Drugs Used in Medication-Assisted Treatment
There are many different types of medications that have been approved by the Food and Drug Administration for the purposes of Medication-Assisted Treatment — specifically, for the treatment of alcohol use disorder and opioid use disorder. The drugs are intended to assist the detoxification process by alleviating withdrawal symptoms and cravings for more alcohol or opioids, and preparing them for psychological counseling and therapy to help them with their long-term rehabilitation.
For alcohol use disorder, acamprosate, disulfiram, and naltrexone are used.
For opioid use disorder, buprenorphine, methadone, and naltrexone are used. They are best used to treat a dependence on short-acting full opioid agonists, like heroin, codeine, and fentanyl, as well as prescription semi-synthetic opioids like hydrocodone and oxycodone. Depending on the degree of dependence, these medications are safe to use for months to an entire lifetime. Their use must be supervised by a doctor because they can become sources of addiction in and of themselves.
How Long Should Medication-Assisted Treatment Last?
In general terms, the longer someone stays in an MAT program, the better their outcome.
Research supports longer treatment timelines, as the following studies suggest:
- For methadone, doctors recommend a 12-month program to maximize its benefits.
- For buprenorphine, research suggests that the majority of people relapse if they take the medication for less than six months.
- For alcohol MAT therapies, research suggests therapy should be continued for at least a year, as this length has been shown to reduce the risk of relapse.
MAT comes to an end when alcohol or opioids have not been consumed for an extended time, the person reports substantially diminished cravings for alcohol or opioids, and doctors are satisfied that the person has enough community support to help them once they are discharged from formal treatment.
Determining the Duration of MAT
Every MAT program is personalized. Providers work closely with their patients to find the right dose, and they stay in touch with those patients to ensure the program is working properly. Often, those conversations involve program duration.
In general, longer programs are more effective than shorter versions. For example, researchers say people who quit buprenorphine after 91 to 180 days are at higher risk of overdose when compared to those who took the medication for more than 365 days. However, there are no hard-and-fast rules about how long programs should last.
Factors that might influence MAT program duration include the type of substance used, the severity of your addiction, and the presence of co-occurring disorders. Since every person is different, it’s difficult to make sweeping statements about how long programs should last. One person’s plan might be longer or shorter than someone else’s plan.
During treatment, doctors look for signs that the person’s health and quality of life have improved since the program began. Those healing signs might include the following:
- Fewer cravings for alcohol or opioids
- Increased energy and wherewithal to pursue healthier interests and hobbies
- Overall health improvements such as physical fitness, less anxiety, and better sleep
- Improved social skills and restored relationships
- The ability to hold a job or resume classwork
Personal Factors Affecting MAT Duration
Since MAT treatment timelines are so personal, treatment teams take time to understand their patients and build the right programs for them.
Factors a team might examine include the following:
- The person’s age
- The perceived need for treatment
- The person’s commitment to getting better
- The goals of treatment
- How many coping skills the person has
- The person’s confidence in achieving sobriety
The addiction’s scope matters too. People with a long-lasting addiction may have deep-seated habits that are harder to break. They might need more help than someone who is relatively new to drugs.
Is It Safe to Stop MAT?
Some people may feel they have a handle on their rehabilitation and want to discontinue their Medication-Assisted Treatment. However, stopping MAT without a proper plan is very dangerous. It is safest to discuss a program for winding down MAT treatment with a doctor. Cutting off the medications suddenly can cause intense withdrawal symptoms, which might precipitate a relapse.
If a doctor concurs that MAT can be discontinued, the treatment will be gradually tapered off, with the patient being carefully monitored for any signs of withdrawal or signs that they are struggling to maintain their sobriety without Medication-Assisted Treatment.
The key to stopping MAT is to let the body gradually adjust to the medication’s lower doses, without overpowering side effects. How long that might take will depend on the medication, the dosage, the degree of psychological dependence that is being treated, and if that patient has a good support system to help them through the transition. Some people might adjust quite naturally, which indicates that their MAT time is drawing to a close. Others will have a harder time dealing with the discontinuation of their medication, which could mean they are not yet ready to stop MAT.
How MAT Can Work With 12-Step Programs
Medication-Assisted Treatment (buprenorphine, methadone) is an accepted and medically established form of treatment for opioid use disorder. However, some schools of thought in the recovery community disagree and feel that participation in 12-step programs like Narcotics Anonymous is off-limits while a person is on any kind of opioid therapy.
Most 12-step programs require total abstinence as a condition for membership. This has caused some conflict with treatment and rehabilitation centers that use MAT and also encourage participants to connect with 12-step groups for ongoing aftercare.
A 2015 study published in the Journal of Substance Abuse Treatment found that “referring patients in buprenorphine treatment to attend Narcotics Anonymous or other 12-step meetings does not have a detrimental impact on treatment outcomes.” In fact, it greatly increases the likelihood that people exiting formal treatment and re-entering normal life will have a much better chance of maintaining their long-term sobriety than those who do not follow that path.
This has led some people in the medical community to call on the moderators of 12-step programs to allow MAT patients to join, opining that most of the skepticism about MAT is based in the myth that such treatments merely swap out one drug for another.
However, since most 12-step programs are not regulated and autonomous, there is no consensus among the wider NA (or Alcoholics Anonymous) community that being on Medication-Assisted Treatment is not a barrier for entry. While some programs may have no objection to MAT patients joining, others may place restrictions on their participation.
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- By Shunning Medication-Assisted Therapy, 12-step Meetings Are Making the Opioid Crisis Worse. (October 2017). STAT.
- Guide for Families: Medications for Opioid Use Disorder. (June 2021). Providers Clinical Support System.
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