What is MAT?
There are 3 general types of medication assisted treatment for opioids.
Substance Use Disorder Medication-Assisted Treatment
Medication-assisted treatment (MAT) is the use of medications for the treatment of substance use disorders. A combination of medication and behavioral therapies, also known as Medication Assisted Recovery, is effective in the treatment of substance use disorders and has been the primary factor in helping many people to sustain recovery. For more information on different types of recovery see our guide on The Multiple Pathways of Recovery. Or see here for information on Harm Reduction.
* Important Note: If you are looking for MAT for you or your loved one – we recommend that you talk to your doctor about all aspects of MAT. These definitions are not a substitute for advice from a medical professional.
Medication for Opioid Use Disorders:
Methadone is the original medication approved for the treatment of opioid addiction. Methadone is a full opioid agonist which can be used to treat pain as well as opioid use disorder as a maintenance or detoxification medication. . Detoxification using methadone can either be done relatively rapidly in less than a month or gradually over as long as six months. A single dose has a slow onset of action. Maximum effect of methadone with even blood levels, known as “steady state,” can take five to seven days of taking the same daily dose. The analgesic, or pain relieving, effects of methadone last from between four to six hours after a single dose, but a daily maintenance dose of methadone will keep an individual out of physical withdrawal symptoms and free from cravings for illicit opioids for up to a day and a half.. The treatment of pain with methadone and the treatment of opioid addiction with methadone are very different medical treatments with very different prescribing/dosing protocols. Methadone is usually taken by mouth and rarely by injection into a muscle or vein. Only oral formulations of methadone are approved for the treatment of opioid use disorder in the United States. Methadone is on the World Health Organization’s List of Essential Medications , WHO’s list of the most effective and safe medications which should be accessible in all health systems across the globe. . The National Institutes of Health (NIH) declared methadone treatment the “gold standard treatment” for opioid addiction in their 1998 Consensus Panel Statement titled, “Effective Medical Treatment of Opiate Addiction,” and the Centers for Disease Control and Prevention (CDC) has deemed methadone maintenance treatment the “most effective treatment” for opioid addiction currently available. When used for the treatment of opioid addiction, methadone may only be dispensed in federally certified and accredited opioid treatment programs (OTPs) in the United States, where methadone is dispensed in conjunction with individual counseling, group therapy, and other psychosocial support services.
Brand Names: Dolophine, Methadose, Disket
Buprenorphine, is an opioid used to treat opioid addiction, moderate acute pain and moderate chronic pain.The combination buprenorphine/naloxone is also used for opioid addiction. Both buprenorphine and methadone are medications used for detoxification, short- and long-term opioid replacement therapy. Buprenorphine has the advantage of being only a partial agonist; hence negating the potential for life-threatening respiratory depression in cases of abuse. Studies show the effectiveness of buprenorphine and methadone are almost identical, and largely share adverse-effect profiles apart from more sedation among methadone users.
Brand Names: Cizdol, Suboxone, Subutex (typically used for opioid addiction), Temgesic (sublingual tablets for moderate to severe pain), Buprenex (solutions for injection often used for acute pain in primary-care settings), Norspan and Butrans (transdermal preparations used for chronic pain)
- Buprenorphine & Naloxone:
Naloxone is a medication generally used to block the effects of opioids, especially in overdose. However, since Naloxone is poorly absorbed when taken by mouth it is commonly combined with a number of oral opioid preparations, especially buprenorphine, so that when taken orally, only the opioid has an effect, but if an opioid like Heroin is misused by injecting, the naloxone blocks the effect of the opioid. This combination is used in an effort to prevent use of a dependant opioid. Buprenorphine/naloxone has a milder side effect profile than methadone, and has limited respiratory effects, due to both agonist/antagonist effects. However, buprenorphine/naloxone is less safe than methadone in patients with stable liver disease.
Brand Names: Suboxone, Bunavail, Zubsolv
Naltrexone hydrochloride is a pure opioid antagonist. It markedly attenuates or completely blocks, reversibly, the subjective effects of intravenously administered opioids. When co-administered with morphine, on a chronic basis, Naltrexone blocks the physical dependence to morphine, heroin and other opioids. Patients must be opioid free before beginning to use Naltrexone as use of the treatment can cause withdrawal symptoms in individuals who are still using/dependant on opioids.
Brand Names: Vivitrol
Medications for Alcohol Use Disorders:
Acamprosate is an anti-alcohol agent. It is thought to work by restoring the balance of certain chemicals in the brain of patients who have used large amounts of alcohol.
Acamprosate affects chemicals in the brain that may be unbalanced in a person who is addicted to alcohol. Acamprosate works by restoring this chemical balance in the brain in an alcohol-dependent person who has recently quit drinking. Acamprosate is used together with behavior modification and counseling support to help a person who has recently quit drinking alcohol continue to choose not to drink.
Acamprosate is not likely to be helpful if you have not already quit drinking or undergone detoxification. It may not help you if you are also addicted to other substances besides alcohol.
Brand Names: Campral
Disulfiram blocks a specific enzyme involved in metabolizing alcohol intake. Disulfiram produces very unpleasant side effects when combined with alcohol in the body- often vomiting. This medication is commonly used with chronic Alcohol Use Disorders. Disulfiram is best used together with behavior modification, psychotherapy, and counseling support to help patients stop drinking.
Brand Names: Antabuse
Naltrexone is also prescribed to alcohol dependent people to help them reduce cravings, control, or abstain from drinking. Naltrexone is prescribed to be taken orally one hour before drinking, and it’s use will curb alcohol withdrawal or craving symptoms. It is not a cure for Alcohol Use Disorders, but it has proven to be an effective anti-addiction drug for many people. Used in conjunction with other behavior modification (commonly with the Sinclair Method), Naltrexone can greatly improve the outcomes for alcohol dependant persons.
Brand Names: Vivitrol