Medication Assisted Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) characterizes medication-assisted treatment (MAT), also referred to as medically assisted treatment, as a therapeutic approach that combines medication with counseling and behavioral therapies. This method aims to provide a comprehensive, “whole-person” strategy for addressing substance use disorders. MAT is a crucial and beneficial component of the extensive care options available to individuals who suffer from chronic alcohol and drug dependency.

Medication-assisted treatment is recognized as one of the five evidence-based practices by the National Quality Forum (NQF), a nonprofit organization dedicated to enhancing health care quality. The NQF supports various methodologies and protocols established by The Joint Commission and the National Council on Quality Assurance, among other reputable health care policy organizations. Beyond being classified as an evidence-based practice, MAT is substantiated by research demonstrating its effectiveness in facilitating recovery. The National Institutes of Health (NIH) provides evidence indicating that MAT enhances rehabilitation outcomes for individuals facing addictive disorders. The treatment has been shown to:

– Improve survival rates among individuals
– Increase retention in treatment programs
– Reduce opiate misuse and criminal behavior among those with substance use disorders
– Enhance the likelihood of securing and maintaining employment
– Improve treatment outcomes for pregnant women dealing with substance use disorders

Medication-assisted treatment is recognized as one of the five evidence-based practices by the National Quality Forum (NQF), a nonprofit organization dedicated to enhancing healthcare quality. The NQF supports methodologies established by The Joint Commission and the National Council on Quality Assurance, among other health policy organizations. Beyond being an evidence-based practice, MAT is substantiated by research conducted by the National Institute of Health (NIH), which indicates that it significantly improves recovery outcomes for those facing addictive disorders. The benefits of this treatment include:

– Enhancing the individual’s chances of survival
– Increasing retention in treatment programs
– Reducing opioid misuse and criminal behavior among individuals with substance use disorders
– Improving the likelihood of securing and maintaining employment
– Optimizing treatment outcomes for pregnant women dealing with substance use issues

All medications utilized in MAT, often referred to as medication treatment, are sanctioned by the Food and Drug Administration (FDA). These approved medications are specifically designed to address opioid and alcohol dependencies. MAT medications help mitigate withdrawal symptoms and psychological cravings that disrupt chemical balance in the body, rather than merely substituting one substance for another. Healthcare professionals evaluating these medications for the treatment of alcohol or opioid use disorders take into account various factors.

Acamprosate, marketed under the brand name Campral, is an oral medication designed to assist individuals in recovering from alcohol dependence by preventing relapse and supporting sustained abstinence. Prolonged alcohol consumption can disrupt various neurotransmitter systems in the brain, particularly affecting glutamatergic neurotransmission. Acamprosate functions by targeting glutamatergic receptors, thereby regulating the physiological factors that may lead to relapse. It addresses the neurochemical imbalances caused by excessive alcohol intake and helps restore the body’s equilibrium. This medication can be safely combined with other commonly prescribed drugs and is not associated with any potential for abuse, while also reducing overall alcohol consumption.

Disulfiram was the first medication sanctioned by the FDA for the treatment of alcohol addiction, specifically for individuals committed to achieving sobriety. This oral tablet is designed to discourage alcohol consumption by inducing unpleasant reactions when alcohol is ingested. These adverse effects typically manifest within 10 to 30 minutes after drinking and serve to deter the desire to consume alcohol. The severity of the reaction is influenced by the dosage of disulfiram and the amount of alcohol consumed, often resulting in symptoms such as sweating, nausea, vomiting, chest pain, dizziness, anxiety, confusion, blurred vision, headaches, and weakness. Individuals who are highly motivated for treatment, dedicated to maintaining abstinence, and actively participating in their recovery process tend to benefit the most from disulfiram.

Naltrexone is utilized for the treatment of both alcohol use disorder and opioid use disorder. It is available in pill form for alcohol addiction or as an intramuscular injection for either condition. Naltrexone interacts with endorphin receptors that are responsible for feelings of euphoria, thereby diminishing the pleasurable effects associated with alcohol consumption. This medication aids in maintaining sobriety by reducing cravings for alcohol and increasing sensitivity to its effects. Similar to acamprosate and disulfiram, naltrexone has a low potential for abuse and is not likely to lead to dependency.

Buprenorphine, a semi-synthetic and regulated partial opioid, is available in multiple formulations for the treatment of opioid use disorder. FDA-approved products containing buprenorphine include Subutex, Suboxone, Zubsolv, Bunavail, Probuphine, and Sublocade. Due to its partial opioid activity, buprenorphine carries a potential for abuse; therefore, naloxone is incorporated into some formulations to mitigate the risk of misuse.

Naloxone is an FDA-approved medication designed to rapidly reverse opioid overdoses. Buprenorphine effectively blocks the effects of opioids when administered, facilitating successful maintenance by reducing opioid abuse and lowering the likelihood of relapse through long-term substitution. Additionally, buprenorphine helps alleviate symptoms of opioid withdrawal, curtails cravings and dependency, and enhances safety in overdose situations.

Methadone, a synthetic opioid available in liquid, powder, and tablet forms, is utilized for both opioid use disorder and pain management. The primary objective of methadone maintenance therapy is to substitute illegally used opioids, which are closely linked to high mortality rates, with a legally prescribed synthetic opioid. Methadone alleviates withdrawal symptoms, diminishes euphoric effects, reduces cravings, and lowers the risk of diseases associated with needle sharing. Dosing of methadone is meticulously tailored to the individual, and medical consultation is essential to address any potential adverse interactions with other medications.

Naltrexone is administered in an intramuscular injectable form to treat opioid use disorder by blocking the euphoric and calming effects of opioids such as heroin, morphine, and codeine. Unlike buprenorphine and methadone, which are FDA-approved for opioid addiction treatment, naltrexone does not alleviate withdrawal symptoms but carries no risk of misuse. It also presents a limited risk of drug interactions; however, individuals typically need to wait a certain period after their last opioid use before receiving their initial naltrexone dose.