Medication-Assisted Treatment (MAT) for Addiction (Suboxone, Methadone or Naltrexone) Reduces Cravings, Saves Lives, Prevents Relapse

COVID-19 Presents Challenges to MAT and May Increase Opioid Overdoses

In the COVID-19 environment there are other considerations as well, as most MAT programs require regular – if not daily – monitoring and dosing. How will these patients stay safe?

It’s easy to be scared before going into detox or other kinds of treatment, and that fear might lead a person to lie, under report symptoms, overreport symptoms, or hide other relevant facts about how much they’re struggling to stay clean or manage feelings. Generally speaking, the more honest one is with a treating psychiatrist or clinicians the better the chance for getting the help needed.

Professionals working in addiction treatment, clients, and the public debate the use of medications like suboxone, methadone, or naltrexone in the treatment of addiction. There is some controversy about Medication-Assisted Treatment (MAT) for treatment for opioid addiction, in particular.

Medication-assisted treatment , including opioid treatment programs, combines behavioral therapy and medications to treat substance use disorders.

There is increasing evidence that medication-assisted treatment with the synthetic opioids methadone or suboxone can help those addicted to opioids by relieving symptoms of withdrawal and reducing cravings, and that when paired with strong outpatient counseling and other support can significantly improve rates of recovery.

The development of effective treatments for opioid dependence is of great importance given the devastating consequences of the disease, says the National Institutes of Health.

When and what level of addiction warrants receiving medication assistance is part of the debate. Some take a very rigid approach in particular to opioid-based treatments, asserting that people are “still using” or “avoiding their pain” by taking opioid replacement / blocking therapies. Others see MAT as a key tactic in combating chronic relapsing.

Research shows that helping clients with MAT is more cost effective in the short-term (see references below for further reading). It results in fewer hospital visits, and fewer overdoses. Long-term MAT helps with detox and post-acute withdrawal, emotional stability, and can help prevent relapse, especially at higher doses.

In an NPR report about treatment of addiction beyond the 28-days model, Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers, addresses the cost benefit of MAT.

“The federal government estimates spending on treatment for all substance abuse will hit a high of $42 billion by 2020. Some people pay tens of thousands of dollars, desperately hoping inpatient treatment will work. But there’s increasing evidence that medication-assisted treatment with the synthetic opioids methadone or suboxone can help those addicted by helping to relieve symptoms of withdrawal and reduce craving, especially when paired with strong outpatient counseling and other support.”

One challenge medical professionals have when prescribing MAT drugs is that there is no collective wisdom about how long a client should stay on one of these medications, and at what doses, because the outcomes across studies, especially for how often MAT helps prevent relapse, are not consistent.

More research is needed to understand how MAT effectively assists clients in treatment, along with the progress of psychosocial changes required for sustained sobriety. This should be no different than when other psychotropic medications clients are prescribed (e.g., antidepressants or antianxiety drugs) for other types of addiction. The rate of death from overdoses of prescription opioids in the United States more than quadrupled between 1999 and 2010, far exceeding the combined death toll from cocaine and heroin overdoses.

An individual suffering from substance abuse disorder can make an informed decision based upon an honest conversation with a treatment team about how intense withdrawal/detox symptoms are and motivation for implementing other psychosocial changes (i.e., leaving a “using lifestyle,” better diet, healthy exercise routine, developing sober peers, and therapy to get to the “root” of the problem).

In the COVID-19 environment there are other considerations as well, as most MAT programs require regular – if not daily – monitoring and dosing. How will these patients stay safe? Although the Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a guide for opioid treatment programs dispensing methadone during the Covid-19 outbreak, implementing the guidelines is contingent on state regulations and may fall short of what is needed.

It’s easy to be scared before going into detox or other kinds of treatment, and that fear might lead a person to lie, under report or overreport symptoms, or hide other relevant facts about how much they’re struggling to stay clean or manage feelings. Generally speaking, the more honest one is with a treating psychiatrist or clinicians the better the chance for getting the help needed.

References

  1. Expert Opinion Pharmacotherapy. Opiod Dependence Treatment: Options In Pharmacotherapy. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874458/
  2. Allen, B. (2016). How we got here: Treating addiction in 28 days. National Public Radio. Retrieved on October 4th, 2017 from: http://www.npr.org/sections/health-shots/2016/10/01/495031077/how-we-got-here-treating-addiction-in-28-days
  3. Khemiri, A., Kharitonova, E., Zah, V., Ruby, J., & Toumi, M. (2014). Analysis of buprenorphine/naloxone dosing impact on treatment duration, resource use and costs in the treatment of opioid-dependent adults: a retrospective study of US public and private health care claims. Postgraduate Medicine, 126(5), 113-120.;
  4. As, S., Young, J., & Vieira, K. (2014). Long-term Suboxone Treatment and its Benefit on Long-Term Remission for Opiate Dependence. J Psychiatry 17: 1000174. doi: 10.4172. Psychiatry, 1000174, 2.;
  5. Sittambalam, C. D., Vij, R., & Ferguson, R. P. (2014). Buprenorphine Outpatient Outcomes Project: Can Suboxone be a viable outpatient option for heroin addiction? Journal of community hospital internal medicine perspectives, 4(2), 22902.;
  6. Huffman, K., Mathews, M., Sweis, G., Shella, E., Taton, V., Umberger, W., & Scheman, J. (2014). (530) Suboxone decreases the odds of opioid resumption in patients with opioid addiction following treatment in a chronic pain rehabilitation program including opioid weaning. The Journal of Pain, 15(4), S108.;
  7. McKeganey, N., Russell, C., & Cockayne, L. (2013). Medically assisted recovery from opiate dependence within the context of the UK drug strategy: Methadone and Suboxone (buprenorphine–naloxone) patients compared. Journal of substance abuse treatment, 44(1), 97-102.
  8. Johns Hopkins University (2017). Many patients receive prescription opioids during medication assisted treatment for opioid addiction. Bloomberg School of Public Health. Retrieved on June 10th, 2017 from: http://www.jhsph.edu/news/news-releases/2017/many-patients-receive-prescription-opioids-during-medication-assisted-treatment-for-opioid-addiction.html;
  9. Schuckit, M.A. (2016). Treatment of opioid-use disorders. The New England Journal of Medicine, 375, 357-368. https://doi:10.1056/NEJMra1604339
  10. Simojoki, K., Vorma, H., & Alho, H. (2008). A retrospective evaluation of patients switched from buprenorphine (Subutex) to the buprenorphine/naloxone combination (Suboxone). Substance abuse treatment, prevention, and policy, 3(1), 16.
  11. Finch, J. W., Kamien, J. B., & Amass, L. (2007). Two-year experience with buprenorphine-naloxone (Suboxone) for maintenance treatment of opioid dependence within a private practice setting. Journal of Addiction Medicine, 1(2), 104-110.
  12. Hill, E., Han, D., Dumouchel, P., Dehak, N., Quatieri, T., Moehs, C., … & Blum, K. (2013). Long term Suboxone™ emotional reactivity as measured by automatic detection in speech. PLoS one, 8(7), e69043.
  13. Sittambalam, C. D., Vij, R., & Ferguson, R. P. (2014). Buprenorphine outpatient outcomes project: Can suboxone be a viable outpatient option for heroin addiction? Journal of Community Hospital Internal Medicine Perspectives, 4(2), 22902. http://dx.doi.org/10.3402/jchimp.v4.22902
  14. Tanner, G. R., Bordon, N., Conroy, S., & Best, D. (2011). Comparing methadone and Suboxone in applied treatment settings: the experiences of maintenance patients in Lanarkshire. Journal of Substance Use, 16(3), 171-178.
  15. Canestrelli, C., Marie, N., & Noble, F. (2014). Rewarding or aversive effects of buprenorphine/naloxone combination (Suboxone) depend on conditioning trial duration. International Journal of Neuropsychopharmacology, 17(9), 1367-1373.
  16. Ling, W., Hillhouse, M., Domier, C., Doraimani, G., Hunter, J., Thomas, C., … & Selzer, J. (2009). Buprenorphine tapering schedule and illicit opioid use. Addiction (Abingdon, England), 104(2), 256-265.
  17. Volkow, Nora D., MD….Medication Assisted Therapies – Tackling the Opioid Overdose Epidemic, retrieved May 5, 2020 from The New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/NEJMp1402780#t=article

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