Opioid Addiction: Medication Assisted Treatment (MAT)

Medication assisted treatment (MAT) with professional medical help is considered the gold standard. It uses medication to transition the patient and help with withdrawal symptoms. MAT may also integrate behavioral health.

Using medication to assist in the treatment of opioid addiction is common and preferred. It can improve a person’s health and positively influence his or her participation in a rehabilitation program. ¹ Schuckit MA. Treatment of Opioid-Use Disorders. N Engl J Med. 2016;375(4):357-68.

There are 3 medications commonly used in MAT to transition patients off prescription opioids (i.e. hydrocodone, oxycodone, and morphine) or more illicit substances like heroin and fentanyl.

Methadone treatment explained

Methadone (Dolophine) is a long acting opioid (full agonist) with a long elimination half-life that reduces opioid cravings thus preventing withdrawal symptoms.

For those with a diagnosed substance abuse disorder, methadone is commonly distributed on a daily basis under the supervision of a doctor in an approved opioid treatment program. ² Principals of Drug Addiction Treatment: A Research Based Guide (third edition). National Institute on Drug Abuse Website. Methadone is less commonly used for treatment of opioid use disorder since the development of buprenorphine and buprenorphine products.

Buprenorphine treatment explained

Buprenorphine/naloxone (Suboxone, Zubsolv) is a partial opioid agonist which slowly disassociates from the opioid receptor making it an ideal drug to prevent cravings and treat substance use disorder.

Sublingual (applied under the tongue) formulations are FDA approved for the treatment of opioid use disorder.

Buprenorphine induction will typically be done when a person is in mild to moderate withdrawal. Buprenorphine induction can take place under the supervision of an addiction specialist and team at an inpatient facility and in rare instances, in an outpatient setting, with close monitoring. When given buprenorphine in a hospital setting, people are frequently released home and followed on an outpatient basis for ongoing management.

A transdermal buprenorphine patch (Burtrans), placed on the skin and changed every 7 days, is FDA approved for chronic pain. The eligibility requirements are very specific as a person must be opioid naïve or on less than 80 morphine milligram equivalents (MME’s) per day. The transdermal system produces serum levels much lower than the sublingual formulations and is not indicated for use with substance use disorder or opioid use disorder.

Naltrexone treatment explained

Naltrexone comes in tablet form as well as intravenous and intramuscular injectable forms (for example, Vivitrol). Naltrexone works differently than methadone and buprenorphine. Instead of binding to the opioid receptor and reducing withdrawal symptoms, naltrexone eliminates the high associated with taking an opioid and helps in preventing relapse. It is required that a person has abstained from opioids for a prolonged period of time, usually 7 days, before starting naltrexone.

Medication assisted treatment for opioid use disorder and substance use disorder is covered by most health plans for those patients with a diagnosed addiction disorders. In some cases, Medicare or Medicaid may pay for treatment, although specific rules vary from state to state.

Success with medication assisted treatment is strengthened with appropriate integration of behavioral health treatments (such as counseling, cognitive behavioral therapy, and group therapy) and comprehensive treatment plans that include non-opioid pharmacologic treatments, interventional treatments, and active therapy, such as physical and occupational therapy.