Medication-Assisted Treatment

For Opioid Use Disorder

What Is OUD?

Opioids1 are prescribed by doctors primarily to treat pain. When used in the long-term, though, a decrease in pain-relieving effects can be experienced, and pain can gradually progress. 

Opioid use disorder (OUD) can develop very suddenly, and dependence on the drug can form even when the opioid is appropriately used, as the doctor prescribed. Nearly all prescription opioids cause withdrawal symptoms, which creates great difficulty when attempting to stop taking them.

Indicators of possible addiction can be seen when the user’s daily routines and mental health become compromised. By taking more than the prescribed amount, the probability of dependence is increased significantly. These substance use disorders often lead to an opioid overdose, which is known to result in death.

Signs & Symptoms of OUD

The struggle with opioid use disorder does not always display visible symptoms right away. However, it is crucial that when the signs or symptoms do appear, they are recognized as soon as possible so that the dangerous addiction can be addressed. Some common signs and symptoms have been seen to include:The struggle with opioid use disorder does not always display visible symptoms right away. However, it is crucial that when the signs or symptoms do appear, they are recognized as soon as possible so that the dangerous addiction can be addressed. Some common signs and symptoms have been seen to include:

Frequent flu-like symptoms

Weight loss

Newer financial issues

Isolation from friends and family members

Intense cravings or urges for the opioid drug

Withdrawing from previously enjoyed activities

Having frequent doctor visits

Inconsistent sleeping habits

Sudden dramatic mood swings

Trouble staying awake

How Opioids Became So Deadly

Deaths from various opioids and synthetics like heroin, fentanyl, and prescription painkillers have all increased since 2013.

Fentanyl is a very potent pain medication that is up to 100 times stronger than morphine. The tremendous strength of this drug stands out because there has been an estimated 800% increase in fatalities from an overdose in just four short years. Since each individual may be affected differently, the drug creates very unpredictable outcomes. Many people can find that even a tiny dose of fentanyl to be deadly.

Opioid-related overdose deaths by substance

In the year 2017 alone, opioids were solely responsible for 46,394 deaths from overdose.

  • This statistic has gotten a lot of attention because it’s nearly double the number of deaths caused by non-opioid substances

What is MAT?

Medication-assisted treatment (MAT) is a practical evidence-based treatment approach in opioid Treatment Programs,2 (OTPs) provided by qualified treatment facilities throughout the United States. The appropriate use of specialized counseling and behavioral therapies is the perfect evidence-based combination proven to save lives and significantly increase the recovery rates.

Everyone seeking treatment for an opioid use disorder should be offered access to all of the approved medication options to assist in the recovery process. This allows addiction specialists or other medical professionals to work with patients individually to select the treatment that proves to be the best fit for their needs. 

Due to the persistent and deep-rooted nature of addiction, the demand for extended services like MAT for opioid treatment should be re-examined periodically. There is not a current recommendation for the duration treatment . In some cases19, it has become the best and safest option for the patient’s treatment to continue indefinitely.

Medications

Methadone3

By being characterized as a full agonist, this drug primarily works with both the nervous system and brain receptors to produce positive results. This combination in methadone is designed to ease opioid withdrawal symptoms and also to block the euphoric effects that come from most opioid drugs. The side-effects of taking methadone are minimal when the drug is administered correctly.

Suboxone4

This drug is made with a combination of buprenorphine and naloxone.
Similar to methadone, suboxone is a partial agonist. So instead of being the primary function, this drug binds to the brain and nervous system receptors too, but only partially. Treatment patients taking suboxone for opioid addiction typically report a decrease in craving intensity, as well as physical symptoms, becoming alleviated.

Vivitrol5

This FDA-approved medication is an injectable naltrexone-based drug that only needs to be administered once a month. The use of Vivitrol, however, requires whoever is taking it to abstain from taking any other opioid for at least 14 days before the treatment and injections can begin. The primary purpose of Vivitrol is to decrease or eliminate the cravings for extended periods significantly.

Sublocade6

Sublocade is most commonly used in treatment where there was evidence of abuse using prescription painkillers such as morphine, oxycodone, and fentanyl. This drug has also been seen to be effective when treating heroin addictions, and like Vivitrol, it is administered just one time per month.

MYTH vs. FACT

Myth:

Risk of overdose increases for MAT patients.

Fact:

If anything, medication-assisted treatment programs help to prevent overdoses rather than increase the chances of them occurring. It’s vital to note that even a single dose of opioids after a full detox has proven to be life-threatening and cause fatal overdoses.

Myth:

MAT programs are only successful short-term

Fact:

Studies have shown that patients participating in MAT-style programs for at least 1-2 years have shown to have the highest rates of achieving long-term success7. There is currently no compelling evidence that indicates that there would be multiple benefits from eliminating MAT programs.

Myth:

MAT programs prolong the recovery process

Fact:

Recent recovery rates show that medication-assisted treatment practices have been more often than not, providing patients the help and guidance necessary to make consistent progress10. Improving the level of basic functionality, the ability to handle stress, and developing a stable overall quality of life.

Myth:

Self-control is better than MAT

Fact:

MAT practices are continually being improved upon based on the evidence seen throughout the patient’s treatment and recovery. MAT has considered being among the most reliable rehabilitation processes and receives more recommendations than any other treatment option when treating opioid addiction.

Myth:

MAT is NOT covered by insurance

Fact:

As of May 2013, Medicaid FFS programs agreed to cover maintenance treatment with methadone in 31 states. This coverage was said to be provided while participating in opioid addiction treatment programs8. Medicaid agencies vary when it comes to buprenorphine being listed on the Preferred Drug List (PDL), while naltrexone is listed on the Medicaid PDL in over 60% of US states9.

Notable recommendations are from:

  • The National Institute on Drug Abuse11
  • Centers for Disease Control and Prevention12
  • Substance Abuse and Mental Health Services Administration13
  • American Academy of Addiction Psychiatry
  • National Institute on Alcohol Abuse and Alcoholism14
  • American Medical Association15

 

Opioid MAT Effectiveness: What Is The Data?

The alarming increases in opioid supply are being pushed by both legal prescriptions written by qualified professionals, as well as illegally trafficked from around the world. The painkiller availability peak hit in 2012, where data16 showed an estimated 81 per 100 people17 receiving prescriptions.

Opioid Prescription Rate

This is given a lot of attention in an attempt to significantly decrease the numbers in the near future

Many efforts including the development of newly controlled state-wide regulations18 are being organized and implemented

Opioid-related versus non-opioid-related overdose deaths

Opioids are responsible for more fatalities than cars or guns and nearly the same as annual suicides in the United States


 

Resources

  • 1. https://www.hhs.gov/opioids/
  • 2. https://www.samhsa.gov/medication-assisted-treatment/opioid-treatment-programs
  • 3. https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone
  • 4. https://www.drugs.com/suboxone.html
  • 5. https://www.webmd.com/drugs/2/drug-144395/vivitrol-intramuscular/details
  • 6. https://www.medicalnewstoday.com/articles/326658#about
  • 7. https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview
  • 8. https://www.asam.org/advocacy/news/asam-advocacy-blog/2017/10/27/asam-issues-letter-of-support-for-legislation-to-permit-medicare-coverage-of-outpatient-methadone
  • 9. https://medicaid.ncdhhs.gov/documents/preferred-drug-list
  • 10. https://www.thefix.com/do-suboxone-and-methadone-prevent-us-experiencing-true-recovery
  • 11. https://www.samhsa.gov/medication-assisted-treatment
  • 12. https://www.cdc.gov/niosh/docs/wp-solutions/2019-133/
  • 13. https://store.samhsa.gov/product/Medication-Assisted-Treatment-of-Opioid-Use-Disorder-Pocket-Guide/SMA16-4892PG
  • 14. https://www.niaaa.nih.gov/news-events/news-releases/naltrexone-or-specialized-alcohol-counseling-effective-treatment-alcohol
  • 15.https://www.ama-assn.org/delivering-care/opioids/medication-assisted-treatment-training-fight-substance-abuse
  • 16. https://usafacts.org/articles/opioid-addiction-deaths-and-treatment-latest-analysis-data/?utm_source=google&utm_medium=cpc&utm_campaign=healthcare&gclid=EAIaIQobChMI_6fe8fOX6AIVFyCtBh0UtweeEAAYASAAEgLfiPD_BwE
  • 17. https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html 
  • 18. https://www.pharmacytimes.com/contributor/marilyn-bulloch-pharmd-bcps/2019/02/opioid-prescribing-limits-across-the-states
  • 19. https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat#:~:text=Medication%2Dassisted%20treatment%20(MAT)%20is%20the%20use%20of%20medications,some%20people%20to%20sustain%20recovery.

 

 

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