The United States is currently being heavily affected by the opioid epidemic. Various regulatory and pharmaceutical changes in the early 1990s led American physicians to prescribe more opioids. From 2012 to 2018, the opioid prescription rate steadily dropped. With no source of regulated opioids, however, countless opioid users turned to unregulated illicit opioids, like heroin and counterfeit pharmaceutical opioid tablets.
Today, opioid users have no clue how strong their drugs of choice are or what they contain. Street heroin often contains dangerous drugs, including illicitly-manufactured fentanyl, which is dozens of times stronger than heroin or morphine.
Seeking help for opioid dependence and addiction is more important than ever before. Addiction treatment providers have widely adopted medication-assisted treatment in response to the opioid epidemic.
The Basics of Medication-Assisted Treatment
Medication-assisted treatment, also called MAT, combines medications, counseling, and behavioral therapies to treat substance use disorder. Considered the ‘gold standard’ for the treatment of opioid use disorder, MAT differs from other substance use disorder treatments by using medications to help patients abstain from drug use. Although it’s also used for alcohol, most patients in MAT programs are seeking help for opioid addiction.
Many detox programs use medications to lessen the withdrawal symptoms that people suffering addiction face when initially quitting drugs. These “comfort meds” are typically only used for a few days or up to a week. These drugs do nothing to treat the root causes of patients’ symptoms.
Medications used in medication-assisted treatment programs are for long-term opioid replacement. They help patients adopt healthy coping mechanisms for mental and emotional stress that don’t involve illicit drug use. As the root of addiction often lies in these flawed coping mechanisms, actively taking part in counseling and behavioral therapy programs is essential for achieving recovery from substance use disorder.
About the Medicines Approved for Medication-Assisted Treatment
Currently, the U.S. Food and Drug Administration (FDA) approves of three drugs for use in medication-assisted treatment programs: buprenorphine, methadone, and naltrexone.
This full-agonist drug is arguably the most well-known drug used in medication-assisted treatment. The FDA approved methadone for opioid dependency in 1972, and it is taken orally via a liquid solution.
Methadone is known for its long half-life. People who use other opioids, including heroin, oxycodone, and morphine, must dose several times per day to avoid symptoms of opioid withdrawal. Much of their day is consumed by finding opportunities to visit dealers and use drugs. With methadone, these issues are resolved. In opioid-tolerant patients, the half-life of methadone is roughly 24 hours. Thanks to this characteristic, patients only dose once per day.
Methadone is also regulated more heavily than any other drug for opioid addiction. Patients are required to visit their providers daily or every other day. On the bright side, patients don’t have to visit pharmacies for methadone. Their physicians are responsible for providing them with the drug.
Finding the right dose is an essential part of using methadone as an opioid replacement. Providers titrate patients’ doses up over time until their cravings and withdrawal symptoms are managed. Patients have an active role in arriving at a suitable dose of methadone. Methadone is also used for chronic pain.
Buprenorphine has been used for chronic pain for decades. In 2002, a new formulation of buprenorphine was approved by the U.S. Food and Drug Administration for opioid addiction. This formulation, which contains a 4:1 ratio of buprenorphine and naloxone, is called Suboxone. Naloxone, also used to reverse opioid overdose, was included in Suboxone to deter high-seeking users from injecting or snorting the drug.
Much like methadone, buprenorphine also has a long half-life, preventing patients from requiring multiple doses throughout the day. Buprenorphine’s half-life is even longer, averaging 37 hours. This extended half-life can prevent patients from facing opioid withdrawal symptoms if personal issues keep them from visiting a treatment provider on their scheduled appointment dates.
Unlike methadone, however, patients fill Suboxone at pharmacies. At first, they’re usually given seven-day supplies. As patients build relationships with treatment providers, prescribers can give patients two-week or monthly supplies for Suboxone.
Subutex, a buprenorphine-only formulation, is safe for pregnant women with opioid addiction. This formulation of buprenorphine reduces neonatal distress caused by the opioid withdrawal syndrome that opioid users frequently face.
A long-term injectable form of buprenorphine is also available. Sublocade, a monthly injection, was approved by the FDA in late 2017. This formulation is ideal for patients with heavy work schedules, other obligations, or transportation difficulties.
Oral naltrexone was initially approved for treating opioid addiction by the FDA in 1984. Although providers have oral naltrexone at their disposal, they typically only prescribe naltrexone for MAT in the form of Vivitrol.
Vivitrol, a long-term injectable suspension of naltrexone, was granted approval by the FDA in 2006. The drug offers several other benefits:
- Patients don’t have to keep up with take-home doses
- Vivitrol has no street value
- The drug is injected monthly, giving patients a higher degree of freedom from program requirements or medical supervision
Important Distinctions Between These Medications
Methadone and buprenorphine bind to the brain’s opioid receptors in place of other opioids. These medications fully satisfy patients’ physical dependencies on opioids. Naltrexone, however, does not satisfy users’ opioid dependencies.
Among the most sought-after benefits of buprenorphine, methadone, and naltrexone are their abilities to block out other opioids. If patients use other opioids while these medications are in their systems, they won’t feel high. This opioid-blocking characteristic deters most patients from thinking about using opioids.
Addressing Myths Around the Topic of Medication-Assisted Treatment
Although the effectiveness of medication-assisted treatment is no secret, myths about MAT are pervasive throughout the world of addiction treatment. People who battle drug addiction may be deterred from enrolling in medication-assisted treatment due to hearing these myths from their friends. These myths are also bounced around by members of the general public.
The following five myths are quite common. Fighting the stigma that still surrounds addiction treatment is essential to ending the opioid epidemic and reducing drug overdose deaths.
- Medication-Assisted Treatment Is a Short-Term Treatment
People who have been to detox or drug rehab facilities and sober living homes are familiar with many programs’ restrictions on medication-assisted treatment. They often induct patients on methadone or Suboxone and require them to taper off within one to three months.
Here at NFA Behavioral Health, we understand that MAT is a long-term treatment. Patients recovering from opioid addiction often do better when they’re on Suboxone or methadone for the long haul. We don’t have any in-house mandates that require patients to taper off their opioid replacement medications over the span of weeks or months. Rather, we allow patients to stay on Suboxone, methadone, or Vivitrol as long as they want.
Long-term medication-assisted treatment prevents patients from returning to their old negative habits like illicit drug use. It also keeps patients from contracting potentially lifelong diseases such as HIV or hepatitis C.
- Suboxone and Methadone Simply Swap One Addiction for a New One
By far, this is the most prevalent myth surrounding medication-assisted treatment. Many current drug users shame people who want to stop using drugs by spreading this myth.
It’s true that taking methadone and buprenorphine daily causes physical dependence. Without these drugs, patients face opioid withdrawal syndrome. Countless medications cause physical dependence. However, dependence isn’t always a bad thing. With medication-assisted treatment, providers give patients steady supplies of opioid replacement drugs. They understand that patients need drugs like buprenorphine and methadone.
Dependence isn’t the same thing as addiction. The National Institute on Drug Abuse (NIDA) defines addiction as “compulsive drug use despite harmful consequences.” These harmful consequences often take the form of failing to meet social, family, and occupational obligations.
Medication-assisted treatment actively helps patients piece their lives back together. MAT providers deal with patients’ addictions first before addressing dependence. This is yet another reason why medication-assisted treatment is such a powerful treatment modality.
Taking Suboxone or methadone under a medication-assisted treatment program isn’t swapping one addiction for another one. Rather, MAT helps patients eliminate their addictions.
- MAT Is Only for People With Severe Addictions
People who battle drug addiction may believe that medication-assisted treatment is only for severe cases of addiction. Many opioid users feel that MAT is only for people who use street heroin or illicitly-manufactured fentanyl, not Percocet, Norco, morphine, codeine cough syrup, or other pharmaceutical opioids.
All opioids, however, regardless of whether they come from pharmacies or the black market or whether they’re mild or strong, can cause addiction. They all rewire the brain in similar ways.
Medication-assisted treatment is ideal for anyone who has been diagnosed with opioid use disorder or alcohol use disorder. The DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders, categorizes opioid use disorders as mild, moderate, or severe, and medication-assisted treatment is suitable for all cases, regardless of severity.
People with long-running or particularly severe opioid addictions may benefit from longer periods of treatment. However, this finding doesn’t give an ounce of truth to this MAT myth.
- Medication-Assisted Treatment Increases Opioid Overdose Risk
This statement couldn’t be more untrue. In fact, medication-assisted treatment reduces patients’ chance of overdose.
MAT programs regularly subject patients to urine drug screenings. These tests address relapse before it can become a major issue. Patients discuss these relapses with counselors and physicians to help them change their lives to prevent future relapses.
Buprenorphine, methadone, and naltrexone all reduce the euphoric effects of opioids. If patients attempt to use heroin, pain pills, or other opioids, these three MAT drugs typically prevent them from feeling any positive effects.
A 2018 National Institutes of Health (NIH) study found that patients taking Suboxone and methadone are less likely to die if they end up overdosing. Compared to opioid users not enrolled in medication-assisted treatment programs, the likelihood of opioid overdose death was 59% less in study participants who took methadone and 38% lower in those who took Suboxone or Subutex.
- MAT Only Delays Your True Recovery From Opioid Addiction
Despite the overwhelming evidence in favor of medication-assisted treatment, you may have heard that MAT only delays your recovery. This is nothing short of a myth.
As mentioned above, an essential part of recovering from substance use disorder is developing new coping skills and healthy behaviors to deal with stress, co-occurring mental disorders, and trauma. Medication-assisted treatment gives patients the opportunity to cultivate these skills in a safe environment.
Don’t Let Withdrawal Get in the Way of Recovery
Opioid withdrawal syndrome worries many people battling opioid addiction. Rather than quitting, they continue using simply to avoid opioid withdrawal. Suboxone and methadone resolve this concern by preventing withdrawal. It’s important to remember that help is available during your recovery. NFA Behavioral Health is standing by to offer a range of recovery programs and treatments, including holistic therapies, group and individual counseling, and medical detox.