Medication-assisted treatment offers options for people with opioid addiction

By CARF International

What is medication-assisted treatment (MAT)? MAT is the term for the combination of counseling and behavioral therapy with FDA-approved medications to treat substance use disorders (SUD).

Although some people believe MAT means simply replacing one drug with another for people suffering from SUD, MAT is in fact an evidence-based and clinically accepted recovery approach that, depending on the setting in which it’s administered, has various levels of additional supports and answers to several regulations at the federal and state levels.

Over the past few years, MAT has become a broad term that describes how medication can support a person’s recovery from SUD. However, due largely to America’s opioid epidemic, MAT is mostly known to the public as it relates to the recovery of people with opioid use disorder (OUD).

MAT for OUD involves three medications: methadone, buprenorphine*, and naltrexone. “All three of these treatments have been demonstrated to be safe and effective in combination with counseling and psychosocial support,” says U.S. Commissioner of Food and Drugs Dr. Scott Gottlieb. “Everyone who seeks treatment for an opioid use disorder should be offered access to all three options. This allows providers to work with patients to select the treatment best suited to a patient’s individual needs.”

Services that incorporate these three medications can be provided in various settings depending on a person’s needs and preferences:

• Opioid Treatment Programs (OTPs)
  An OTP, once known as a Methadone Clinic or Methadone Maintenance Treatment Program (MMTP), is the only setting in the U.S. that can prescribe methadone for OUD (although many OTPs offer all three FDA-approved medications). U.S. OTPs must be certified by the Center for Substance Abuse Treatment, a division of HHS-SAMHSA
  
  OTPs operate under the supervision of a physician, and provide medical services related to dosing and treatments on site. In addition, OTPs offer group and individual counseling and many offer family services, integrated primary care, peer support services, and other recovery services.
  Learn more about OTPs here

• Office-Based Opioid Treatment Programs (OBOTs)
  OBOT programs offer buprenorphine and/or naltrexone in conjunction with counseling and other support services. They also offer additional services to support a holistic recovery, including individual and group counseling and more.
  Learn more about OBOT programs here

• SUD treatment programs
  Outpatient, inpatient, and residential SUD treatment programs may also offer MAT. They may have a prescriber on staff or partner with an outside prescriber.

• Primary care or other medical setting
  Physicians, nurse practitioners, and physician assistants may prescribe buprenorphine and/or naltrexone in their practice. Ancillary services vary depending on the setting and needs of the population served.

The level of service and integration of counseling, social services, and other recovery supports vary based on the setting, the local continua of care, and a person’s needs. Access to multiple options promotes a “no wrong door” approach that allows individuals to receive care in a setting most in line with their strengths, abilities, and preferences.

“As no single treatment is effective for all individuals with opioid dependence, diverse treatment options are needed, including psychosocial approaches and pharmacological treatment,” states the World Health Organization. “Both detoxification with subsequent abstinence-oriented treatment and substitution maintenance treatment are essential components of an effective treatment system for people with opioid dependence.”

For more information about MAT programs for OUD, contact CARF.

*Buprenorphine may only be prescribed by a provider that has obtained a DATA 2000 waiver.

1/29/2019
(Behavioral Health,Opioid Treatment and Recovery)