Medication Assisted Treatment (MAT)

What is Medication-Assisted Treatment (MAT)?

Medication-Assisted Treatment (MAT) is the use of specific medications to treat substance use disorders (SUD). MAT, combined with counseling and treatment programming, creates a “whole patient” approach to managing substance use disorders. For many patients, MAT helps sustain recovery.

How Does Treatment Work?

MAT is primarily used to treat opioid addiction but is also effective for treating alcohol use disorder. 

It works by administering controlled prescription medication to normalize brain chemistry, block the euphoric effects of alcohol and opioids, ease physiological cravings, and normalize body functions without the negative effects of the abused drug. Treatment programs are clinically tailored to meet each patient’s needs. 

MAT treats opioid/opiate use disorder and alcohol use disorder. MAT for stimulant use disorder is still in development. Many people are familiar with some of the earliest emanations of MAT, which is for treating tobacco use disorder. This includes nicotine replacement patches, gum, and lozenges, as well as some prescription medications like Varenicline (Chantix) and Bupropion (Wellbutrin). 

Medication-Assisted Therapy and Opioid Use Disorder (Addiction)

MAT does not cure opiate dependence but assists the patient in maintaining abstinence. The most commonly used MATs prescribed are methadone and buprenorphine/naloxone. These are medications that are technically classified as opioids, but when administered in a controlled environment are opiate replacement therapy (ORT). Used properly, they do not trigger euphoria. 

All opioids, including the variety found in MATs, bind to the opiate receptors in the brain; however, in medication-assisted treatment, they are less addictive with a lower potential for abuse.

Although they have the potential for misuse, when taken properly, they help those in treatment live normal lives. Common medications are Suboxone, Subutex, and Zubsolv, which are all examples of buprenorphine/naloxone. Another is Vivitrol, an injectable form of naltrexone, which lasts for 30 days. 

Medication-Assisted Therapy and Alcohol Use Disorder (Addiction)

MAT for alcohol use disorder includes the medications disulfiram (more commonly known as Antabuse), acamprosate (Campral), and naltrexone. Just as MAT for opioid addiction does, these medications do not cure alcohol use disorder. Instead, they work by controlling cravings for alcohol.

Disulfiram (Antabuse) is a medication that has been in use for decades and works by causing the body to be unable to metabolize alcohol. If a person taking Disulfiram drinks alcohol, they will experience vomiting, sweating, dizziness, and heart palpitations. Naltrexone and Acamprosate work by controlling cravings for alcohol, making it easier to abstain. This, combined with therapy produces longer-lasting recovery. 

There are many different medications used in MAT. These include:

Naltrexone (Vivitrol, Revia) 

Naltrexone is an opioid antagonist, which means it blocks the effects of opioid drugs. People who relapse while taking naltrexone don’t experience the euphoria they felt in the past when using their opioid of choice. Naltrexone is also used to block the effects of alcohol.

Acamprosate (Campral) 

Acamprosate prevents those who have given up alcohol from relapsing. It does not prevent withdrawal symptoms if you just stopped drinking, so you need to wait about five to eight days before using it.

Antipsychotics 

Antipsychotics treat a person’s disconnect from reality. They tend to be most effective when treating psychosis rooted in mental illness, as opposed to psychosis caused by substance use. However, they are still effective in managing alcohol and drug use linked to mental illness.

These medications include:

• First-generation antipsychotics including Chlorpromazine (Thorazine), Haloperidol (Haldol), Loxapine (Loxitane), Molindone (Moban), and Perphenazine (Trilafon)
• Second-generation antipsychotics including Clozapine (Clozaril), Olanzapine (Zyprexa), Risperidone (Risperdal) and Quetiapine (Seroquel)
• Third-generation antipsychotics including Aripiprazole (Abilify), Brexpiprazole (Rexulti), and Cariprazine (Vraylar)

Side effects of antipsychotics include:

• Sedation
• Low blood pressure
• Cardiac arrhythmias
• Seizures
• Weight gain
• Sexual dysfunction
• Anticholinergic effects, such as dry mouth, urinary retention, constipation, and blurred vision
• Pseudoparkinsonism, which includes tremors, social withdrawal, and shuffling
• Akathisia, which is a feeling of restlessness
• Dystonic reactions, which causes spasming of muscles throughout the body and can be permanent and life-threatening
• Tardive dyskinesia, which involves involuntary movements, usually of the face and mouth and is usually permanent
• Agranulocytosis, which is a decrease in white blood cells that increases a person’s risk of infection

Anticonvulsants

Anticonvulsant medications aren’t FDA-approved for treating alcohol use disorder, but are prescribed off-label and have shown promising results. These include topiramate and gabapentin.

Beta-Blockers 

Beta-blockers are medications primarily used to prevent heart attacks, angina, and migraines. It is also used off-label for several things, including drug and alcohol rehabilitation with co-occurring disorders. They work by preventing neurotransmitters from attaching to beta receptors on nerves, which reduces anxiety.

Side effects of beta blockers include:

• Decreased blood pressure
• Decreased heart rate
• Imbalance in blood sugar levels in diabetics
• Dizziness
• Closure of airways

Clonidine

Clonidine is an anti-hypertensive that works by blocking chemicals in the brain that trigger sympathetic nervous system activity. It treats opioid dependence by reducing the symptoms of detoxification, such as sweating, hot flashes, watery eyes, and restlessness. Clonidine also reduces anxiety and might shorten the time it takes to detox. It does not cure addiction, but it makes relapse less likely during the detoxification phase.

Clonidine has several benefits, including:

• Not being a scheduled medication
• Allowing for immediate use of opioids in preparation for naltrexone use
• Not producing euphoric feelings associated with opioid use

Clonidine is also used in combination with Librium, Valium, or Xanax to treat alcohol use disorder.

Potential side effects of clonidine include:

• Breathing problems
• Constipation
• Headache
• Hives
• Irregular heartbeat
• Mood changes
• Rashes
• Swelling
• Vomiting
• Weakness

Clonidine is addictive and should only be used as part of a medically supervised, comprehensive treatment program.

Naloxone

Naloxone is used to treat someone who has overdosed on heroin and some types of painkillers. Some states allow people who know a person with an opioid use disorder to carry naloxone in injectable form in case of overdose. There is also a nasal spray version used without any special training.

Naloxone works by blocking the effects of opioids and heroin. These drugs slow a person’s breathing, and when someone overdoses, their breathing can stop. When naloxone is administered soon enough after an overdose, it counters the effects and can save someone’s life.

Side effects of naloxone include:

• Chest pain
• Seizures
• Hives
• Trouble breathing
• Face, lip, and tongue swelling

All of these side effects are medical emergencies. Naloxone also puts a person into withdrawal, which can trigger vomiting, shaking, and sweating.

Methadone

Methadone is one of the most popular drugs used in MAT. It is a full opioid agonist, which means it completely activates the opioid receptors in the brain. This alleviates cravings and withdrawal symptoms. Methadone is carefully monitored under a doctor’s supervision and, when used properly, does not produce the overwhelming high that leads to addiction. It is the only drug approved for pregnant or breastfeeding women using MAT.

Buprenorphine (Subutex)

Buprenorphine is a partial opioid agonist, which means it produces lower intensity effects than heroin or methadone. People are unlikely to abuse buprenorphine because of its “ceiling effect,” which means more doses don’t trigger additional side effects. The MAT medication Suboxone is a combination of buprenorphine and naloxone.

Disulfiram

Disulfiram is used to deter the consumption of alcohol by disrupting the body’s usual way of metabolizing alcohol. Taking it triggers an uncomfortable physiological reaction to acetaldehyde, which is a chemical in alcohol. Drinking alcohol while using this drug creates a buildup of acetaldehyde, which triggers headaches, nausea, and vomiting.

Am I sober if I’m using MAT?

The most common concern about medication-assisted therapy arises because the patient continues to use a drug even though he or she is in recovery. Some people wonder if it’s possible to be sober with MAT. It is possible to get sober through MAT.

The medications used in MAT help patients avoid relapse and manage their addiction. They are no different than using medication to control blood pressure, diabetes, or any other chronic condition. MAT medications are safe, controlled, and effective, and do not trigger highs or euphoria like the drugs associated with addiction.

Can I be a member of Alcoholics Anonymous or Narcotics Anonymous if I’m using MAT?

Built on the basis of completely sober living, some people aren’t sure if they can participate in 12-step programs when using MAT. Some AA and NA members even discourage MAT.

Unfortunately, this is misleading and incorrect information. Furthermore, they are overstepping the boundary of not giving advice to one another that is part of the 12-step philosophy. There is no official stance in AA or NA literature for or against MAT. However, if you feel uncomfortable or unwelcomed by traditional 12-step programs, you have other group options, including SMART Recovery, Secular Organizations for Sobriety (SOS), or LifeRing.

How Much Does MAT Cost?

The cost of Medication-Assisted Treatment varies a great deal from program to program depending on which drug is administered and other factors.

For example:

• Methadone treatment costs about $126.00 per week or between $4000 and $7000 per year.
• Buprenorphine/Naloxone given to stable patients is approximately $115 per week or just under $600 per year.
• Naltrexone is approximately $1200 per month or $14,100 per year.

Does Insurance Cover MAT?

Treatment coverage for substance use disorders (SUD) became more widely available following the passage of the Affordable Care Act. The Mental Health Parity and Addiction Equity Act of 2008 also requires insurance providers to offer the same level of benefits for mental and/or substance use treatment as they do for medical and surgical care.

Does Medicaid Cover MAT?

Medicaid programs and what they cover vary from state to state. For example, most state Medicaid plans cover Methadone treatment. Arkansas, Idaho, Kansas, Kentucky, Louisiana, Nebraska, North Dakota, South Carolina, Tennessee, and Wyoming do not. Most states cover suboxone treatment, but there are specific requirements regarding amounts and administration. 

The best way to determine what financial support is available is to contact a specific state’s Medicaid office.

How Effective is Medication-Assisted Treatment?

MAT is effective for helping people overcome substance abuse disorders. It is an evidence-based form of treatment, which means there is research proving its effectiveness. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT is “clinically effective” and significantly reduces the need for inpatient detoxification.

The use of medication-assisted treatment in treating drug and alcohol use disorders (AUD):

• Prevents relapse
• Blocks the euphoric reaction of substances
• Alleviates withdrawal symptoms
• Reduces cravings
• Helps facilitate behavioral therapy
• Allows patients to focus on obligations and responsibilities during recovery

MAT provides a comprehensive and individualized treatment option that increases the chances of successful recovery. Long-term benefits of MAT include:

• Improving patient survival rates
• Increasing treatment retention
• Decreasing illicit opioid use and criminal activity among those with a SUD
• Increasing patient employability
• Improving birth outcomes in women with SUDs
• Reducing the risk for HIV and hepatitis C

Many healthcare professionals believe MAT is underused due, in part, to the misconceptions about substituting one drug for another. Patients also have concerns about using drugs in their recovery from addiction. More training and education is needed to change opinions toward MAT in the addiction community.