What is MAT?
Medication-assisted treatment is the drug and alcohol treatment approach of using medications to help a person go through withdrawals from a particular substance. Medication-assisted treatment also helps keep a person from returning to drug or alcohol abuse, depending on the MAT medications a person takes. 1
FDA-approved medications for the treatment of opiate use disorder include buprenorphine-containing products(suboxone, Bunavail, Zubsolv, Probuphine implact), and naltrexone (an oral daily form, as well as one monthly injection, vivitrol). Other drug and alcohol addictions may be treated with other medications. For example, we have been using antabuse, Campral, and Naltrexone for alcohol use disorder for some time now with encouraging results.
However, the specific types of medication chosen for each patient in recovery is a highly individual process, depends on numerous factors and is something that is determines following a through evaluation by our experienced clinicians.
The idea of medication-assisted treatment has been around for more than 40 years with the inception of methadone treatment that has helped people struggling with heroin addiction. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the approach to substance abuse treatment gained popularity in 1997 when the National Institute of Health published a report concluding that medication-assisted treatment was an effective method of treatment for opioid addiction.
Some people who learn about medication-assisted treatment as a treatment option raise concerns that include the concept that it is just switching one addiction for the next. However, it’s important to remember that most medical experts agree addiction is a medical disease. Doctors treat medical diseases with medications – this is true for conditions like high blood pressure and diabetes. Therefore, they argue that medicines should be no exception as treatment.
Additionally, medication-assisted treatment allows a person who is routinely abusing an illegal substance or abusing a legal one in an unhealthy and sometimes illegal manner and helps them use a legal one. This change can make a person less likely to get in trouble with the law related to their substance abuse.
These examples are just some of the initial benefits that medication-assisted treatment can offer as a treatment option. While it isn’t available for all types of addictive substances, two of the most common methods of treatment are for alcohol and opiate addiction.
MAT Medications for Alcohol Withdrawal
An estimated 2.5 million people die across the world on a yearly basis. 2 Many people in the United States are affected by alcohol dependence. An estimated 38 million or about 12.5 percent of people living in the United States meet the criteria for alcohol dependence in their lifetimes.
Ideally, MAT medications for alcohol withdrawal should be combined with other treatments (such as psychotherapy) for helping reduce a person’s overall alcohol consumption. When a person uses a combination of treatments that address both their physical and mental health, they can usually have greater success in maintaining sobriety.
What it is:
N-acetyl homotaurine or Acamprosate is an FDA-approved MAT medication doctors use to treat alcohol dependence. The MAT medication also helps to reduce cravings when a person is going through alcohol withdrawal. According to an article in the journal Therapeutics and Clinical Risk Management, taking acamprosate has been clinically proven to be more effective than a placebo medicine in reducing drinking and extending the amount of time a person is sober.
Doctors have also found that taking acamprosate and participating in behavioral therapy has greater results than taking acamprosate alone. While acamprosate can be effective in helping a person struggling with alcohol abuse, researchers haven’t found the MAT medication is more effective than other MAT medicines used to aid in alcohol withdrawals.
How it works:
Doctors don’t know exactly how acamprosate works to help treat alcohol dependence. They currently think the drug works to balance between excitatory and inhibitory neurotransmitters in the brain. Doctors think this may help to reduce the levels of stress and anxiety a person can experience when they withdraw from alcohol.
Because a person’s liver doesn’t break down acamprosate, it is a safer MAT medication to use for patients who have lots of liver problems or hepatitis due to their drinking. However, the kidneys are responsible for releasing the medicine from the body. If a person has severe kidney problems, they may not be able to take acamprosate.
What it is:
Disulfiram is a MAT medication doctors have used to treat alcohol dependence for more than 50 years. Doctors call disulfiram an “aversion therapy” because it works by having a person take the MAT medication and if they return to drinking, they will feel very ill when they drink. The MAT medication’s brand name is Antabuse.
People who are going through alcohol withdrawals will usually wait to take Disulfiram until they have stopped drinking at least 12 hours. 3 If they start taking it too soon, they will start to feel ill because they may still have alcohol in their system. Disulfiram does not take long to be effective in a person’s system.
A person should also avoid products that contain alcohol. Examples include rubbing alcohol, aftershave, mouthwashes, hand sanitizers, cold and flu products, and hair sprays. Also, some food products have alcohol-like products. These include vinegars, kombucha, and some sauces.
How it works:
Disulfiram works by keeping the body from breaking down certain components of alcohol. This causes a person to feel very sick if they drink while taking it. Ideally, the fear of getting very sick to a person’s stomach will keep a person from drinking again when they are taking it.
Other symptoms that occur when a person takes disulfiram and drinks include:
Because of how long disulfiram stays in a person’s system, a person may have these reactions up to two weeks after they stop taking the medicine if they start drinking again. Doctors have found missing even one dose of disulfiram can increase a person’s risk for relapse.
What it is:
Naltrexone is a MAT medication that antagonizes (blocks) opioid receptors in the brain. Doctors use it to treat alcohol withdrawals as well as opiate addiction. The U.S. Food & Drug Administration first approved naltrexone in 1984 as a therapy for drug and alcohol treatment. Pharmaceutical manufacturers sell the MAT medication under the brand name Campral.
How it works:
Naltrexone is a mu-opioid antagonist. In some ways, it works as an aversion therapy as well. This is because if a person takes naltrexone and then drinks, they will not experience a sense of euphoria that they usually experience when they drink. According to Therapeutics and Clinical Risk Management, an analysis of 50 randomized controlled trials that enrolled nearly 7,800 patients found that taking naltrexone helped to reduce the incidence of heavy drinking days by 83 percent.
Taking naltrexone has been found to reduce drinking by 83%
Doctors have found that naltrexone may not be effective for treating people who have certain genetic mutations. As a result, some people may find the MAT medication doesn’t help them while it helps others.
What it is:
Topiramate is an anti-seizure drug that doctors have found helps to treat alcohol dependence and withdrawals. 4 The brand name for topiramate is Topamax. Doctors may prescribe the MAT medication to reduce alcohol-related cravings when a person is going through the withdrawal stag. According to an article in the journal BMC Psychiatry, taking topiramate may also help to reduce anxiety and depression symptoms when a person is going through alcohol withdrawals.
A study followed people through a 7- to 10-day inpatient alcohol detoxification program. Thirty patients received therapy alone while 60 took topiramate and participated in psychotherapy treatments. At the study’s conclusion, those who took topiramate had reductions in depression, anxiety, and an obsessive-compulsive desire to drink compared to the group that did not. The authors also followed up with patients over a four-month time period. They found that people who had taken topiramate were less likely to relapse than people who didn’t.
How it works:
Doctors don’t know exactly how topiramate works to help those struggling with alcohol dependence. They think that the MAT medication helps to depress the central nervous system in a way that is similar to alcohol by keeping compounds that excite the nervous system at bay. Also, the MAT medication reduces the amount of the feel-good chemical dopamine the brain releases when a person drinks.
MAT Medications for Opioid Withdrawal
According to SAMHSA, there were 750 opiate treatment programs treating 115,000 patients in the United States and its territories in 1993. In 2005, this number had increased to 1,100 opiate treatment programs caring for more than 200,000 patients. In the 15 years since this initial report was published, opiate treatment programs have only likely expanded. More research is available about how effective these MAT medications can be in helping people who are struggling with opioid addiction.
There are several MAT medications the FDA has approved to treat opioid withdrawals. Some of these MAT medications require monthly monitoring while others are monitored less frequently. It’s important a person discuss the potential side effects and benefits of each with a doctor. Individual health considerations may make one MAT medication a better fit than another.
What it is:
Methadone is a long-acting opiate MAT medication that doesn’t give off the same euphoric high that using other opiates like heroin or pain medications can.
Methadone is the oldest MAT medication that led the movement toward this therapeutic approach to rehabilitation. One of the first-known research projects on methadone was in 1965 when a group of researchers at Manhattan General Hospital first studied methadone therapy. The researchers gave methadone doses of between 80 and 120 milligrams a day and studied the MAT medication’s effects on patients. These researchers found many of the patients who took methadone were able to reduce or eliminate their opiate use.
Methadone therapy as a treatment for opiate abuse has continued over time. For example, in 1994, the California Department of Alcohol and Drug Programs released a study about methadone treatments in the state. They found that methadone was an effective and cost-saving treatment. They estimated methadone saved $3 to $4 for every $1 spent on treatment. They also found those who used methadone reduced their heroin use by as much as two-thirds, which was the most significant decrease in the addiction treatments studied.
How it works:
Methadone is a mu-opioid agonist. This means that it activates opioid receptors in the body to provide pain relief. However, there are different types of opioid receptors. Methadone activates the ones that relieve pain, but not the ones that cause a euphoric high that is addictive.
However, this doesn’t mean methadone is a totally safe drug. The U.S. Drug Enforcement Agency classifies it as a schedule II drug. This means it has a medical use, but can be addictive. Doctors can prescribe methadone as an oral solution, liquid, tablet, or powder.
When a person takes an oral dose of methadone, doctors estimate a person’s cravings should be reduced for anywhere from 24 to 36 hours after a person takes the medicine. Methadone requires an induction phase where a person takes the MAT medication to achieve a steady-state where the amount their body releases is the same as the amount a person takes in. This usually requires about 5 to 7.5 days to be most effective.
If a person takes methadone, they must do so through a methadone maintenance clinic. At this clinic, they must have testing for methadone to make sure they don’t have too much in their system. Because methadone is much longer-acting than most other opiate MAT medications, a person can overdose on the medicine if too much builds up over time.
Reduced Side Effects
Doctors have found methadone is helpful in not only helping a person overcome their addiction to opiates, but also to reduce the risks for side effects associated with intravenous drug use, such as cellulitis, hepatitis, and HIV infections.
What it is:
Buprenorphine is a MAT medication sold under the brand name Subutex. It is most commonly prescribed as a sublingual tablet that disintegrates under a person’s tongue when they take the MAT medication. Doctors have to be specially certified to prescribe buprenorphine. If a doctor does qualify, they usually can only treat up to a certain amount of people at a time.
Doctors in medical detox facilities may also prescribe buprenorphine to help a person detoxify from using illegal opiates and prescription painkillers. Because buprenorphine is rather long-lasting, it can attach to opioid receptors and reduce a person’s withdrawal symptoms over time.
How it works:
Buprenorphine is a partial mu-opioid agonist. Like methadone, it can help to relieve pain without causing euphoric symptoms. Because it is a partial agonist, it may not work as well as methadone to relieve pain. The U.S. Food and Drug Administration (FDA) approved buprenorphine in 2002 as a treatment for opiate addiction.
The U.S. Drug Enforcement Agency places buprenorphine as a Schedule III drug. This means it has the potential to be addictive, but is not as great a risk for overdose as MAT medications like methadone can be.
What it is:
Some people like to take naltrexone because it doesn’t usually cause withdrawal symptoms when a person stops using it. Unfortunately, patient compliance can be a problem with the MAT medication. For this reason, doctors haven’t found that it is as effective as MAT medications like methadone and buprenorphine for treating opiate addiction. One study found that 70 to 80 percent of patients who participate in naltrexone therapy drop out after starting therapy.
The high rates of dropout are why they combine it with the MAT medication buprenorphine and sell it under the brand name Suboxone. This MAT medication can facilitate very fast withdrawal from opiates. That’s why it is important a person isn’t taking any opiates if they take this MAT medication.
How it works:
Instead of activating opioid receptors, it sort of “sits” on the receptors and keeps opioid medications from working. When naltrexone is present on opioid receptors, it keeps other medications (like morphine and methadone) from occupying the receptors. Ideally, this helps to deter a person from using medications because they won’t be effective.
Doctors sell naltrexone under the brand name Depade in 25, 50, and 100-milligram tablets. The medication doesn’t usually cause a significant amount of side effects. However, an estimated 10 percent of patients report gastrointestinal upset due to naltrexone.
Medication-Assisted Treatment Supports Recovery
Medication-assisted treatment for alcohol and opiate withdrawals can often help a person experience greater success with sobriety compared to not using these methods. It’s important that a person using these treatments understand they aren’t a crutch, but a medical treatment that can help them get sober and avoid some of the unpleasant side effects and cravings that substance abuse withdrawal can cause.
Going through substance withdrawals can be difficult enough as it is. Because many of these medications have fewer side effects than when compared to the dangers of substance abuse, it’s important a doctor discuss the possibilities of MAT when a person decides to get help for their substance abuse concerns.