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You’ve probably heard of Medication-Assisted Treatment, also known as MAT.

For those who are managing an alcohol or opioid use disorder, MAT is a highly effective tool that can help make recovery possible.

Medication Assisted Treatment is exactly what the name implies:  treatment assisted by medications. The Substance Abuse and Mental Health Services Administration (SAMHSA) states the following regarding MAT:

To clarify, when used for the treatment of alcohol use disorder, the preferred term for MAT is Medications for alcohol use disorder or MAUD. For the treatment of opioid use disorder, the preferred term is Medications for Opioid Use Disorder, or MOUD. While medication helps manage the physical aspects of an alcohol or opioid use disorder, such as cravings and withdrawal, it takes a full range of counseling and other support services to help a person understand what they are going through and how to manage their condition.  It’s not unlike treatment for a person with diabetes: the doctor prescribes insulin, and the patient is provided counseling and behavioral steps to support lifestyle changes. 

MAT can occur on an outpatient basis with the support of an opioid treatment program (i.e. methadone maintenance program), an office based opioid treatment program (OBOT), or through an independent healthcare practitioner who has specialty training and is able to prescribe the appropriate medications. Treatment can be on a short-term basis or as part of a long-term maintenance program. Treatment will typically start by addressing the physical dependence component of an alcohol or opioid use disorder which can include medication management of withdrawal symptoms. From there,  MAT will focus on the intense craving for the substance and subsequent compulsion to use. Medications intended to assist with treatment work by inserting chemicals that better control what is going on with the opioid receptors of individuals who have become physically dependent on alcohol or opioids.

MAT can also be leveraged for tobacco cessation efforts.

Three medications are currently approved by the FDA to use for MAT when treating opioid use disorder: buprenorphine, naltrexone, and methadone.

According to the American Society of Addiction Medicine, no matter which medication is prescribed the goal is the same: getting the patient to feel normal, have little to no side effects or withdrawal symptoms, and have controlled cravings for opioids.

Buprenorphine is a partial opioid agonist. That means it binds to and activates opioid receptors in the brain, but with less intensity than full agonists. It can reduce cravings and withdrawal symptoms, but does not produce the level of euphoria found in heroin and prescription pain relievers. Buprenorphine is most commonly prescribed in a clinical setting. It also blocks other narcotics while reducing withdrawal risk, and is available as a daily dissolving tablet, cheek film, or 6-month implant under the skin.

• Suboxone® – Contains both buprenorphine and naloxone. Because it is formulated with naloxone — which reverses opioid overdoses — it is designed to reduce the potential of misuse through intravenous delivery.   

Subutex® – Only contains buprenorphine,and does not contain Naloxone.  This particular formulation of buprenorphine is recommeded for women who are pregnant or for those who are unable to tolerate Naloxone for any reason.

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Naltrexone is an opioid antagonist, which means that it blocks the activation of opioid receptors in the brain.. Instead of controlling withdrawal and cravings, it treats opioid use disorder by preventing any opioid drug from producing the “high” or euphoric effect of opioids.

Because Naltrexone prevents any opioids from attaching to the receptors, it is critical that a patient go through medically managed withdrawal so the brain’s receptors are “re-sensitized.” If not, withdrawal can be extremely uncomfortable. It is advised that an individual seek medical assistance when navigating their way through withdrawal.In order to leverage Naltrexone, a patient must be free of any opioids for at least 7-10 days. Additionally, naltrexone causes serious side effects if a person attempts to use opioids while being treated.

• Naltrexone is available in pill form and is also available as a low-cost generic, or under two brand names: ReVia and Depade. The pill is taken every 1 to 3 days.

Vivitrol® is an extended release version of Naltrexone. It’s available in an injectable form and administered by a physician or other treatment provider once a month. As an opioid antagonist, it fills receptors and controls cravings without being an opioid itself. Just like the oral version of Naloxone, a person must be opioid free for 7 to 10 days or will experience a very severe opioid withdrawal. Price may be a factor – average costs for a monthly injection is $1200 and up.

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Methadone – Attaches to the mu receptors without creating the euphoric effects of opioids, and lasts much longer than other opioids.  However, methadone is a synthetic opioid which has been shown to be addictive and lead to dependence. Because it dramatically reduces cravings, it reduces relapse rates when used in a clinical setting. Methadone – a clinic-based opioid agonist that does not block other narcotics while preventing withdrawal while taking it; daily liquid dispensed only in specialty regulated clinics, otherwise known as “Methadone Maintenance Clinics” or “Opioid Treatment Programs”.

How MAT Makes a Difference

State Example: Easier and faster access to MAT helped Vermont’s Chittenden County reduce its opioid-related overdose deaths by 50% in 2018. Vermonters with substance use disorder who want MAT no longer have to wait to get started, because the state significantly expanded the number of providers offering it.

The state developed an innovative “Hub and Spoke” model providing quick access to higher or lower levels of care as needed,   Nine regional “Hubs” offer daily support for people with complex addictions, plus another 75 local “Spokes” provide ongoing treatment integrated with general healthcare and wellness.

Despite the cost for treatment, a study of Vermont’s program in the Journal of Addiction Medicine showed that health care costs for Vermonters receiving MAT had lower annual healthcare expenditures than those who did not. 

Other states are making efforts to increase the use of MAT to encourage people with opioid addictions to seek help. In fact, California’s MAT expansion program funds radio and TV ads across the state as well as a website where Californians can now easily locate medication assisted treatment.

NOTE: In 2019, through the end of year U.S. Congress Omnibus Bill package, a law passed which no longer requires healthcare practitioners who are licensed to prescribe narcotics through their DEA license to hold a special “buprenorphine waiver”. This has significantly expanded the ability of the broader healthcare ecosystem to prescribe buprenorphine for the treatment of opioid use disorder in traditional medical settings including primary care.

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Read our frequently asked questions about MAT here.

DISCLAIMER: This information is provided for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Content was based on information provided by SAMHSA, National Institute of Drug Abuse, American Society of Addiction Medicine, and the Surgeon General’s Office.