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Frequently Asked QuestionsMedication-Assisted Treatment FAQs

“Medication-assisted treatment works. The evidence is voluminous and ever growing. Failing to offer MAT is like trying to treat an infection without antibiotics.”

– Alex Azar II, Secretary of the U.S. Department of Health and Human Services, 2018-2021

Medication-Assisted Treatment for Opioid Use Disorder (OUD)

In the ongoing nationwide effort to mitigate harm caused by the opioid overdose crisis, medication-assisted treatment (MAT) has emerged as an effective strategy to help individuals, families, and communities reduce rates of addiction, fatal overdose, and the negative personal, social, and financial consequences associated with opioid use disorder (OUD).

WHAT IS MEDICATION-ASSISTED TREATMENT (MAT)?

Medication-Assisted Treatment is the use of medication, in combination with therapy, counseling, and community support, to treat substance use disorders (SUD). MAT can be used to treat people with opioid use disorder, alcohol use disorder and nicotine use disorder. At Pinnacle Treatment Centers, we use MAT primarily for the treatment of opioid use disorder (OUD).

DOES MAT WORK?

Research shows that MAT for opioid addiction decreases opioid use, opioid-related overdose, criminal behavior related to addiction, and the transmission of various infectious diseases. MAT also increases social functioning, the ability to manage basic life tasks, and time-in-treatment – all of which lead to better treatment outcomes and quality of life for people with opioid use disorder, when compared to treatment in non-MAT programs.

WHAT MEDICATIONS ARE APPROVED FOR MAT?

There are three medications approved by the Food and Drug Administration for the treatment of opioid use disorder (OUD). These medications are called medications for opioid use disorder (MOUD):

  • Methadone. Brand names include:
    • Dolophine
    • Methadose
  • Buprenorphine. Brand names include:
    • Suboxone (buprenorphine + naloxone): sublingual (under-the-tongue) film
    • Subutex: sublingual tablet
    • Zubsolv (buprenorphine + naloxone): sublingual tablets
    • Sublocade (extended release): injection
    • Brixadi: newly approved, extended-release (one week or one month) injection
    • Bunavail (buprenorphine + naloxone): buccal (on the inside of the cheek) film
    • Cassipa (buprenorphine + naloxone): sublingual film
    • Probuphine: implant for subdermal (under the skin) administration
  • Naloxone: Brand names include:
    • Vivitrol: extended-release injection
    • Depade: oral tablet

HOW DOES MAT WORK?

MOUDs work by either occupying or blocking opioid receptors in the human brain. Receptors are structures on brain cells that trigger the chemical reactions that relieve pain, induce euphoria, and cause various other physical reactions, including the respiratory depression associated with fatal overdose.

When MOUDs occupy opioid receptors in the human brain, they:

  • Reduce or eliminate opioid withdrawal symptoms
  • Fully or partially prevent the effects of opioids
  • Reduce or eliminate opioid cravings

MAT with a MOUD approved by the FDA is considered the gold-standard treatment for opioid use disorder.

Methadone is a full opioid agonist, which means it completely occupies opioid receptors and prevents the action of other opioids – whether prescription or illicit – in the brain.

Buprenorphine is a partial opioid agonist, which means is partially occupies opioid receptors and creates a ‘ceiling effect’ on other opioids, meaning it prevents the extreme euphoria associated with opioid use, and significantly reduces respiratory depression associated with fatal opioid overdose.

Naloxone is a full opioid antagonist, which means it completely blocks the action of any chemical on opioid receptors, including prescription and illicit opioids.

WHERE CAN I FIND MAT PROGRAMS?

There are two types of treatment centers that offer MAT programs:

Office-Based Opioid Treatment Programs (OBOTs):

Office-Based Opioid Treatment (OBOT) is outpatient addiction treatment for people with opioid use disorder (OUD). OBOTS are federally licensed treatment locations/providers of medication-assisted treatment (MAT), recognized by the Substance Abuse and Health Services Administration (SAMHSA), the American Society of Addiction Medicine (ASAM), and the World Health Organization (WHO) as the first-line therapeutic approach for treating people with OUD.

Providers in OBOTs are licensed to initiate and prescribe medications containing buprenorphine. At Pinnacle Treatment Centers, we most often prescribe Suboxone, a combination of buprenorphine and naloxone. Clinicians and medical experts consider Suboxone the safest MOUD.

See our OBOT locations here

Opioid Treatment Programs (OTPs):

Opioid treatment programs (OTPs) are clinics that have fulfilled all federal requirements to initiate and prescribe treatment for opioid use disorder (OUD) with methadone. Because methadone is a full opioid agonist and has an increased risk of diversion, compared to buprenorphine, the rules and regulations for treatment with methadone are more restrictive than the rules and regulations for treatment with buprenorphine.

Federal law requires that OTPs provide the following:

A comprehensive assessment to identify presence of OUD, co-occurring mental health disorders, and any biological, psychological, and social factors that may contribute to the disordered use of substances.

Professional support in the form of addiction counseling, provided by a clinician with the appropriate experience, licensing, and credentials to support people with OUD.

Educational workshops and helpful information about the science of addiction/recovery, general health, wellness, stress relief, relationship management, relapse prevention, and prevention of communicable diseases related to opioid use.

Community support in the form of mentorship and any additional help needed to access/connect to community resources, vocational training, employment services, general education, general healthcare, mental health treatment, and access to programs that address food and housing instability.

Treatment plans that include relapse prevention techniques, stress management techniques, and lifestyle changes that facilitate sustainable recovery.

See our OTP locations here

HOW CAN I START/INITIATE OUD TREATMENT WITH MAT?

In all cases, beginning or initiating participation in MAT requires a comprehensive biopsychosocial assessment performed by a licensed and qualified physician. A comprehensive assessment has five primary goals:

  1. Establish an accurate diagnosis of OUD.
  2. Determine the duration and severity of OUD.
  3. Identify any contraindicated medications.
  4. Identify any other medical or mental health conditions that may affect treatment.
  5. Identify current or past personal, family, and social issues that may affect treatment.

Patients with a primary care physician or a psychiatrist/therapist/mental health counselor should ask these providers first, because they should know their medical history and any special circumstances that may affect OUD treatment in an MAT program. Primary care physicians and psychiatrist/therapist/mental health counselors may not be trained in addiction medicine, but they can perform a professional screening for opioid misuse. If they identify opioid misuse in an initial screening, they can refer a patient for a comprehensive biopsychosocial evaluation administered by a specialist at treatment center for substance use disorder (SUD) that offers MAT.

CAN ANYONE WITH OPIOID USE DISORDER PARTICIPATE IN MAT?

MAT is considered a safe and effective approach to OUD treatment. However, there are specific populations that may require additional assessment to determine whether MAT is the best available treatment alternative:

Pregnant women
Pregnant women with OUD may engage in MAT. Evidence shows MAT is safe and effective for pregnant women and is recommended as a first-line treatment for pregnant women with OUD. However, initiation of MAT requires a thorough physical examination, laboratory tests, psychological screening, and a full psychosocial assessment. In some cases, MAT programs will require a sonogram before initiation of an MAT program.

Chronic pain
Chronic pain patients with OUD may engage in MAT. Chronic pain patients with a history of prescription opioid use must consult with their provider to assess their current status and formulate a treatment plan that manages both chronic pain and opioid use disorder safely and effectively. Providers can design special protocols for circumstances including acute pain, surgeries, injuries, and other medical conditions/emergencies that arise before or during MAT treatment.

Adolescents
Adolescents with OUD may engage in MAT. Buprenorphine is approved for patients age 16 and over, while methadone is approved for patients age 18 and over. There is not a broad base of evidence for MAT for adolescents, and recommendations for MAT for adolescents is based on professional consensus and recommended by the American Society of Addiction Medicine (ASAM). Providers considering MAT for adolescents are advised to prioritize three things: privacy/confidentiality, collaboration with families, and psychosocial support.

Patients with co-occurring mental health disorders
Patients with co-occurring mental health disorders and OUD may engage in MAT. Special consideration and assessment are required to identify any current psychiatric medication or psychiatric treatment that may affect participation in MAT. For patients who report suicidality, providers must create and follow up on a treatment plan that reduces immediate risk and manages factors associated with future risk.

Incarcerated patients
Incarcerated patients with OUD may engage in MAT under the supervision of licensed and qualified medical providers. Patients with OUD entering custody should advocate for MAT services. Patients with OUD currently participating in MAT should avoid interruption in MAT upon release.

More FAQs with Dr. Johnston | Chief Medical Officer

What is the difference between methadone & suboxone?
Suboxone is a medication that has fewer side effects than methadone but is harder to get started on due to the need to be in moderate withdrawal before the first dose. Both are equally effective in helping people stop using opiates.
Will I be on methadone for the rest of my life?
Only if you want to be! About 95% of people who start methadone taper off it. If the taper is slow, the long-term abstinence from opiates is better.
Can I take methadone while on other medications?
There are many medications that interact with methadone. Making sure that all members of your health care team speak with each other is particularly important. Even a short-term antibiotic or heartburn medication can change the level of methadone.
Can I drive after I take methadone? Can there be any other legal issues?
Some people experience mild drowsiness that requires a dose reduction. At a stable dose, there should be no problems with being alert enough for safe driving.
When am I going to get take homes?
Getting take homes is much quicker since the pandemic. It depends on your progress in treatment, but you should consult with your counselor and clinic doctor.
Why is the intake four hours?
There are a lot of forms to fill out, documents to sign and the clinical evaluation. Some programs are quicker than others, but we recommend allowing plenty of time for the first visit!
Will I be medicated the same day?
If you are alert with no signs of intoxication you will receive medication the same day.
How long do I have to be off opiates to start Suboxone?
24 hours is usually sufficient, but it depends on the type of opiate you have been using. The goal is to avoid precipitative withdrawal.
How long do I have to be off opiates to start methadone?
This is the advantage of methadone. Street opiates leave the body as the methadone slowly activates. It is important to try not to use on the morning of your first visit, but we don’t have a specific time limit.
How long do I have to be off Suboxone to start methadone?
Methadone treatment can start the day after suboxone, there is no specific time limit.

IS MAT JUST REPLACING ONE ADDICTION WITH ANOTHER?

This is a common misconception that increases stigma around MAT treatment. The simple answer is “No, it’s not.” Addiction experts and the federal government (the entity that creates the rules around MAT) both have the same position: a person engaging in MAT is in recovery.
In fact, we wrote a series of articles on this topic called “Methadone Mythbusters.” These articles are about methadone, but apply to buprenorphine, as well:

READ: “Do People Use Methadone to Get High?”

READ: “Do People on Methadone Lack Willpower?”

READ: “The Addiction Bait and Switch”

READ: “Methadone Programs are Only for Heroin Addicts”

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