Medication-Assisted Treatment (MAT)

The World Health Organization has called MAT “one of the most effective types of  pharmacological therapy of opioid dependence.” Numerous studies have shown that MAT contributes to significant reductions in opioid use, criminal activity, overdose, and other risky behaviors. MAT quells cravings and allows patients receiving it to stabilize their physical dependency. This stability allows MAT patients to achieve healthy social, psychological, and lifestyle changes.

A note about the three FDA-approved medications for opioid use disorder:

While all three medications (methadone, buprenorphine, and naltrexone) can be effective in the treatment of opioid use disorder, decades of research support the efficacy of opioid agonist medications (methadone and buprenorphine) in preventing overdose. We are now learning about the overdose prevention capabilities of long-acting, injectable naltrexone. Early research indicates that long acting naltrexone may share methadone and buprenorphine’s overdose prevention effects. Though naltrexone has also proven effective, research has shown that this medication is harder to initiate in some patients and that less effective attenuation of withdrawal symptoms during the first days of treatment may predict treatment drop out. Differences in treatment response and outcomes with naltrexone are actively being researched. Medications, therefore, should be selected carefully and tailored to the needs of each individual patient.

• It is combined with ancillary treatment strategies like counseling and social support with fixed, safe, and predictable doses of medications.
• Public awareness of MAT as an effective medical intervention is promoted by local leadership. This helps to reduce stigma against MAT that discourages people from seeking this form of care.
• Entry into treatment is voluntary. Compulsory treatment programs through legal and social welfare systems are less effective than voluntary treatment.
• Patients have access to a variety of medication options. All patients are different, and treatment is best when individualized. Some people fare significantly better on buprenorphine than on methadone, and vice versa. Some may need to try several treatment options before discovering what works best, and some may not have access to all MAT medications.
• n The challenges of receiving MAT are understood and mitigated. Many individuals face hurdles in receiving approval for MAT from their health insurance provider. Many methadone clinics require patients to attend daily to receive treatment. This can mean long, burdensome commutes at odd hours, which can conflict with professional, familial, or care-giving responsibilities. Those who live in rural areas, for example, may have to drive hours to receive care. Treatment is more successful when these obstacles are not placed in the way.

• A meta-analysis that included eleven different studies of methadone as a medication for opioid use disorder found that methadone was more effective at treating opioid use disorder and reducing illicit opioid use than nonpharmacological treatments.
• A 2014 review of all available evidence on buprenorphine as a treatment for opioid use disorder found it to be effective in retaining patients in care and just as effective as methadone in reducing illicit opioid use among those retained in care.
• A longitudinal study that followed MAT patients for more than four years found both methadone and buprenorphine to be effective long term treatments for opioid use disorder throughout that follow-up period.
• Two studies, one conducted in Australia and one conducted in Washington state, have found higher death rates among patients receiving oral naltrexone compared to patients receiving long-acting injectable naltrexone or methadone, respectively. 

• A meta-analysis concluded that participation in pharmacological treatment for opioid use disorder, such as MAT, improves HIV treatment across the entire continuum of care, increasing coverage of antiretroviral treatment by 54%, increasing enrollment into antiretroviral treatment by 87%, increasing antiretroviral treatment adherence by nearly 200%, increasing rates of viral suppression by 45%, and reducing antiretroviral treatment discontinuation by 23%.
• A study that followed MAT patients for a year after initiating treatment found that MAT patients experienced a significantly improved quality of life during the course of their treatment.
• In a clinical trial of more than 300 criminal justice-involved individuals with opioid use disorder, long-acting injectable naltrexone was compared to basic counseling with no medication. During the 24-week study period, there were no overdose events among the 153 individuals offered long-acting naltrexone and 7 overdose events among the 155 individuals offered no medication.