It seems that the new “hot commodity” in the addiction treatment industry is Medication-Assisted Treatment (MAT.) For the past month, as I have scrolled through various addiction treatment related social media groups and conversed with colleagues it seems that everyone is opening a new MAT clinic in the near future or have done so already.
What Is MAT
“Medication-Assisted Treatment (MAT) is the use of FDA approved medications in combination with counseling and behavioral therapies, which is effective in the treatment of opioid use disorders (OUD) and can help some people to sustain recovery.” – United States Food & Drug Administration
This approach is not necessarily new by any means. The first blockade medication treatment utilized dates back to the 1960’s and 70’s with the large scale emergence of Methadone as a valued solution to the nation’s narcotic epidemic of the time. Society during those periods experienced significant increases in drug use coupled with the return of American Vets from the Vietnam war, who also came back with a heroin addiction. I would like to highlight that addiction treatment options available during those years in no way compares to what is available now. As of 2018:
“In the United States, more than 14,500 specialized drug treatment facilities provide counseling, behavioral therapy, medication, case management, and other types of services to persons with substance use disorders.” – National Institute on Drug Abuse
Methadone was first introduced as a method of replacement treatment for narcotic abuse. Established Methadone clinics dispensed the medication, normally taken orally, to those wishing to abstain from illicit heroin abuse. Methadone then grew to become not only a replacement treatment for addicted individuals but also a pain management solution for those with chronic pain. Almost from the beginning Methadone treatment has been met with controversy as addiction professionals viewed the treatment as a mere substitution of substance as well as a way to control an “undesirable” population of people. Methadone is in fact an opioid narcotic itself that targets the same receptors as illicit opiates do in the brain. Interestingly enough, Methadone maintenance treatment is still the most systematically studied, and controversial, method of treating drug addiction in the United States. Not all of those studies were positive.
As the United States has been thrown into another epidemic of heroin and prescription opioid abuse, government and private agencies are turning their resources towards another blockade medication in an effort to stop the problem. The amount of overdose related deaths we currently have in the United States is substantial, with 2017 having a record high of over 70,000 deaths (beating out vehicular accidents and gun violence). Buprenorphine in combination with Naloxone (commonly prescribed as Suboxone and Subutex) is a similar acting medication to Methadone but considered less narcotic due to the presence of Naloxone (an opioid blocker). Buprenorphine is an opioid itself that targets the same receptors in the brain however the feelings of euphoric high associated with heroin or opiate abuse is non-existent because Naloxone blocks the reward stimulation of those receptors.
Similar to Methadone maintenance, treatment and medical professionals are looking at increasing the amount of Suboxone maintenance availability as a means to treat opioid addicts. Studies done on groups who take Suboxone have shown positive results in decreasing the chance of overdose deaths and increasing the chances of an addict remaining in treatment. The same medical and treatment professionals argue that utilizing medication-assisted treatment treats addiction as the chronic illness it has been classified as by the American Medical Association. Suboxone has been around for a number of years, long enough for studies to be administered and data to be collected and until recently, it was commonly used as a means to mitigate the detoxification process for opiate addicts. The use allows for a controlled and slower detoxification from opiate abuse. Of course, maintenance options have been available, however it was usually only prescribed for individuals with chronic relapses and multiple treatment episodes. Sadly, in today’s addiction treatment field, there are a lot more of those individuals and cases.
The discussion for what may the causes for so many treatment relapses and continued use is for another post, but my current writing is to give information and point out some questions that families, addicts and other professionals should be asking before Suboxone maintenance is prescribed.
- Is the patient being told the specific effects of Suboxone on the body and body
- Is the patient being told how Suboxone interacts with opioid receptors in the brain
- Is the patient being told what they can expect when they decide they want to come off of the medication
- Does the MAT clinic or treatment center have specific criteria and assessments for when the patient is deemed “appropriate” to come off of their medication
- Does the MAT clinic or treatment center offer detoxification services in a residential setting for when the patient decides to come off of their medication
- Will health insurance (if applicable) cover the patient’s necessary costs of coming off of Suboxone
- What support groups are available for the patient who is taking Suboxone as a maintenance solution
- What are some statistics and data on the use of Suboxone in treating opiate abuse and addiction
- Is Suboxone enough for to treat all areas of the addiction
- What other services does the MAT clinic or treatment center provide for those on Suboxone maintenance (ie. therapy, group therapy, psychiatry, etc.)
There is no cure for addiction. I don’t know if there will ever be a clear cut method for helping addicts and alcoholics overcome their addictions in a quick, painless way. Though science and pharmacology has provided us with some tools that definitely help in the fight against drug related deaths and the destruction that comes with active substance abuse. Through my time working in the field of treating addicts, I have seen the positives and negatives of medication-assisted treatment so for me to say that it is not a worthwhile alternative, additive or solution would be asinine. I believe in information and education. Before jumping on the bandwagon of Suboxone maintenance or Methadone maintenance, do the research and ask the questions I have above. It may make the difference in how effective one’s treatment experience goes.