Medication-Assisted Treatment: Fact vs Fiction
The intense cravings, pain, and discomfort from withdrawing from opioids have been the cause of relapse in many of the strongest-willed people. As a means to help a person recover from the physical and mental aspects of addiction, doctors have created medication-assisted treatments or MAT. 1
MAT involves taking FDA-approved medications while stopping using illegal drugs or using legal drugs in an illegal fashion. 2 It’s been shown to be very effective in helping people overcome opioid addictions, but there are a lot of misconceptions and misunderstandings about the therapies. This has resulted in people who would be a great fit for MAT not receiving treatments. Here’s a guide to some of the most common “fictions” and “facts” related to medication-assisted treatments.
FICTION: MAT just swaps one addiction for another
FACT: MAT can facilitate a new life
A common misconception about MAT is that medication-assisted treatments switch an addiction to one substance, such as alcohol or heroin, for another substance.
A lot of experts have strong feelings to the contrary, including Dr. Stuart Gitlow, a past president of the American Society of Addiction medicine interview in “Stat News”, saying “The drug that we’re replacing is a dangerous one that will kill you, and we’re replacing it with a drug that allows you to go back to work and have money in your pocket and allow you to live normally again,” Dr. Gitlow said.
FICTION: MAT is the only treatment I need to get sober
FACT: MAT is one part in healing from addiction
MAT can address one component of addiction – the physical cravings for a substance. However, most addiction experts don’t recommend it as the only treatment for substance abuse. Using a combination of MAT as well as psychosocial therapies is “the most effective” intervention to treat opioid use disorder, according to the Pew Trusts Foundation. Combining MAT with therapy is more effective than either therapy alone.
The therapy types can vary – some people choose counseling while others prefer to participate in 12-step groups or cognitive-behavioral therapy. What matters most is that a person addresses both the physical and mental aspects of addiction.
FICTION: Methadone is the only FDA-approved drug for MAT
FACT: Other medications are available
While methadone is an excellent treatment option for helping those with opioid addictions, other medications are also available. The FDA has approved buprenorphine and naltrexone to treat opioid use disorders. As with methadone, a person must use these medications through a certified opioid treatment program.
Opioid treatment programs are those the Substance Abuse and Mental Health Services Administration (SAMHSA) certifies. These programs aren’t just offered at rehabilitation facilities. They’re also at residential, intensive outpatient, hospital, and doctor’s office settings. Physicians must qualify for a special waiver and complete eight hours of training regarding psychiatry and addiction if they don’t have these degrees.
FICTION: MAT programs don't work
FACT: MAT programs are an effective way to treat drug use
According to the Pew Trust Foundation, MAT can enhance a person’s adherence to their substance abuse treatment regimen while also reducing risky behaviors, such as the injection of illegal drugs. This can reduce a person’s risk for diseases transmitted via IV drug use, such as hepatitis C or HIV.
According to an article published in the journal Harvard Review of Psychiatry, MAT therapies doubles the rates of abstinence from opioids compared to treating a person with a placebo medication or taking no medication at all. They’ve also been shown to be effective in preventing relapses.3
Addiction is a life-changing and chronic disease. Every person is different. It’s true that sometimes a treatment like MAT that works for many people won’t for others. However, MAT is an option that has helped many people overcome their addiction to opioids. If you’ve tried other methods and experienced relapses, perhaps it’s time to see if MAT could work for you.
FICTION: Methadone and MAT therapies are dangerous drugs
FACT: All Medications include risks and benefits
Any medication has both risks and benefits that are important to evaluate. However, MAT therapies are typically much, much safer than injecting illegal drugs or using legal drugs illegally.
To understand the risks of each medication, it’s important to evaluate how each works. Methadone is a full-agonist medication that fully occupies or covers the opioid receptor in the brain and body. This means that methadone can act as a pain reliever while also blocking the euphoric and often addictive feelings that can accompany using other opioids.
Methadone is much longer-lasting in the body than most pain medications and drugs such as heroin. Methadone typically lasts between 24 and 36 hours in the body. This is one of the reasons why a person must undergo monitoring at a methadone program to ensure an excess of the medication hasn’t built up in the body.
Methadone can, in a dose-dependent fashion, increase the risks for prolongation of the heart’s QT interval. This means the more methadone a person takes, the more at-risk they are that their heart could get in an irregular heart rhythm. Doctors usually prescribe methadone in low enough doses and intervals so this doesn’t occur. But if a person did take more than was prescribed, they could be at risk for heart rhythms that cause sudden cardiac death.
In addition, methadone can interact negatively with some other medications. The body breaks methadone down via a pathway known as the cytochrome P450 pathway. This is a very common pathway that many other medications are broken down using. Sometimes drugs can cause methadone to be broken down more slowly. This can cause more of the substance to build up in a person’s blood, potentially leading to lethal heart rhythms.
Examples of substances that can cause harmful heart rhythms include:
- benzodiazepines, such as Xanax or Valium
- calcium channel blockers
- tricyclic antidepressants
If a person takes methadone and these medications, they should talk to their doctor about dosages and ways to take methadone more safely.
Other medication types, such as buprenorphine and naltrexone, do not have the same degree of side effects as methadone. These medications are partial agonists, so they work slightly differently than methadone. Buprenorphine can cause respiratory depression if taken at the same time as sedatives like Valium. However, it doesn’t typically depress the respiratory drive as much as methadone can.
FICTION: You can't overdose if you're taking MAT drugs
FACT: Misuse of any drug can result in negative consequences
You can overdose from these medications under certain circumstances. As a full agonist, methadone can depress a person’s respiratory drive so they don’t breathe as much. If a person takes too much methadone, they can overdose, stop breathing, and die.
Naltrexone doesn’t depress a person’s respiratory drive (breathing), but does have a unique risk for overdose deaths due to an “override” blockade. A person who takes naltrexone doesn’t feel the euphoric high effects of using opioids. Sometimes, a person will try to override this effect by using lots of opioids. As a result, they can overdose.
It’s important to remember that MAT therapies aren’t intended to keep someone from overdosing if they continue to use drugs AND these therapies. Instead, they’re intended to prevent a person from using drugs at all. When used safely and according to a doctor’s prescription, MAT therapies are very effective. They’ve also proven themselves an effective way to prevent overdoses in those addicted to opioids.
FICTION: If I start using MAT, I'm going to be on them forever
FACT: MAT therapies may continue for as long as needed
It does take time to fully break the addiction to drugs, but MAT therapies aren’t intended for long-term use. According to the
Harvard Review of Psychiatry, methadone maintenance programs are usually intended to last one year.
While the timing of naltrexone and buprenorphine programs can vary, they are often about about 24 weeks or six months long . Before beginning a MAT program, it’s a good idea to talk to a doctor about how long they think you may need to be in a MAT program. However, it’s important to know this timing could be subject to change based on where you are in your therapeutic regimen.
The Future of Medication-Assisted Treatment
In February 2018, MAT therapies received further funding and support from federal agencies, including the U.S. Food and Drug Administration (FDA). 4 Currently, only about one-third of substance abuse treatment programs in America offer MAT therapies. Pharmaceutical companies are also working on new medications or extended-release versions of current ones so that people can have the best treatment options possible as they fight – and win – against opioid addiction.