Is Medication-Assisted Treatment Evidence-Based?
Last Updated Dec 2, 2021
Is Medication-Assisted Treatment Evidence-Based?
Medication-Assisted Treatment has a strong body of research and evidence to support its use in clinical settings. Doctors advocate for the use of drugs to help people overcome alcohol and opioid use disorders, pointing out that the goal is to wean people off their physical dependence on harmful substances.
How Does Medication-Assisted Treatment Work?
Medication-Assisted Treatment (MAT) is the process of helping a person break their physical dependence on certain drugs or alcohol, if the person’s consumption of those drugs or alcohol was excessive to the point of harming themselves and lowering the quality of their life.
Cutting off the compulsive consumption of addictive substances, without a proper plan to wind down their use, can cause a number of physical and psychological problems. Medication-Assisted Treatment is the use of prescribed medications to give patients a better chance of reaching their goal of abstinence and sobriety while mitigating the symptoms of withdrawal.
In cases of severe alcohol use disorder, going cold turkey can be fatal, so doctors will often encourage people to sign up for a Medication-Assisted Treatment program to ensure that quitting drinking can be carried out as safely as possible.
Is Medication-Assisted Treatment Based in Research?
There is a lot of research to show that Medication-Assisted Treatment is backed by evidence. The longer the treatment (starting with a MAT program, continuing with therapy and counseling, and then maintaining the work with aftercare support), the better the chance of lasting, even lifelong, sobriety. A 2019 study in the Journal of Substance Abuse Treatment concluded in support of Medication-Assisted Treatment for opioid use disorder, “especially with regard to community substance use treatment engagement.”
There has occasionally been pushback from some recovery advocates about the methodology of Medication-Assisted Treatment because of the practice of using drugs (albeit prescribed) to wean a patient off their unhealthy consumption of more dangerous substances. Advocates call for an abstinence-only approach, feeling that using drugs to get off drug/alcohol use defeats the purpose of sobriety.
What Is the Effectiveness of This Treatment?
The effectiveness of Medication-Assisted Treatment is supported by many doctors. STAT News writes that doctors would rather patients be on a drug “that allows you to go back to work […] and to live normally again,” compared to “a dangerous [drug] that will kill you.”
STAT News continues that data has shown that Medication-Assisted Treatment is effective for the general population, but each patient will need different drugs, at different doses. There is no one-size-fits-all approach.
The overwhelming message from the medical community is that “the data […] clearly shows better outcomes with medication-assisted therapy than without it,” in the words of Dr. Nora Volkow, director of the National Institute on Drug Abuse. Study after study, according to Dr. Volkow, has backed that outcomes for patients are significantly better when they transition from substance abuse to MAT. Reasons include a significantly lower risk of relapse, preventing infectious diseases like HIV, and preventing overdoses.
What Drugs Are Used Most Often in This Process?
Many medications have been found to help those struggling with alcohol use disorder get through withdrawal without significant symptoms or risk of death.
Benzodiazepines are the primary choice for treating alcohol use disorder. They are a class of drugs administered at high doses early on in the treatment phase, and they are gradually tapered as the person’s condition improves. There are many types of benzodiazepines that doctors can choose for MAT based on the degree of the patient’s physical dependence on alcohol and other health concerns.
Diazepam and chlordiazepoxide are administered intravenously or orally. Both diazepam and chlordiazepoxide have long half-lives (how long it takes for half of the dose to be metabolized). This means the medications have more control over withdrawal symptoms between doses, making them among the most popular Medication-Assisted Treatment drugs for alcohol use disorder.
Lorazepam is an anti-anxiety drug, but its anticonvulsant properties have made it a popular drug for Medication-Assisted Treatment, to prevent seizures in patients who are withdrawing from alcohol use disorder. According to the American Family Physician journal, lorazepam has an “excellent record of efficacy” when it comes to treating alcohol withdrawal.
Oxazepam is better suited for those whose withdrawal symptoms are only mild to moderate because it has a slower absorption rate and a shorter half-life than diazepam. On the other hand, oxazepam has been found to have successful outcomes for people with alcohol use disorder who have experienced severe liver failure.
Other drugs prescribed for Medication-Assisted Treatment in alcohol use disorder include clorazepate, carbamazepine, and gabapentin.
MAT for Opioid Use Disorder
Medication-Assisted Treatment is also used in the treatment of opioid use disorder. Effectively — but controversially — doctors use less potent opioids to help patients wean off their compulsive use of stronger opioids, whether prescribed ones like OxyContin, recreational ones like heroin, or even other opioids that were prescribed to wean off stronger opioids, like methadone.
The therapeutic opioids share the same chemical process as the opioids of abuse, but the therapeutic opioids have a much slower mechanism of action. They are absorbed into the bloodstream over a longer period of time, keeping withdrawal symptoms under control and disconnecting the act of consuming opioids with the immediate high that many users seek out.
This is because the opioids used in Medication-Assisted Treatment are typically slow-acting partial opioid agonists, and not full opioid agonists. As the drugs only partially activate the regions of the brain that are stimulated, people feel a very reduced degree of pleasure from the consumption, which doctors use to gradually lower the baseline of administration until it is negligible enough to conclude treatment.
Drugs Used in MAT for Opioid Use Disorder
Buprenorphine and methadone are the primary medications used for opioid use disorder.
Methadone alleviates the worst withdrawal symptoms and reduces cravings for stronger opioids. Patients will not feel any euphoria when consuming methadone as prescribed. However, methadone is still a full opioid agonist, so those with an untreated dependence on opioids might come to experience a psychological need for methadone. If this is the case, another Medication-Assisted Treatment drug should be used, and the patient should continue to receive therapy and counseling to help them break their psychological need for methadone. This is one reason why some treatment advocates are skeptical about the use of methadone (and other drugs) in drug recovery.
Buprenorphine is a partial opioid agonist that is sometimes administered with naloxone (an opioid antagonist, a medication that completely blocks opioids from reaching the brain). Naloxone can induce immediate withdrawal symptoms, so it is combined with buprenorphine to mitigate the effects of that immediate withdrawal.
Backed by Data
Notwithstanding concerns that Medication-Assisted Treatment is merely “swapping one drug for another,” it is still considered the “gold standard” of drug treatment and rehabilitation by many in the scientific community. It is a careful, research-backed, and evidence-based approach to help people overcome their physical need for opioids or alcohol. MAT prepares people for psychological counseling and therapy to continue their recovery.
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Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions. (March-April 2015). Harvard Review of Psychiatry.
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