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The case for Medication for Addiction Treatment (MAT)

Home Resources The case for Medication for Addiction Treatment (MAT)

Recovery Centers of America

The case for Medication for Addiction Treatment (MAT)

White paper
Date: August 2020

There’s a common misconception that MAT is a “crutch” or simply substitutes one drug for another and is inferior to complete abstinence. In this paper, RCA’s Chief Scientific Officer, explains the research behind the numerous benefits of MAT and why RCA supports and offers this treatment option.

Why wouldn’t addiction treatment professionals offer every type of treatment? Is it stigma? Financial incentive? Moral judgement?”
– RCA’s Chief Scientific Officer

Download the complete white paper to read it later.

The Misconception

According to The Substance Abuse and Mental Health Services Administration, the federal agency in the U.S. Department of Health and Human Services responsible for leading the nation’s efforts in substance abuse prevention and treatment, Medication for Addiction Treatment (MAT) is the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Although numerous medications have been shown to significantly decrease cravings for alcohol and other drugs, reduce the harm from substance use, and even save lives, there remains significant controversy, stigma, and resistance to using these medications as part of a comprehensive treatment for individuals with substance use disorders (SUD).

A common misconception is that medications, even when appropriate used as part of a comprehensive treatment program, simply substitute one drug for another, or that the medications are “a crutch.” In reality, these medications have shown numerous benefits to a large group of stakeholders, across a variety of uses and stages of recovery. Some effectively relieve withdrawal symptoms, others reduce physiological and even psychological cravings, some block the effects of abused substances in the brain, some provide an ongoing safe, and controlled level of medication to overcome the use of an abused opioid.

RCA Position

Recovery Centers of America’s position is that substance use disorders are chronic medical illnesses and like any other illness, we should rely on the science when deciding on treatment options to provide to our patients. And further, that every type and form of treatment, including psychosocial services and medications that have been proven effective in valid scientific studies should be offered to all appropriate patients just as is the case in the treatment of other chronic illnesses such as diabetes, asthma, depression or anxiety.

Rationale

To adequately discuss and provide rationale and supporting facts for RCA’s position on the use of Medications in SUD Treatment often referred to as Medication for Addiction Treatment or MAT), a review of the medications available to assist with substance use disorder treatments is necessary. Below is a list of the most studied and used FDA (Food and Drug Administration) approved medications for treatment of alcohol, tobacco, and opioid use disorders. Currently there are no FDA-approved medications available for treatment of amphetaminecocaine, or marijuana use disorders.

Primary Medications for Treatment of Opioid Use Disorders

Methadone – Approved by the FDA for use in treating opioid addiction in 1972, methadone is a long acting, full opioid agonist. An opioid agonist imitates the action of other opioids (including prescription opioids, heroin, fentanyl, etc.) by binding with the opioid receptors in the brain but have a lower level of affinity with the receptors resulting in less of the rewarding properties of other opioids like euphoria. The effectiveness of methadone treatment for individuals struggling with heroin or other opioid problems has been established in numerous studies conducted over four decades. When used while a patient is detoxifying from opioids (heroin, fentanyl, morphine, codeine, oxycodone, hydrocodone, etc), it lessens the painful symptoms of opioid withdrawal and allows the patient to detox safely over a period of time increasing the chance that the patient will be able to achieve a complete detoxification. Patients on methadone for ongoing treatment (methadone maintenance) have shown improvements in a number of outcomes including decrease or cessation of heroin/opioid and other drug use, reduced crime, decreased transmission of HIV and HEP C viruses, and improved personal and social functioning.

However, in addition to the benefits to the individual, methadone has two additional objectives including enhancing public safety, and safeguarding public health. It is agreed that these outcomes are achieved by the combination of methadone when provided with counseling.

Methadone is used in specially licensed residential substance abuse detoxification programs or for maintenance, is dispensed in clinic-based opioid treatment programs.

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Primary Medications for Treatment of Alcohol Use Disorders

Disulfiram or Antabuse – Approved by the FDA in 1951, this medication has no effects until the person drinks alcohol. When alcohol is consumed, the person experiences acute sensitivity resulting in nausea, vomiting, headaches and other acutely uncomfortable symptoms. For someone having difficulty with abstaining from alcohol, this medication helps them not to drink during periods of cravings or impulsive desires to drink.

Naltrexone – Oral Naltrexone, approved by the FDA for the treatment of alcohol use disorders in 1994, works by decreasing cravings for alcohol and by blocking some of the euphoric effects and feelings of intoxication. This makes alcohol less rewording resulting in reduced frequency and volume of drinking. The injectable form of Naltrexone (VIVITROL®) was first approved by the FDA in 2006 for the treatment of alcoholism.

Primary Medications for Treatment of Nicotine Use Disorders

Bupropion – Known by its most commonly prescribed trade names Zyban or Wellbutrin in the treatment of depression, bupropion products have also been shown to reduce nicotine cravings and withdrawal symptoms in adult smokers making quitting smoking and maintaining recovery easier.

Nicotine Replacement Therapies (NRTs) – Often available over the counter in the form of gum, lozenge, or inhaler, NRTs help smokers wean off cigarettes by activating nicotine receptors in the brain in an increasingly lower dose over time. This alleviates many of the withdrawal symptoms experienced when tobacco users try to quit abruptly.

Varenicline – Better known by its trade name Chantix, this prescription medication works on three areas – it reduces the pleasurable effects of cigarettes (or other tobacco products), decreases cravings for nicotine, and decreases withdrawal symptoms by mildly stimulating nicotine receptors in the brain.

It is with this review as background that we provide the rationale and supporting facts for RCA’s Position on the Use of Medication-Assisted-Treatment. We also make a number of analogies among these medications and between these medications and medications for other chronic diseases to show examples of the stigma that keeps people, including families, employers and many well intentioned treatment providers, from adopting the use of some proven effective medications in the treatment of addiction.

Conclusion

Substance use disorders, or addiction to drugs or alcohol are chronic medical diseases with notable similarities to numerous other chronic medical illnesses. As with other medical diseases such as asthma, hypertension and diabetes, addiction has proven genetic factors, and these factors are not limited to just becoming addicted. At least half of a person’s susceptibility to drug addiction can be linked to genetic factors. In fact, with tobacco, genetics account for about 75 percent of a person’s inclination to begin smoking, 60% of the tendency to become addicted and 54 percent of one’s ability to quit. Like all chronic medical disorders, environmental and behavioral factors also play a role, so susceptibility isn’t destiny. Not everyone will express their genetic loading to any illness.

Just like other chronic medical disorders, there is no cure for addiction, but the illness can be managed over the lifespan with a variety of medical and psychosocial treatments as well as continued commitment to behavioral change and social supports.

Similar to quality healthcare professionals treating other diseases, Recovery Centers of America will always endorse any treatment method that has been shown scientifically to effectively address the chronic medical illness of addiction in an effort to give our patients every possible chance at success.

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Resources

https://www.samhsa.gov/medication-assisted-treatment
https://archives.drugabuse.gov/publications/drug-abuse-addiction-one-americas-most-challenging-public-health-problems/addiction-chronic-disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883750/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994240/
https://www.drugabuse.gov/publications/research-reports/marijuana/available-treatments-marijuana-use-disorders
https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone
https://www.ncbi.nlm.nih.gov/books/NBK232111/
https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat
https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone
https://en.wikipedia.org/wiki/Naloxone#:~:text=It%20works%20by%20reversing%20the,the%20United%20States%20in%201971.
https://www.ncbi.nlm.nih.gov/books/NBK64036/
https://en.wikipedia.org/wiki/Bupropion
https://en.wikipedia.org/wiki/Varenicline#:~:text=Varenicline%20(trade%20name%20Chantix%20and,cigarettes%20and%20other%20tobacco%20products.
https://www.apa.org/monitor/2008/06/genes-addict.aspx
https://drugfree.org/learn/drug-and-alcohol-news/25-treatment-facilities-offer-medications-alcohol-use-disorder-study/

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