People seeking treatment for opioid use disorder (OUD) are often referred to rehab programs, but this is neither the only nor the best option for many patients. Across the country, a growing number of people are seeking help through medication-assisted treatment, or MAT. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT is now available in almost every state, and it is covered by a growing number of insurance plans.
MAT is a strategy used to mitigate and help patients recover from the effects of OUD while simultaneously aiding them in breaking the habit. This is accomplished by combining medication with counseling and psychosocial support to uplift patients in all aspects of recovery at the same time.
How does MAT work?
Medication-assisted treatment starts by using FDA-approved medications to reduce cravings for opioids and lower the risk of overdose. The most common medications are methadone and Suboxone®. Methadone was first created during World War II as a painkiller, and Suboxone was introduced to the market in the early 2000s as a response to methadone’s increased role in prescription opioid overdoses. Suboxone is generally the safer prescription, though both are still available and prescribed based on an individual patient’s needs.
Suboxone is a medication consisting of two substances: buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, meaning it binds to the brain’s opioid receptors and only partially activates them. This results in the medical effects of opioids—such as pain relief—while blocking the euphoric effects of a high. Buprenorphine also relieves most symptoms of withdrawal.
Naloxone is a full opioid antagonist, which means that the opioid receptors prefer to bind with naloxone. This effect can essentially force bound opioids out of the receptors and replace them, all without producing any feelings of euphoria. By taking up space at the opioid receptors and forcing out previously attached compounds, naloxone can reverse the effects of an opioid overdose. Reversing the heart rate and breathing depression of an overdose and blocking receptors from binding further save lives.
Once on this medication, a patient’s cravings should be significantly reduced. This gives patients and doctors a valuable opportunity to address the underlying causes of opioid misuse through counseling and behavioral therapy.
What are the benefits and disadvantages?
One major benefit of Suboxone is that it is difficult to misuse. Buprenorphine has a “ceiling effect” that stops it from producing a high or risky overdose, even at high dosages. The presence of naloxone aids in this, while also greatly lowering the risk of overdose. MAT patients may be up to 80% less likely to experience an overdose during treatment.
The main drawback of medication-assisted treatment is that it may need to continue for months, years, or even indefinitely. Unfortunately, there is no quick and easy answer for permanently treating OUD, so the process can be extensive. While on Suboxone, patients may also have to deal with unpleasant side effects, which are primarily physical. They may include headaches, nausea and vomiting, insomnia, and drowsiness.
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