The opioid crisis, which affects millions of people in the U.S., shows no signs of stopping. Misusing prescription and non-prescription opioids have led to an increasing number of fatal overdoses. It is devastating for the victims, their loved ones and their communities.
The government and medical community are addressing the national crisis by regulating prescription pain relievers, challenging pharmaceutical companies and expanding access to Narcan (Naloxone), an opioid antagonist that can reverse overdoses.
Finding a solution to help people struggling with opioid use disorder is difficult, but medication-assisted treatment (MAT) has risen to the top. This evidence-based treatment practice has gained recognition as a particularly effective method of addressing opioid addiction and other types of substance use disorder.
If you or a loved one are battling an addiction to opioids, read on to understand more about MAT and how it can help.
What is opioid use disorder?
“Opioid use disorder (OUD), like other medical conditions, is a treatable chronic medical disease,” said Krista LaBruzzo, MD, an addiction medicine specialist with Banner - University Medicine. “A use disorder involves complex brain circuitry, genetics and your own life experience. This can result in symptoms we see with a use disorder, where people engage in compulsive behaviors despite harmful consequences.”
Opioid use disorder can range from mild to severe. It can occur with the use of any type of opioid – prescriptions like oxycodone, fentanyl and morphine or illegal opioids like heroin.
What is medication-assisted treatment?
Medication-assisted treatment, MAT, is a modern-day option that combines medication and behavioral therapy and counseling to treat opioid use disorder and addiction. MAT has a proven track record of successfully combating opioid use and substance abuse disorders.
Counseling and cognitive behavioral therapy are equally important. Most programs require that you participate in therapy – not medication alone.
Some of the key benefits of MAT are:
- Reducing the potential for relapses and overdoses
- Relief from withdrawal symptoms
- Blocking the euphoric effects (“the high”) associated with the drug or alcohol
- Curbing or eliminating intense drug and alcohol cravings that accompany withdrawals
- Increasing the ability to retain jobs and enjoy a social life
- Improving birth outcomes for pregnant people
- Assistance in long-term recovery
Are medications used in medication-assisted treatment safe?
The Food and Drug Administration (FDA) currently approves three drugs to treat opioid use disorder: methadone, buprenorphine and naltrexone. These medications are classified as opioids but don’t produce the same “high” or likelihood of misuse or addiction.
When administered by a treatment provider, these medications have proven to be safe and effective.
“They are extremely effective and should be offered to anyone with a use disorder,” Dr. LaBruzzo said. “Similarly to other chronic diseases, these medications for opioid use disorder can be continued as maintenance treatment.”
How are the medications used in opioid use disorder treatment?
The medications work in slightly different ways by either fully or partially blocking other opioids’ brain effects. Medication is tailored to each person, considering different situations, such as pregnancy and mental health disorders.
“No matter the medication chosen, the goal is to help patients feel normal, curb the symptoms of withdrawal and control cravings,” Dr. LaBruzzo said.
Buprenorphine
Buprenorphine is known as a partial agonist at the opioid receptor site. This means that it acts like an opioid and doesn’t at the same time. You can reduce cravings and withdrawal symptoms without the dramatic highs and lows of illicit drug abuse.
“I like to think of it this way: If oxycodone, heroin or fentanyl were a light switch, they would be our regular on/off switch,” Dr. LaBruzzo said. “When they’re present, the light is on, and when they aren’t, it is off. Buprenorphine is a little more like a dimmer switch at a medium setting. The light is on, but it’s not quite the same. It’s still a strong medication, just different.”
Buprenorphine comes in a tablet or film (a paper-thin, rectangular strip) and is most typically prescribed by a physician and in treatment facilities or clinics. An injectable form is also available and administered in the abdomen once a month.
Methadone
Methadone, like fentanyl, heroin and oxycodone or morphine, is a full agonist. “It is extremely long acting and has specific properties that allow you to stay on a consistent dose for a long time,” Dr. LaBruzzo said.
The medication helps reduce cravings and withdrawal without causing you to feel “high” or sleepy.
“Methadone must be given in an opioid treatment center, and it comes in liquid form that is taken daily,” Dr. LaBruzzo said.
Naltrexone
Naltrexone is an opioid antagonist, meaning it blocks all opioids. This decreases cravings and prevents any opioid drug from producing a “high,” but it does not prevent withdrawal symptoms.
“This medication requires that you not be on prescribed or nonprescribed opioids before taking it and must be supervised by your provider,” Dr. LaBruzzo said.
Naltrexone can be taken once a day as a pill or once a month via a long-acting injectable.
Which medication is right for me?
Anyone with a use disorder is a candidate for these medications and should be offered them as part of their treatment. However, speaking with a health care provider before starting any of these medications is important.
“Methadone should be avoided or used with caution if you have a heart rhythm disorder known as long QT syndrome,” Dr. LaBruzzo said. “Naltrexone should be used with caution in patients who have liver disease.”
Methadone and buprenorphine are the first-line therapy options for pregnant people with opioid use disorder. Some treatment centers use naltrexone, but there is limited information on its safety during pregnancy.
Is medication-assisted treatment the right treatment for you?
MAT may be the right treatment if you or a loved one have tried to quit before and have been unsuccessful. MAT is safe and often leads to better outcomes than other addiction treatments.
Call Banner Health’s Opioid Assistance and Referral Line 24/7 at 888-688-4222, or find an opioid treatment program near you.
