More about medication-assisted treatment

Medication-assisted treatment is not the answer for everyone. Some people do not want to use medications for treatment. Others have health conditions that could be affected by MAT. Some people prefer other approaches that have worked for them in the past. Talking with your physician and treatment team can provide the answers you need and help you weigh your options.

There are two key ways medications work to help reduce opioid use:

  1. Methadone and buprenorphine are long-acting medications that reduce craving and control withdrawal symptoms by satisfying areas of the brain affected by opioid use disorder. This allows people to continue to work and function normally.
  2. Naltrexone blocks the actions of opioids. It stops their euphoric effects and their ability to take away pain. Research studies found that long-acting injectable naltrexone reduced cravings and helped people to stay in treatment longer and maintain their abstinence from opioid use.

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Options

MAT includes several treatment approaches. What is right for you will depend on your situation, your needs, and what is important to you.

Detoxification (or “detox”) is medically supervised withdrawal from drugs with gradually reduced doses of medication to ease withdrawal symptoms and cravings. It is short-term, usually lasting no more than 21 days. The goal is to reduce the medications slowly and discontinue them by the time the person is discharged. Research shows that without further support or treatment, medication assisted detoxification is not likely to result in long-term recovery. Relapse is common among people receiving less than 90 days of treatment.

Maintenance is long-term MAT, usually a minimum of 1 year, with periodic reassessment of the need for ongoing treatment. Maintenance therapy can help control cravings and stabilize functioning over the long haul, which allows time to focus on building a life in recovery. Research shows that maintenance therapy is better than detoxification alone. But, the most successful path to recovery combines maintenance therapy with counseling and a strong recovery support system.

Once people are medically withdrawn from opioids or once they discontinue maintenance therapy, they have a lower tolerance to opioids and cannot handle the amounts they were accustomed to using before treatment. Overdose deaths have occurred when people have resumed opioid use after a detoxification or after stopping maintenance therapy. The risk is even higher if they also use alcohol or benzodiazepines (such as Ativan, Xanax, and Valium).

Research

Research shows that the longer people stay in treatment and remain involved with recovery support programs, the better they do at maintaining recovery. Studies measure success a number of ways:

  • How long people stay in treatment and whether they complete treatment.
  • Whether they remain free from or reduce their drug use.
  • If they reduce risk behaviors for contracting HIV and HCV infections.
  • If they reduce criminal activities and illegal involvement.
  • If they maintain stable housing.
  • If they maintain stable employment.
  • Whether they report fewer problems with mental health.
  • Lower death rates.

Overall, the evidence shows that MAT helps people overcome opioid use disorder and sustain recovery. With MAT, there are decreases in drug relapse rates, death rates, and rates of criminal behavior. Maintenance therapy reduces the spread of HIV and HCV among people who are addicted to opioids. None of the MAT medications actually protect against HIV. However, people in MAT are more likely to reduce their high-risk behaviors.

In the United States, the three medications that are approved for use in MAT for opioid use disorder are: methadone, buprenorphine, and naltrexone. Medications such as clonidine (for high blood pressure) and baclofen (a non-narcotic muscle relaxant) sometimes are useful during withdrawal, but they are not approved for MAT.

Methadone

Methadone is a long-acting opioid medication that reduces cravings and withdrawal symptoms. It is usually taken by mouth in liquid form, and dispensed daily, in single doses, only by certified opioid treatment programs. Limited take home dosing may be permitted, and can become more frequent over time, if long-term treatment is going well. But, in order to begin methadone treatment you need to be able to get to an opioid treatment program daily. Methadone is highly effective for treating opioid use disorder. Side effects of methadone include constipation, sexual problems, swelling, and sweating. It can also cause heart problems or make them worse.

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Buprenorphine

Buprenorphine is usually taken daily and must be dissolved under the tongue. It comes in tablet form and as a film. Once doctors complete the required training and certification process, they can prescribe buprenorphine for office-based treatment or for clients at various treatment programs. Patients making satisfactory progress may receive take home prescriptions for up to a 30-day supply of buprenorphine.

Buprenorphine has proven to be very effective. Although it has not been more effective than methadone, for some people it may offer advantages. Risk of overdose is lower and withdrawal from buprenorphine may be milder. Buprenorphine is widely available in a formula that contains added naloxone, which discourages abusing or injecting it. Access to buprenorphine has helped many individuals seek treatment who otherwise might not have. Some common side effects are headache, nausea, and constipation.

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Naltrexone

Naltrexone is available in an extended release injectable form that is administered every 30 days and in tablet form, taken once a day by mouth. It blocks the action of opioids on the brain and stops their rewarding effects—the pain relieving effects and the euphoria. This can help discourage relapse. The long-acting injection has been the most effective form for treating addiction. It has helped to prevent relapse when combined with counseling and other supportive treatments.

Naltrexone is a MAT option for people who have been able to get through the initial 7–10 days of withdrawal and are highly motivated to prevent a return to drug use. Overdose risk is high for people who try to override the blocking effects of naltrexone by using large amounts of opioids, and for those who return to opioid use after a period on naltrexone. This can happen when people take amounts they were used to prior to treatment, but are no longer are able to tolerate them.

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