Addiction medications save lives. Get the facts about how they work, and learn how to advocate for MAT access for yourself or a loved one.
MAT involves the controlled use of FDA-approved medications as part of an individual’s addiction treatment plan. These medications help reduce cravings, prevent overdoses, and even block the effects of certain substances. Medications are an effective treatment for addictions to alcohol, opioids, and tobacco.
Experts consider MAT to be the gold standard of addiction care, especially for opioid use disorders. For people addicted to heroin or prescription painkillers, the use of medications has been shown to substantially increase the odds of successful, long-term recovery. Research shows that MAT is clinically proven to help prevent relapses and overdoses. Overall, the use of MAT reduces the death rate among addicted populations by 50% or more. Many countries, including France and Russia, have made MAT widely accessible with impressive results.
MAT is endorsed by the FDA, World Health Organization, the Substance Abuse and Mental Health Services Administration, the Surgeon General, the American Medical Association, and the American Association of Family Physicians. Several studies, most recently the National Academy of Sciences’ “Medications for Opioid Use Disorder Save Lives” report that MAT can help prevent relapses and fatal overdoses.
The use of medications should be one part of a customized, comprehensive addiction treatment plan. Other elements of the treatment plan may include individual and group psychotherapy, the support of family and other loved ones, life coaching, vocational counseling, and more. Addiction treatment plans should always be respectful of the patient, taking their unique needs and circumstances into account. Patient-centered treatment approaches have proven very successful.
How Does MAT for Opioid Use Disorder Work?
To understand the importance of MAT for opioid addiction, it’s good to have a basic knowledge of how opioids affect the brain. Opioids such as oxycodone, heroin, fentanyl, Percocet and Vicodin attach to certain receptors on brain cells, igniting neurotransmitters and sending signals that block pain, slow breathing, and promote a feeling of calmness.
When misused, they also flood the brain’s circuits with dopamine—that “feel-good” chemical that sends the brain feedback about rewards—creating a feeling of euphoria. For the sake of survival, our brains are naturally wired to repeat behaviors associated with pleasure or reward. So, when that reward system is over-stimulated by the effects of opioids, the brain remembers that behavior and records it as something that should be repeated without even thinking about it.
In short, opioids change the brain on a physiological level. When misuse leads to addiction, a person continues to use these drugs despite negative consequences in their lives. Recovering from this complex medical condition requires more than just individual will power.
FDA-approved medications—methadone, buprenorphine, and naltrexone—can either safely replace the opioids, or block the opioid effects on the brain. These medications can also relieve physiological cravings.
Before starting MAT, authorized clinicians screen patients to be sure they are prepared to undergo treatment, both physically and psychologically. Before beginning MAT, patients will need to stop taking anti-anxiety medications including Xanax or Valium which, when combined with MAT meds, could be fatal.
Naltrexone (Vivitrol or ReVia), buprenorphine (Suboxone), and methadone are three effective medications used to help treat opioid use disorder. MAT strategies vary because each patient is unique. That’s why it’s important to seek a licensed practitioner to determine what the best treatment plan is in each case.
Medications for opioid use disorder treatment: quick facts for patients
- Uses & effects: Taken orally once daily. Reduces cravings + withdrawal symptoms. Most often used for patients who have a greater dependence on opioids.
- Advantages/Disadvantages: Highly effective, good results for patients using methadone as directed. But, patients must report to a methadone clinic every day to receive their medication.
- Where to find: Authorized methadone treatment clinics.
- Uses & effects: Taken orally once daily, or via sustained-release forms like an implant or injection. Reduces cravings + withdrawal symptoms.
- Advantages/Disadvantages: Available by prescription, eliminating the need to go to an authorized clinic every day. But, finding a provider who is licensed to prescribe buprenorphine can be challenging.
- Where to find: Does not require daily visit to authorized clinic. But, patients must be completely substance-free for 7 days prior to beginning naltrexone treatment.
- Uses & effects: Taken orally or via a monthly sustained-release injection. Reduces withdrawal effects and cravings. Blocks the effects of opioids and prevents overdoses.
- Advantages/Disadvantages: Does not require daily visit to authorized clinic. But, patients must be completely substance-free for 7 days prior to beginning naltrexone treatment.
- Where to find: Via prescription via clinicians at ERs, general practice offices + treatment clinics. Fill prescriptions at pharmacies that offer MAT meds.
Sources: New England Journal of Medicine + US Department of Health and Human Services
Methadone is an agonist, meaning that this medication bonds tightly to the body’s opioid receptors. It lasts the longest in preventing withdrawal symptoms and suppressing cravings. Buprenorphine is a partial agonist—it replaces opioids, and blocks the effects of any other opioids that are taken in addition. While allowing patients to taper off opioids gradually, methadone and buprenorphine (or “bupe”) also reduce the debilitating side effects of withdrawal. Methadone is more often prescribed to patients who have greater dependence on opioids, and requires patients to receive treatment in a specially licensed methadone clinic. Specially licensed clinicians can prescribe buprenorphine in pill form, allowing patients to take their medication without supervision. Buprenorphine is also available as a monthly injection and as a time-released implantable device, administered by a specially licensed clinician.
Unlike methadone and buprenorphine, naltrexone is an opioid antagonist. Naltrexone binds to receptors in the brain in order to fully block the effects of opioids. In the U.S., naltrexone is available in prescription pill form and as a monthly extended-release injectable. Extended-release naltrexone is available as in implantable device in Russia and other countries and has proven effective at reducing impulsive behavior leading to relapses and fatal overdoses.
Every patient’s needs are different. While buprenorphine and naltrexone are very convenient and eliminate the need for daily dosing at a clinic, methadone is highly effective for many patients. Working closely with a coordinated care team, including family, friends, counselors, and clinicians to identify the best strategy will help ensure the chances of successful treatment and recovery.
Common Hurdles That Obstruct MAT Access
Despite overwhelming expert support for evidence-based addiction care, only 20 percent of the 2.1 million Americans who meet the clinical criteria for opioid addiction are receiving specialty treatment. Why is there such a disconnect? There are 3 main types of hurdles standing between patients with addiction and effective medical care.
There is widespread misinformation about addiction treatment—even among clinicians. For many years, most clinicians and addiction treatment specialists prescribed total abstinence from any substance, believing that this was the only way for patients to recover. Even though many scientific studies have proven that medications are highly effective in treating substance use disorders, stigma persists, keeping patients from accessing the most effective treatment for their illness.
From doctors to family members to recovery coaches, many Americans think of MAT as crutch, a cop-out, or a way for people with addiction to continue using drugs.
These misconceptions couldn’t be farther from the truth. MAT is not replacing one drug with another. When used as directed, addiction medications do not trigger euphoria, or have dangerous adverse effects. In fact, MAT is designed to make it possible for patients to be productive, to become healthier, to secure employment, or to return to work or school. People taking medications to treat their substance use disorders can work, drive, and care for their families. And that’s what recovery is all about.
Training, Authorization, and Coordinated Care
It’s a puzzling fact, but a fact nonetheless: Even though most physicians in America can prescribe addictive and dangerous opioid painkillers with few if any restrictions, doctors must become specially certified in order to prescribe addiction medications.
The training and certification of clinicians, including family physicians, is a huge hurdle that stands in the way of widespread MAT access. There are many restrictions on where MAT can be offered, and who can administer it. And due to these restrictions, many clinicians and facilities have limited capacity for the number of patients they can accept at one time. In many communities, only some of the MAT medications are available, which limits patients’ options.
Some clinicians refuse to administer MAT medications—even when they are authorized to do so—because of personal beliefs, the lack of coordinated care with mental health professionals (especially in rural communities), the additional time commitment required, and the potential threat of raids by the Drug Enforcement Administration and the FBI.
What’s more, it’s hard to access medications even within traditional addiction treatment centers. Few inpatient treatment facilities offer all three FDA-approved medications for opioid use disorder. While the American Society of Addiction Medicine (ASAM) has defined detailed standards of care, there is no established national accreditation program for treatment facilities in the U.S. (Shatterproof’s Rating System for Addiction Treatment Providers, expected to launch in 2020, is a groundbreaking initiative that will drive improvement, accountability, and a standardization of care among treatment providers. Learn more about that project here.)
Medicaid and CHIP Payment Access Commission has also detailed key obstacles to patient access to MAT, including finding prescribers who take Medicaid as payment for treating opioid use disorder, Medicaid drug formularies that only offer some of the MAT medications, and time limits on MAT treatment.
As the opioid epidemic draws increasing attention to the lack of addiction treatment in America, there’s a new focus on finding ways to ease these restrictions. The newly passed SUPPORT for Patients and Communities Act, which Shatterproof advocated for on Capitol Hill, helps knock down some of these access barriers. Shatterproof continues to advocate for state and federal policy change that improves access to MAT.
Insurance Coverage for Substance Use Disorders
Insurance coverage for addiction treatment varies by plan and by state. While the Affordable Care Act requires most insurance providers to cover addiction treatment, not all plans cover all three FDA-approved MAT medications. Some limit the number of doses and prescription refills for MAT patients. Many insurance companies limit what they cover. For example, some patients must pay out of pocket to see a psychiatrist and get prescriptions for their MAT medications. Each of these visits can cost upwards of $400.
Substance use disorders are chronic, often lifelong medical conditions. In spite of this, some insurance companies restrict how long they will cover MAT medications, as well as any other care that patients need to support their ongoing recovery. The Mental Health Parity and Addictions Equity Act requires health insurance providers and group health plans to cover behavioral health just as they do any other medical conditions. Still, finding medical and behavioral health clinicians certified to provide MAT is an obstacle to comprehensive treatment for substance use disorders.
Shatterproof regularly advocates for state and federal legislation that will improve mental health and substance use disorder parity.
Advocating for MAT in Your Community
Want to advocate for access to addiction medications in your community? Here are some helpful resources.
- Challenging the Myths, a one-page PDF from the National Council on Behavioral Health
- MAT Support Organizations, a list of nonprofits and government agencies from SAMHSA
- Advancing Access to Addiction Medications, a comprehensive guide from The American Society of Addiction Medicine
- Shatterproof’s Action Center, which features several petitions and advocacy campaigns. Take action now to join the movement!
Lead the MAT Conversation with Your Doctor
Your doctor may not know about Medication-Assisted Treatment (MAT), may not be authorized to administer it or may not support it. Lead the discussion. Declare that MAT is what you need. Advocate for yourself. Be armed with evidence. Know your rights.
Here are some talking points and sources to cite when you discuss the importance of MAT with health care professionals.
- The American Medical Association, The American Association of Family Physicians, The World Health Organization, the American Society of Addiction Medicine (ASAM), the Centers for Disease Control (CDC) and many others have identified MAT as the standard of care for Substance Use Disorder (SUD), including Opioid Use Disorder (OUD).
- MAT helps save lives and prevent relapses and overdoses, according to several clinical studies.
- MAT is patient-centered, built around a coordinated care team of clinical, vocational + psychotherapeutic experts with the active participation and support of loved ones.
- Opioid Use Disorder (OUD) is a chronic condition, much like diabetes and asthma. MAT provides ongoing treatment for this chronic condition.
- Stigma can kill. How we talk about OUD matters. OUD is not a moral failing.
- MAT drugs, if administered properly, can save lives. MAT is NOT trading one drug for another. Each patient responds differently to MAT, requiring individualized approaches.
- FDA approved medications—methadone, buprenorphine, and naltrexone—can regulate brain chemistry and/or block the euphoric effects opioids produce. These medications can also relieve physiological cravings.
- Many clinicians consider MAT too much trouble. Many are keen to refer patients with OUD out to other clinicians or programs. When patients’ own doctors and even emergency rooms won’t help administer MAT, OUD goes untreated and fatal overdoses and relapses increase.
- Primary care and other practitioners need to step up. A growing number of clinicians can get authorized to prescribe MAT.
- MAT Saves Lives presentation, produced by the National Academies of Science Engineering and Medicine.
What to Ask an Inpatient Facility About MAT: Clinical
Here is a link to Shatterproof’s core criteria and principles of care to use when evaluating treatment facilities. We encourage you to be inquisitive and your own best advocate.
- How do you treat opioid use disorder?
- How do you define Opioid Use Disorder (OUD) medically? Do you agree that it is a chronic condition?
- Do you offer Medication-Assisted Treatment (MAT)? If so, which medications do you offer? In what forms do you administer them? How long does it take to get access to these medications?
- How do you decide on an individualized MAT strategy for each patient?
- What steps do you take if a MAT strategy isn’t working for a patient?
- Do you offer a coordinated care approach? If so, how does it work for each patient?
- Are all your clinicians authorized to prescribe and qualified to monitor the effectiveness of MAT medications?
- Do you offer psychotherapy? Please describe.
- Do you offer vocational counseling? Please describe.
- Do you offer life coaching? Please describe.
- Are family members and other loved ones part of the treatment program? If so, how?
- What are the biggest obstacles to OUD treatment success? How do you and your team tackle them?
- What outpatient and/or referral programs do you offer once inpatient treatment is successfully completed? Can I continue to work with the counselors I worked with here after I leave? If not, can someone on your clinical care team help me put together a coordinated care team with MAT experience before I check out?
What to Ask an Inpatient Facility About MAT: Administrative
- How many years have you offered Opioid Use Disorder (OUD) treatment?
- Do you specialize in OUD?
- Do you offer medications to treat addiction (MAT)?
- Which medications do you offer?
- Do you offer ongoing medication treatment, even beyond an initial “detox” period?
- Who is on my care team? I would like to have a psychiatrist, a licensed therapist credentialed in behavioral health and life coach as part of my care team. Would it be possible to interview members of the care team before making my decision?
- Is there a patient advocate I can work with, a point person I can check in with and someone, in particular, my family can stay in touch with?
- What will my first days be like? What is the daily routine?
- Are there current and/or former patients willing to talk about their experiences here?
- How many days is your inpatient treatment program?
- What insurance do you take? Do you have an insurance specialist I can work with to go over my policy with them to see just what my policy covers at your facility?
- Are there any safety or security issues? Have there been any assaults or other altercations? If so, how were they resolved?
- What sorts of activities do you offer here?
- How many patients are treated here at one time?
- What are your policies for phone use and visitors?
- How do you help me manage my care after I check out?