In 2019, over 70,000 people died from a drug overdose in the U.S. — 70% of which were due to opioids. These statistics are a stark reminder of the raging drug epidemic in America and the dire need to slow down this problem. Overdoses are particularly worrisome due to the potency of illicit opioids like fentanyl, which can be 100 times more powerful than morphine.
Luckily, however, advances in medication-assisted treatment (MAT) have helped treat substance abuse and minimize drug overdoses in some cases. These drugs are not only effective at curbing cravings, but they can also help individuals wean off drugs like alcohol and heroin.
This article provides information about MAT, as well as what types of medications are available.
What Is Medication-Assisted Treatment (MAT)?
Medication-assisted treatment (MAT) involves the use of medications — combined with counseling and behavioral therapies — to provide comprehensive treatment for substance abuse. While MAT therapy can be used for a variety of substance use disorders, it is largely used for opioid addiction.
The medications used in MAT therapies are FDA-approved and are designed to help minimize cravings, ease withdrawal symptoms, normalize body functions, and prevent or reduce overdoses. Medication-assisted treatment is especially effective for helping individuals wean off substances and reduce relapses that arise due to the discomfort of withdrawal. MAT programs are also clinically driven and customized to meet the patient’s needs.
While it may seem as if using medication is simply replacing one drug for another, studies have shown that MAT combined with other evidence-based therapies can not only effectively treat addiction, but may also help clients stay in treatment for longer. The primary benefit of MAT is that it can ease a person off substances and prevent relapses by helping with cravings and withdrawal.
Types of MAT Therapies
Several FDA-approved medications are used for substance use disorders. Below are the most common.
Buprenorphine
One of the most common MAT therapies is buprenorphine, a partial opioid agonist which only partially activates the opiate receptors in the body. This makes it a less potent opioid compared with drugs like heroin, OxyContin, or morphine, which means its effects are also less intense.
While buprenorphine is used to slowly wean someone off stronger opioids, it still has the potential for abuse. Therefore, buprenorphine is sometimes combined with naloxone, an opioid antagonist which blocks the brain’s opioid receptors. This means that the effects of the opioid are greatly diminished, and the person won’t feel a euphoric “high.” The benefit of this combination is that it allows a person to safely have an opioid in their system, but they won’t feel the need to take more.
Another benefit of medications like buprenorphine is that it is difficult to overdose on. Once a person has reached a certain dose, the effects will plateau, and they won’t increase if they decide to take more.
Buprenorphine can be found under several different names, including:
Buprenorphine Only
- Buprenex
- Butrans
Buprenorphine + Naloxone
- Suboxone
- Bunavil
- Zubsolv
While buprenorphine side effects can be minimal, there are a few to watch out for:
- Insomnia
- Fever
- Irritability
- Muscle aches
- Nausea
- Vomiting
- Constipation
Probuphine
Probuphine is a buprenorphine implant that is also used to treat opioid addiction. Approved by the FDA in 2016, this implant also helps minimize cravings and withdrawal symptoms without leading to an opioid “high.” The main benefit of the implant is that the patient doesn’t need to take daily pills or attend the clinic as often. It also poses less chance of abuse than pills as long as the implant stays in place.
Probuphine implants are inserted into the upper arm, and they administer a continuous dose of buprenorphine into the bloodstream. The implants work for a period of 6 months and are usually prescribed to patients who are stable and already on lower to moderate doses of buprenorphine. However, the use of probuphine implants is not recommended beyond two 6-month treatment periods.
Disulfiram and Acamprosate
Disulfiram and acamprosate are medications that are used to help people struggling with alcohol addiction. Disulfiram, also known by its brand name, Antabuse, works by blocking the activity of enzymes that metabolize ethanol. This results in unpleasant effects if a person drinks even a small amount of alcohol. Some of the adverse effects include:
- Nausea
- Vomiting
- Chest pain
- Sweating
- Blurred vision
- Headaches
- Breathing problems
Therefore, disulfiram works by creating negative associations between drinking alcohol and the subsequent effects.
Acamprosate (Campral), on the other hand, helps balance the GABA system and minimize relapses. Alcohol abuse can lead to neurological adaptations in the brain, particularly in the GABA system. When a person frequently abuses alcohol, the brain responds by creating an adapted environment that only exists when alcohol is present. If a person stops drinking, then that system can become overly excited, causing all kinds of uncomfortable withdrawal symptoms. Acamprosate helps balance this excited activity and is therefore a useful medication for reducing withdrawal effects and minimizing relapses.
Methadone
Unlike buprenorphine, methadone is a full opioid agonist, which means that it produces similar effects as drugs like heroin. However, the effects are milder and do not impair a person’s ability to function in the same way as strong opioids.
Methadone is one of the most common forms of medication-assisted treatment for opioid addiction. It works by alleviating withdrawal symptoms and reducing cravings and is typically administered by a methadone clinic. According to the Center for Substance Abuse Treatment (CSAT), methadone is so effective that it can prevent cravings and withdrawal symptoms for up to a day and a half.
However, while methadone produces milder effects, it can still create withdrawal symptoms of its own if use is suddenly stopped. Therefore, methadone should always be taken and discontinued under medical supervision.
Some of the potential side effects of methadone include:
- Sleep disturbances
- Stomach pain
- Vomiting
- Dry mouth
- Loss of appetite
- Headache
- Sweating
- Mood changes
- Reduced sex drive
Naloxone
Naloxone works by blocking the activity of opioids at their receptor sites. As an opioid antagonist, it is an effective medication for preventing or reversing life-threatening overdoses. Many emergency medical technicians (EMTs) carry naloxone injections so that they can quickly administer them to people who overdose on opioids like heroin or fentanyl. Some of the signs to watch out for when it comes to overdoses are:
- Tiny, constricted pupils (pinpoint pupils)
- Shallow breathing
- Severe drowsiness
- Loss of consciousness
- Unresponsiveness
In rehab centers or clinics that treat opioid use disorder, naloxone is also sometimes combined with buprenorphine as a treatment for addiction. This is more commonly known as Suboxone, which is the brand name of buprenorphine and naloxone combinations. Naloxone is also sometimes handed out as a harm reduction measure in communities where opioids use is rampant.
Naltrexone
Naltrexone is a medication that is used to treat alcohol and opioid addiction. Available as an injection or in pill form, naltrexone is similar to naloxone in that it blocks the body’s opioid receptors. This means that a person won’t experience a euphoric high if they take it, and it also poses a low risk of abuse.
The injectable form of naltrexone is known as Vivitrol, and it can be injected intramuscularly once per month. Alternatively, naltrexone can be taken orally once per day.
One important thing to note is that naltrexone decreases your tolerance to opioids, which means relapses can be more dangerous and lead to overdoses if you consume the same dose that you used to. People who relapse after taking naltrexone should therefore be careful as a fatal overdose can occur.
When it comes to alcohol, there are no associated risks with drinking aside from liver damage if a person drinks a lot. While naltrexone blocks the euphoric effects of alcohol, it doesn’t prevent the other intoxicating effects, which include issues with coordination and impaired judgment.
Some of the potential side effects associated with naltrexone include:
- Sleep disturbances
- Vomiting
- Nervousness
- Headache
- Diarrhea
- Muscle or joint pain
Other Medications
Along with the medications above, there are other drugs that are being explored or used to help treat substance abuse. These include:
- Baclofen — a skeletal muscle relaxant that is being investigated as a treatment for opioid addiction.
- Gabapentin — an anticonvulsant medication that may help manage withdrawal symptoms in people going through methadone-assisted detox.
- Vigabatrin — an anticonvulsant that may reduce alcohol withdrawal symptoms.
- Topiramate — an antiepileptic medication that is being explored for reducing alcohol cravings, as well as anxiety and depression.
How Medication-Assisted Treatment Works
Medication-assisted treatment (MAT) should always be administered by a doctor or qualified medical team. Not only can they prescribe the right dosages, but they will be able to advise on what medications are best for your situation.
MAT therapies are often available at rehab clinics, doctor’s offices, or specialized clinics. The usual protocol consists of an intake evaluation by a mental health professional. During this intake, three main things are usually evaluated:
- Whether a person has a substance use disorder
- The severity of the addiction
- If there are any co-occurring mental health conditions
Once these things are assessed, you will be told whether you are a good candidate for medication-assisted treatment. This will be followed by a tailored plan that meets your individual needs and goals. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a patient is a good candidate for MAT therapy if they:
- Receive an official diagnosis of an addiction to alcohol or opioids.
- Are willing to obey any prescribing instructions.
- Do not have any physical health issues that could be worsened or affected by the medication.
- Have been fully educated on alternative options to medication-assisted treatment.
Conversely, a person may be deemed unsuitable for MAT therapy if they have:
- A history of misusing or abusing medications.
- An addiction to a substance that cannot be treated with medication.
- More than one substance addiction. This is because the medication(s) may negatively interact with the drugs.
- A severe physical condition or health issue that might be complicated or worsened by opioid medications.
- A weak motivation to get sober.
Counseling and Behavioral Therapies
Something else to expect when it comes to medication-assisted treatment is counseling and behavioral therapy. Patients receiving MAT therapies are required under federal law to have access to these services during treatment. They are also expected to be provided with medical, vocational, educational, and other treatment services.
While MAT therapies are highly effective, they are more successful when combined with counseling and other behavioral therapies. These treatments help clients get to the root cause of their addiction and enable individuals to heal from past traumas while learning skills to build a new life.
Effectiveness of Medication-Assisted Treatment
Studies into the effectiveness of medication-assisted treatment show great promise, especially when it is combined with counseling and behavioral therapy. Methadone and buprenorphine, in particular, have been proven to be both economically viable and highly effective in the treatment of opioid abuse. Research also indicates that the use of MAT reduces mortality rates and criminal activity.
According to SAMHSA, MAT has also proven to be clinically effective because it provides a comprehensive and tailored program that meets the needs of most patients. They also add that MAT therapies have been proven to:
- Increase the chances of patient survival
- Increase how long people stay in treatment
- Decrease illicit opiate use and criminal activities associated with substance use
- Increase clients’ ability to find and maintain employment
- Improve the outcomes for births among women who are pregnant and struggling with addiction
Finding MAT Treatment
Many alcohol and drug treatment centers provide medication-assisted treatment. While some are part of integrated programs, there are also clinics that are dedicated primarily to delivering MAT therapies. To ensure that you’re getting the best treatment possible, be sure to check that the program offers counseling and behavioral therapy as part of their MAT therapies. It’s also important to look for accredited facilities which are staffed with qualified medical practitioners and mental health professionals.
Resources
If you or a loved one are struggling with substance abuse, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
Key Sources
Food and Drug Administration (FDA). (2019). Information about Medication-Assisted Treatment (MAT). https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat.
Rieckmann, T., Kovas, A., and Rutkoski, B. (2010). Adoption of Medications in Substance Abuse Treatment: Priorities and Strategies of Single State Authorities. J Psychoactive Drugs. 6, 227–238.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2021). Medication-Assisted Treatment (MAT). https://www.samhsa.gov/medication-assisted-treatment
Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). MAT Medications, Counseling, and Related Conditions. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions.
Medical Disclaimer
At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.
We provide our readers with factual, evidence-based content concerning the causes and nature of addiction, as well as available treatment options. However, this informative content is intended for educational purposes only. It is by no means a substitute for professional medical advice, diagnosis, or treatment. With regard to any addiction-related health concerns, you should always seek the guidance of a qualified, registered physician who is licensed to practice medicine in your particular jurisdiction. You should never avoid or delay seeking professional health care advice or services based on information obtained from our website. Our authors, editors, medical reviewers, website developers, and parent company do not assume any liability, obligation, or responsibility for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a result of the material presented on RehabAid.com.