The American Medical Association (AMA) recently released a statementcalling on policymakers to help those with opioid addiction in a way some might say is unconventional. The call for support comes after the CDC released startling statistics about the addiction crisis, including 72,000 fatal drug overdoses and 88,000 annual deaths attributed to excessive alcohol use in 2017.
The means of treatment that the AMA is recommending is an approach called medication assisted treatment – sometimes referred to as MAT – and in the past year over 15,000 physicians have become certified to treat patients with opioid addiction in this manner.
“We know what works,” said Patrice A. Harris, M.D., chair of the AMA Opioid Task Force. “We can point to states where making access to medication assisted treatment (MAT) has been a priority, and the mortality rates are doing down. The Centers for Disease Control and Prevention (CDC) provisional numbers yet again underscore that this epidemic will not be reversed until we deal with access issues and stigma associated with opioid misuse.”
What is Medication Assisted Treatment?
Medication-assisted treatment combines behavioral therapy and medications to treat substance use addiction. This means that treatment for individuals with opioid (and other) addictions could include FDA-approved medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use addiction.
“For those with opioid use disorders, medications can save lives by helping to prevent relapses, ” says Joe Gerstein, MD, FACP president of the SMART Recovery Board of Directors.
According to the Substance Abuse and Mental Health Services Administration, this approach has been shown to:
- Improve patient survival
- Increase retention in treatment
- Decrease illicit opiate use and other criminal activity among people with substance use disorders
- Increase patients’ ability to gain and maintain employment
- Improve birth outcomes among women who have substance use disorders and are pregnant
What Medications Are Prescribed as Part of Medication Assisted Treatment?
Medications such as methadone, buprenorphine, naltrexone and naloxone could be prescribed in different situations and in a responsible manner to someone with an opioid addiction. These medications are used to manage dependence and addiction to short-acting opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.
Disulfiram, Acamprosate and naltrexone are often used to help treat someone with an alcohol addiction.
Does MAT Just Substitute One Addiction For Another?
This is a common misconception about MAT. MAT relieves withdrawal symptoms and psychological cravings that cause chemical imbalances in the body and provides safe and controlled level of medication to overcome the use of an abused opioid. And research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability.
How Long Will Someone Need to Use Medication Assisted Treatment?
People may safely take medications used in MAT for months, years, several years, or even a lifetime. An individual’s plan is created with their doctor, and plans to stop medication should always be discussed before making changes to their prescriptions or treatment.
Who Can Treat An Individual With Addiction Using Medication Assisted Treatment?
Methadone used in the treatment of opioid addiction can be prescribed and dispensed only through a SAMHSA-certified OTP. Buprenorphine-containing drugs, such as Suboxone can be prescribed by physicians who obtain a waiver from the DEA after taking specified training in the use of these drugs. Naltrexone, oral or injectable, can be prescribed by any licensed physician.
Why Aren’t More People Using MAT?
The slow adoption of these evidence-based treatment options for alcohol and opioid dependence is partly due to misconceptions about substituting one drug for another. Discrimination against MAT patients is also a factor, despite state and federal laws clearly prohibiting it. Other factors include lack of training for physicians and negative opinions toward MAT in communities and among health care professionals.
What is SMART Recovery’s Stance on Medication Assisted Treatment?
SMART Recovery supports the scientifically informed use of psychological treatment and legally prescribed psychiatric and addiction medication.
Although SMART Recovery publicly released its position on MAT in 2005, the organization has welcomed participants at meetings using legally prescribed medications since its beginnings. This includes drugs needed to treat mental health disorders, which are common among people trying to recover from addiction problems.
According to the SMART Recovery website, “As a whole, SMART Recovery is based on maximizing choices in life, and we don’t tell participants what they should choose. We offer SMART Tools, like the CBA, ABC, and HOV to help people think about how to live better.”
SMART Recovery also recently released a podcast on this topic, SMART Recovery Podcast: Can Medication Help Conquer Addiction, interviewing Donald Sheeley, MD who is uniquely positioned to speak on this topic, as a long-time volunteer at SMART, an Emergency Room physician, and as a practitioner in his own practice, “ACT SMART New York.”