Medication-Assisted Treatment

Medication-Assisted Treatment (MAT)

Many people assume using medication during treatment for substance abuse disorders creates yet another addiction, but this assumption is also easily challenged according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Using FDA-approved medications in conjunction with evidence-based therapies, the SAMHSA determined that medication-assisted treatment is an effective way to treat addiction as it may even assist recovering users to remain in treatment for longer periods of time. This helps to extend overall phases of sobriety and paves the way for a triumphant recovery.

This grouping of therapies is referred to as Medication-Assisted Treatment (MAT) and is frequently integrated into the treatment for alcohol and opioid substance use disorders.

What Exactly is MAT?

Addiction and its recovery process tend to come with very powerful cravings to use. This is true even once the detox and treatment process have been successfully completed. These cravings, which are completely normal for those individuals who are struggling to get clean and remain sober, can potentially interfere with the treatment process and increase the overall threat of relapse. However, there are certain medications that have proven to be effective at helping to hinder these cravings and promote abstinence.

Grouping these medications with evidence-based therapies educates the recovering individual on how to successfully manage cravings and relapse triggers on a cognitive and emotional level that encourages extended periods of sobriety.

What Kinds of Medications are Used in MAT?

There are numerous kinds of medications that are given to help treat two main types of substance use disorders/addictions: alcohol and opioids. Currently, there aren’t any FDA-approved medications used to treat other drug addictions like cocaine, marijuana, or methamphetamine dependence.

Some of the medications that are most commonly prescribed for the treatment of alcohol or opioid dependence are listed below.

Buprenorphine

A partial opioid agonist, buprenorphine is used in the treatment of an individual who is addicted to opioids regardless of if the substance is a prescription painkiller like Vicodin or OxyContin, or heroin. There are only a few medications that can be used for opioid dependence, and buprenorphine is the medication that is the first one that can be given. It can also be obtained from the doctor’s office directly. Until now, drugs that can be used to treat an opioid dependency, like methadone, can only be obtained in a clinic.

Buprenorphine is not prescribed in seclusion; instead, it is a component of an inclusive recovery program that is intended to address the individual needs of a patient. Alone, the medication has potential for prescription and abuse diversion as a result of its opioid effects. However, there are formulations that contain a combination of naloxone and buprenorphine that decrease the abuse potential. This is because naloxone blocks the opioid effects and initiates the withdrawal symptoms if there are any efforts made for abuse via injection.

When buprenorphine-containing medications are used properly, they can help to alleviate unpleasant withdrawal symptoms and decreased associated cravings. These medications tend to be hard to overdose on because of the ceiling effect that the drug has (and because of the naloxone). When you reach a certain dosage, the effects will plateau and simply  increase when you increase the dosage.

Potential Side Effects

There are some adverse side effects when taking buprenorphine, including the following:

  • Constipation
  • Nausea
  • Vomiting
  • Fever
  • Sleeping difficulties
  • Irritability

Because buprenorphine is a partial opioid agonist, these side effects are very similar to that of other opioids such as prescription painkillers and heroin.

Probuphine

The first buprenorphine implant was approved by the FDA in May 2016 to help treat opioid dependence. Like naltrexone and methadone, Probuphine is intended to help people recovery from an addiction to opioids by reducing withdrawal symptoms and cravings without creating a euphoric high. Essentially, by ensuring that the patient is stabilized and reducing the opioid addiction-associated cravings that are often overwhelming, the patient is able to better engage in therapy and treatment.

The Probuphine implant consists four individual rods that are placed in the upper arm. These rods will administer a constant dose of buprenorphine into the patient’s bloodstream for six months, which is a suitable and convenient substitute to other treatment forms of the medication (dissolvable films and pills). A Probuphine implant is prescribed to individuals who are already established on low-to-moderate prescribed amounts of buprenorphine, and the implant isn’t recommended for more than two six-month treatment periods as each six-month treatment period requiring a new implant.

A Probuphine implant does have benefits over other types of medications like methadone, including the following:

  • Probuphine doesn’t require administration on a daily basis since it will release a low dosage of the drug continuously.
  • Probuphine is unable to be abused as long as the implant remains in place.

Keep in mind that if the implant is removed or becomes expelled, there is the chance for intentional misuse or accidental exposure.

Methadone

A full opioid agonist, methadone produces effects similar to other opioids such as buprenorphine. Since methadone is longer-acting than drugs such as heroin, the overall effects tends to milder and should not considerably impact the patient’s ability to function.

Methadone is used to ease withdrawal symptoms as well as cravings to individuals who are addicted to painkillers or heroin. According to the Center for Substance Abuse Treatment (CSAT), one dose of methadone has the ability to prevent withdrawal and cravings for as long as 36 hours. To help prevent abuse, the medication is only administered on a specific schedule in a clinic.

Though methadone’s effects are somewhat mild and not associated with extreme highs, individuals taking the medication may still experience uncomfortable withdrawal symptoms if associated therapy is stopped suddenly. Therefore, it is crucial to speak to a healthcare provider if you decide to stop methadone or associated therapy.

Potential Side Effects

Some frequent side effects associated with methadone include the following:

  • Headache
  • Dry mouth
  • Sweating
  • Loss of appetite
  • Vomiting
  • Mood changes
  • Stomach pain
  • Low sex drive
  • Sleep disturbances

While these side effects are troublesome, they are not likely to present real danger.

However, if you experience any of the following side effects, you should seek medical attention immediately.

  • Swelling of the face
  • Itching
  • Rash
  • Breathing difficulties
  • Severe drowsiness
  • Hallucinations
  • Seizures

Naloxone

Another opioid antagonist, naloxone is a medication that will block the activity of an opioid at the receptor site. This potentially prevents or reverses a life-threatening overdose. For someone who may be an experiencing an overdose of an opioid, an emergency naloxone injection should be administered. It is important that opioid users and their family members understand how this medication works and how it can be used in the case of an overdose to prevent a potentially life threatening situation.

Naloxone is available in automatic injection devices. These are frequently given out as harm reduction measures in areas with reportedly high heroin abuse. The devices are equipped with voice control to provide step-by-step instructions for the person administering the injection. If you’ve been given a device and use opioids, keep the device on you at all times in the event of a medical emergency.

It is vital that you are aware of the warning signs and symptoms of an opiod overdose so that in an emergency situation, you’ll be able to recognize it immediately and have naloxone administered, if it is accessible.

Some of the signs of an opiod overdose include the following:

  • Small, constricted pupils
  • Severe drowsiness
  • Shallow breathing
  • Unresponsiveness
  • Loss of consciousness

Naltrexone

Available in pill or injectable form, naltrexone is also used to treat individuals who are suffering from alcohol or opioid addiction. Vivitrol, the injectable form of naltrexone, can only be injected into muscle and requires a monthly dosage. The pill form must be taken once per day. Unlike methadone and buprenorphine, naltrexone does not have the potential for abuse or diversion.

Instead, naltrexone works by blocking opioid receptors, which means that if you take naltrexone and then take opioids or drink alcohol, you will not experience a euphoric high related with those particular substances. The lack of the high often reduces the urge to use those substances.

Keep in mind that naltrexone does reduce your overall tolerance to opioids. Therefore, relapse can be extremely dangerous if you go back to the same amount that you were once taking. It could result in overdose and deadly respiratory depression.

Conversely, there are no risks that are linked with drinking while taking the recommended amount of naltrexone. However, when it is taken in surplus, it can result in severe damage to the liver. For that reason, it is crucial that patients follow the instructions given by their doctor carefully. As long as the medication is taken with prescribed limits, there are no specific contraindications to using the medication along with alcohol. Even so, naltrexone can still assist in reducing drinking behaviors because of the reduced “high” that the user experiences. Though the medication will block the person from experiencing the euphoric effects and other satisfying effects of drinking alcoholic beverages, it will not reduce other intoxicating effects like impaired coordination and judgment.

Potential Side Effects

Some of the most common side effects individuals experience with naltrexone treatment include the following:

  • Diarrhea
  • Vomiting
  • Headache
  • Muscle or joint pain
  • Nervousness
  • Difficulty sleeping

Disulfiram (Antabuse)

Disulfiram (also known as Antabuse) assists in curbing drinking behaviors by drawing out displeasing effects when an individual consumes alcohol. These unwanted effects generally appear 10 - 30 minutes after consuming alcohol and can include the following:

  • Sweating
  • Flushing
  • Headache
  • Weakness
  • Confusion
  • Blurred vision
  • Anxiety
  • Vomiting
  • Chest pain
  • Vertigo
  • Heart palpitations
  • Tachycardia

These effects last for approximately an hour and are simply meant to discourage individuals from partaking in drinking behaviors. The severity of the aforementioned reactions is related to the amount of the medication taken and the amount of alcohol that has been consumed.

For individuals to have success with this particular medication treatment, they have to make a commitment to remain sober. Without that commitment and motivation, there is a good chance that the individual will digress from their treatment plan and return to poor drinking behaviors. However, for those who are highly motivated, disulfiram can be particularly useful, particularly in triggering social situations that involve alcohol such as bars, parties, etc.

Acamprosate (Campral)

Acamprosate (also known as Campral) is yet another medication that is often used to help avert relapse and encourage abstinence in individuals who are alcohol dependent. According to the Center for Substance Abuse Treatment (CSAT), alcohol abuse can lead to neurological adaptations in numerous neurotransmitter systems such as the glutamate and gamma-aminobutric acid (GABA).

Once the brain becomes dependent on alcohol, a  new “equilibrium” is created that is only maintained when alcohol is present. When alcohol slows down or stops completely, the balance is likely to tip toward a hyper-excitatory state. Acamprosate helps normalize the balance between excitatory and inhibitory neuronal activities. During this process, it can reduce the post-acute withdrawal systems that have the potential to result in relapse.

The post-acute symptoms of withdrawal are those that tend to go beyond the typical acute withdrawal phase. Sometimes referred to as “protracted” symptoms of withdrawal, these symptoms may include the following:

  • Anxiety
  • Restlessness
  • Insomnia
  • Dysphoria (dissatisfaction feeling)

Potential Side Effects

When using acamprosate, some side effects may include the following:

  • Nausea
  • Diarrhea
  • Dizziness
  • Headache
  • Itchiness
  • Muscle weakness
  • Flatulence

While these side effects are generally mild and will disappear in a matter of weeks, some more serious side effects include depression as well as the thoughts of suicide. If this occurs, speak to a healthcare provider immediately.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), acamprosate doesn’t have any potential for abuse or negative effects when used in conjunction with alcohol. Therefore, it is ideal for individuals who have liver damage since it is not metabolized by the liver and won’t result in additional hepatic complications.

What is the Protocol for MAT Use?

If you decide to enter into an alcohol or opioid addiction treatment program, an intake evaluation by a mental health professional is required. The three main goals of this evaluation are as follows:

  1. To adequately diagnose the individual’s substance use disorder
  2. To determine the severity of the individual’s addiction
  3. To assess for the occurrence of co-occurring physical or mental health issues

Once the facility’s staff members have assessed your condition, they will determine whether you are a solid candidate for MAT. According to SAMHSA, you qualify as a good candidate for MAT if you meet the following criteria:

  • You have received an official diagnosis of an opioid or alcohol addiction.
  • You are willing to 100 percent comply with instructions that are provided to you.
  • You don’t have physical health problems that the medication could potentially aggravate.
  • You have been educated on alternative choices.

Conversely, you do not qualify as a candidate for MAT if you have:

  • A past history of medication abuse misuse
  • An addiction to a substance that is unable to be treated with a medication that has been approved by the FDA
  • A co-occurring substance addiction (meaning that the drug could negatively interact with treatment medication)
  • A severe physical limitation like a heart or lung condition that opioid agonists could exacerbate
  • A low level of commitment/motivation to get and remain sober

Treatment Does Not End with Medication

It is important to understand that medication alone is not and will never be enough to help a person achieve and maintain sobriety and abstinence in the long run.

Effective and successful addiction treatment will address a person as a whole, using the following in grouped efforts:

  • Medication
  • Education
  • Evidence-based behavioral therapies
  • Relapse prevention programs

Utilization of medications can assist individuals in remaining clean while behavioral therapies work to focus on underlying issues related to substance abuse, negative feelings, negative thoughts, and poor behaviors. This helps to endorse positive self-worth as well as teach, construct and apply healthy coping skills. This therapeutic combination is the core of MAT.

Want to Find a Program That Uses MAT?

If you are interested in learning more about MAT for yourself or a loved one that is suffering from an alcohol or opioid addiction, please reach out to our experienced, well-trained staff at Shadow Mountain Recovery. We would love to give you more information and talk with you about the benefits of medication-assisted treatment, so give us a call today!

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