction is a chronic brain disease. A client who takes medication under the advice of Sanford medical staff is like any other patient who utilizes medication to treat a disease. Recovery from addiction is a process and proper medications give those clients in MAT, the time to work on recovery without unnecessary discomfort.
Sanford MAT Program Description
Sanford Addiction Treatment Center’s Medication-Assisted Treatment Program (MAT) combines psychosocial/behavioral therapy and pharmacotherapy to treat alcohol and/or opioid use disorders. At Sanford, our clinical team uses evidence-based practices in therapy, and our clinicians work alongside our medical team. Both clinical and medical teams 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). The MAT program at Sanford encompasses a person-centered treatment approach for treating substance use disorders. We use a combination of counseling, evidence-based therapies and medication.
Persons enrolled in the MAT program may participate at various levels of care within Sanford Addiction Treatment Centers. Clients who participate at the Intensive Outpatient Program level of care or higher are considered eligible for participation in MAT services at Sanford, unless contraindicated by medical or clinical reasons.
The MAT program strives to continually develop and improve community relationships that directly impact the medical and clinical needs of our clients in a positive way. We offer a variety of group therapy sessions, so clients can choose from programs that address their specific challenges and fit into their individual schedule. 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 (OTP) 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.
MAT Services Provided at Sanford
All levels of treatment at Sanford, from residential to once weekly outpatient classes, are person-centered and aim to assist individuals in the acquisition of skills and resources that reduce the risk of relapse. In addition, treatment at Sanford is crafted to aid individuals in improving self-sufficiency and achieving their treatment plan goals. Outpatient services include supportive counseling, resource referral, and case management.
Treatment Services Offered:
- 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
Details About MAT 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 different 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 our 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. Follow-up exams are performed by an MD or NP. The frequency of these exams are dependent on the client’s individual medical needs. Medical needs are determined by Sanford. Weekly medical visits are usually required in early treatment until further stabilization.
Nursing assessments are done at the Intensive Outpatient and Outpatient level of care to pre-screen and determine if medication assisted treatment is appropriate for the client. Nursing assessments are performed by a Registered Nurse.
Medications used for medication assisted treatment (Naltrexone and Buprenorphine) can be prescribed to be taken orally or by injection. Injections are administered monthly. Clients 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, & others.
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 client. Drug testing provides opportunities for appropriate medical and therapeutic intervention. In accordance with MI licensing requirements, urine samples will be tested within 72 hours of being collected.
Family involvement is the cornerstone of Sanford’s treatment philosophy. 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 clients 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)
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.
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.
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.
How Naltrexone Works
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 Goal Is Full Recovery
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
- 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.