Therapy known as MAT (medication-assistant treatment) receives a mixed bag of reviews. MATs are quite often used as part of the treatment plan for opioid, alcohol and substance abuse disorders.
Some people have the opinion that you’re trading one addiction for another. Others believe that these medications can be helpful when used properly and in conjunction with evidence-based therapies.
Substance Abuse and Mental Health Services Administration (SAMHSA), believes that using FDA- approved medications responsibly can be effective in treating addiction. Their conclusion comes from research that proves the theory of efficacy.
There are certain methods that reduce dependency to addictive medication-assisted treatment. If used properly, an addict is given the break they need to abstain for longer periods of time. This has been shown to create a greater success rate for recovery.
Medications that are available to assist with treating addiction include:
- Butrans, Subutex, Belbuca, Buprenex (Buprenorphine on its own)
- Suboxone (Buprenorphine combined with naloxone)
- Probuphine (Buprenorphine Implant)
- Dolophine (Methadone)
- Narcan (Naloxone)
- Revia, Vivitrol (Naltrexone)
- Antabuse (Disulfiram)
- Benzodiazepines, which include:
- Xanax (Alprazolan)
- Klonopin (Clonazepam)
- Diastat, Valium (Diazepam)
- Ativan (Lorazepam)
- Campral (Acamprosate)
What the Medical Industry Thinks about Medication-Assisted Treatment
MAT has two different ways of being used, blocking and replacing. We’ll use medication assisted treatment for opioid use disorders as an example. Doctors give patients opiates that activate the same receptors in the brain. These opioids absorb into the blood over a longer period of time. They are known as opioid replacement therapy (ORT).
The person doesn’t get the big high they once did. This breaks the mental link of the reward of being high. They also stave off withdrawal symptoms. Another method is to give patients an opioid antagonist. This is a non-opioid drug that blocks the feelings people get when they take opioid drugs.
If someone relapses and takes the opioid, they won’t feel anything which deters them from taking a high amount. Relapses are the reason for most of the overdose deaths because the body has lost tolerance.
There are medication assisted treatment pros and cons. One of the arguments among people is that MATs is substituting one drug for another when they have addictive qualities. This is not true for all medications used to help with addiction.
Even in the event that there is potential for addiction, doctors feel it’s a good thing because they are replacing a dangerous, life-threatening drug with a drug that allows a person to function.
MAT allows a person to start rehabilitating their life. They can work and redevelop relationships. Data has shown MATs are effective for almost everyone. It may not be as effective for some as it is for others however. The life someone has been leading, their degree of severity, and other factors can play a role in efficacy.
MAT is Part of the Sobriety Process
The medication-assisted treatment definition implies that medicine is used to help the process of sobriety success. It is specific to what substance you’re addicted to and what your motivation level is.
For effectiveness, it must always be used along with counseling and behavioral therapies. It is not something that stands alone as a solitary treatment.
Using one drug to help someone stop using another drug has seen its challenges in the past. There are medication assisted treatment pros and cons.
Using methadone to get people off heroin just caused a different epidemic. Some MATs are not addictive at all and come with high benefits. There are also times when medication-assisted treatment has shown to be more effective when certain processes are used.
How Effective is Medication-Assisted Treatment?
Data has shown that those taking part in medication-assisted therapy will have better outcomes than those who don’t have them as part of their recovery plan.
It’s effective because it decreases risk of relapse by a significant amount. It’s also preventing infectious diseases such as HIV because people aren’t sharing needles. It is also preventing overdoses.
One study found that deaths from opioid overdose fell as buprenorphine became more popular in one state. Buprenorphine is a one of three drugs used to help people overcome their opioid addictions. Methadone hasn’t prevented deaths but it did decrease heroin use.
The Dosing Downfall with MAT
Within the research of choosing the right MAT dose for patients, there has been some gaps. The American Society of Addiction Medicine found that some medication are more effective than others.
There are no studies that have compared benefits of one medication over another that would be helpful for the medical industry in drug options and dosage. The main conclusion is that every drug carries their own risks and benefits.
There are pros and cons of medication-assisted treatment regardless of what medication you’re prescribed. People can die from overdosing on methadone but can’t when they use buprenorphine or naltrexone. If a person needs a surgery, they can quickly be taken off buprenorphine, something you can’t do with methadone.
Protocol for Using MATs
If you admit yourself into an addiction treatment program, they will have a protocol for the use of MAT. First, you would be evaluated by a mental health professional. They would diagnose your substance abuse problem and how severe the addiction is. They would then access physical health issues and co-occurring mental disorders.
Getting professional help for medication assisted treatment for co-occurring disorder is important due to its complexity. Some medication treatments for substance addiction may cause a problem with a mood disorder.
Being assessed fully by someone with medication assisted treatment training ensure you are properly diagnosed and medicated correctly. They follow guidelines set out by SAMHSA. A good candidate for MATs are defined by;
- You are diagnosed as having an addiction to alcohol or opioids.
- You’re willing to comply with the prescription instructions.
- You don’t have health problems that would cause medications to be in conflict with.
- They have told you the other alternatives beyond medication.
For those who have abused medication in the past, you will likely be denied MAT. Opioid replacement therapy for opioid dependence can cause problems for people with serious conditions in the heart and lung. Also, if you show very little motivation to recover from substance addiction, you will likely be denied MAT.
Types of Medications Used for Medication-Assisted Treatments
The two main addictions that medication-assisted treatments are used for are opioids and alcohol. Methamphetamine, marijuana, and cocaine do not have an FDA-approved medication-assisted treatment.
There are quite a few medication-assisted treatments for opioid dependence as well as for alcohol. Here are some of the most common.
Buprenorphine-ORT for Opioid Dependence
Buprenorphine is in a variety of brands and trade names which include:
- Buprenorphine on its own:
- Buprenorphine combined with naloxone:
Buprenorphine is useful in helping people recover from opioid drugs such as heroin, OxyContin, or Vicodin. It is particularly helpful because the drugs are highly addictive and often cause overdose deaths when one does relapse.
It is a partial opioid agonist so it affects the brain in the same way without causing the big high. Someone can take buprenorphine and negate the terrible withdrawal symptoms that come from abstaining from strong opioids.
When used with naloxone, there is no high at all which means there is no reward. This is a dual effect of the drug and when managed properly, it can be extremely helpful in opioid recovery.
Where methadone needs to be administered in clinics, Buprenorphine can be prescribed by your doctor and you can take it at home. This makes it a lot more convenient and is also a testament to how safe it is to use. Buprenorphine has a ceiling so there’s no possibility of overdosing on it.
The Downside of Buprenorphine
There are pros and cons of Buprenorphine. Buprenorphine can become addiction because it does have opioid effects. This risk can be decreased if the medication is Buprenorphine and naloxone together. This is because naloxone blocks the opioid effect so you never feel the reward.
Medication that includes buprenorphine can get rid of opioid withdrawal symptoms and you’re going to experience less cravings. The side effects of using buprenorphine can be similar to using drugs like heroin or OxyContin because it’s also a partial opioid antagonist.
Side effects can include:
- Tingling skin.
- Pain in the stomach.
- Numbness around the mouth.
- A feeling that you’re drunk.
- Difficulties with concentration.
Probuphine for Opioid Dependence
This new drug on the market was FDA-approved in 2016. It is the first Buprenorphine implant used to treat opioid addiction. It is similar to methadone and naltrexone in that it helps you recover from addiction by getting rid of craving and withdrawal symptoms.
When you take Probuphine, you don’t get a euphoric high so it helps to retrain your brain that these drugs are not rewarding. The hope is to stabilize the patient by reducing intense cravings that are associated with opioid addiction. It allows you to engage in the treatment and therapy more effectively so you can focus on the root issue of your addiction.
Some like the idea of an implant because it’s more convenient. You don’t have to remember to take pill every day. There are four rods inserted in the upper arm. Each rod will administer a constant dose of Buprenorphine into the blood for 6 months. This gives you time to get to the root of your addiction and start to rebuild your life.
Probuphine is prescribed to addicts who are already on a stable, low to moderate dose of Buprenorphine. It shouldn’t be prescribed past twelve months which means two treatments of six month implants.
The advantages that Probuphine has over other opioid replacement therapy options is that it releases a low dose of Buprenorphine daily. You don’t have to think about it. It can’t be abused if the implant remains in place.
There are pros and cons of buprenorphine no matter what brand or type you use. The one cautionary aspect of Probuphine is that if the implant is moved or removed, there is possibility of accidental exposure or intentional misuse.
Methadone-Medication Assisted Treatment for Opioid Dependence
Methadone has been used to get people off heroin. It is a full opioid agonist so the effects on the brain are the same. Benefits of methadone treatment for opiate addiction are equal to the risks.
Methadone is longer-acting than heroin and the effects are milder but it is still addictive. It does take away withdrawal symptoms and strong cravings for those addicted to heroin or opioid prescription pain killers.
Benefits of a methadone program is that even one dose can prevent cravings and withdrawal for over a day. Cons of methadone treatment is that it has to be administered in a clinic on a set schedule. For someone who isn’t wholeheartedly committed, missing their appointments, they can quickly go through withdrawal symptoms.
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Naloxone is another medication-assisted treatment that is used to help people get over opioid addiction. It works differently than the other drugs we’ve discussed though. It blocks activity of opioids from hitting the brain so you don’t feel high and life-threatening overdoses are reversed or altogether prevented.
Naloxone can be injected in an emergency situation for someone overdosing from opioids. Especially with Fentanyl on the streets, Naloxone is proving to be an intervention lifesaver.
Naloxone can be used alone and comes in automatic injection devices. It is often given out to communities that have a dense popular of heroin addicts. Combined with buprenorphine, it works as a double action MAT to help opioid addicts abstain.
Naltrexone-Medication Assisted Treatment for Alcohol and Opioids
Naltrexone comes in injectable or pill form and is used to help alcoholics and opioid addicts. The injectable medication is called Vivitrol and is administered once a month. Vivitrol is expensive so pill form is more common. The name brand for the pill form is ReVia.
Naltrexone differs from Buprenorphine and methadone because it can’t be abused. It blocks opioid receptors so if you drink or take opioids, you won’t receive the reward. You won’t feel high or drunk so you lose the use to use alcohol and opioid drugs.
The downside is Naltrexone decreases tolerance to opioids so relapse can be even more risky. Overdose or problems with breathing can result. If you drink while taking Naltrexone, there aren’t risks however. Naltrexone does stop you from getting the full rewarding effects of alcohol but you’ll still be impaired and lack coordination as though you were drunk.
Disulfiram for Alcoholism
Disulfiram, also known as Antubuse, helps people to abstain from drinking alcohol. It works by causing unpleasant side effects if you drink. This discomfort helps discourage the cravings for alcohol. Side effects include:
- You can become anxious.
- Vision can become blurred.
- You feel weak.
- Heart palpitations.
- Dizziness of vertigo.
- You may feel confusion.
These side effects don’t last long, maybe up to an hour. The more disulfiram you take coupled with how much alcohol consumed will dictate the severity of the side effects. The downfall of this medication assisted treatment for alcohol is you have to be committed to your sobriety.
It’s easy to stop the treatment and start drinking without consequence. It is helpful for those who are motivate but are having a challenge with the triggers that often cause you to drink.
Benzodiazepines for Delirium Tremens
Benzodiazepines based medications will help reduce psychological withdrawal symptoms like anxiety. Drugs like Diazepam, which is valium, are commonly used to reduce the stress that comes along with trying to abstain from drinking.
It is used with many treatment patterns. Anticonvulsants are often used in conjunction with benzos to prevent delirium tremens that cause great risk to those in alcohol recovery treatment.
The downside of benzodiazepines is that there is a risk of dependency. They are depressants, so they relax areas of the brain, causing the whole mind and body to relax. This feeling you experience can create the reward factor that attributes to addiction.
Acamprosate for Alcohol Addiction Recovery
Acamprosate, sold under the brand Campral, is a medication to help with alcohol recovery. Acamprosate is believed to stabilize brain chemicals that would otherwise be changed from alcohol.
Alcohol sets a new “equilibrium” in the brain and when you abstain, it can cause a hyper-excitatory state. Science doesn’t quite understand how acamprosate works but it is thought that is normalizes the balance of the brain, counteracting how alcohol effects it.
Acamprosate reduces acute withdrawal symptoms from alcohol. The downside are the side effects that might come with it. You may experience allergic reactions, abnormal heart rhythms, or changes in blood pressure. More serious effects can be headaches, insomnia or impotence.
Whole Patient Approach
Medication-assisted treatment guidelines include incorporating other treatments for an overall program. Medication is not enough to really help patients achieve long-term success in their recovery.
The “whole patient approach” implies that the whole person must be tended to in order to heal. This means utilizing therapies that attack the root of any emotional issues surrounding addiction. There could be dual diagnosis where the person is anxious which lead to a drinking problem.
Education on what drugs can do and what a person will experience throughout recovery is important to prepare them for challenges. Relapse prevention programs are also important and help people overcome times when they go back to old habits.
The medication helps an addict stay clean while they move through behavioral therapies that bring issues to the surface. The longer a person can stay sober, the better chance they have of feeling good about themselves. They begin to think differently as they build coping skills. The therapy really is the core of medication-assisted treatment.