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Medication-Assisted Treatment for Opioid Dependence and Addiction

Executive Summary

Medication-Assisted Treatment (MAT) or Opioid Agonist Maintenance Treatment is a treatment for opioid addiction that includes the use of medication along with counseling and other support. Examples of some medications used for this type of treatment include Methadone, Buprenorphine, Suboxone, or Naltrexone.

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MAT appears to be the most cost-effective treatment for opioid dependence. Countries with established opioid agonist maintenance programmes usually attract 40–50% of dependent opioid users into such programmes, with higher rates in some urban environments. Most of the unmet need for treatment is in Asia and eastern Europe, particularly in China, India and the Russian Federation. Because of their cost, inpatient facilities are typically reserved for those with specific needs, and most patients wanting to withdraw from opioids are encouraged to attempt opioid withdrawal as outpatients.

Including medication in treatment helps patients achieve recovery successfully by reducing problems of withdrawal and craving. Taking medication for opioid addiction is like taking medication to control heart disease or diabetes. It is not the same as substituting one addictive drug for another and does not create a new addiction but helps manage the existing. When planning treatment, there are regulation, supply chain, and effectiveness considerations dictating which drugs are chosen for each patient case. 


Methadone

Methadone has been used for opioid dependence since 1964. It is a synthetic, long-acting opioid, so it can replace multiple heroin uses by being taken once daily. It works by binding to the opioid receptors in the brain and spinal cord, activating them, reducing withdrawal symptoms and cravings while suppressing the "high" that other opioids can elicit. The decrease in withdrawal symptoms and cravings allow the user to slowly taper off the drug in a controlled manner, decreasing the likelihood of relapse. 

Methadone is a regulated substance and typically requires that each dose be picked up from a methadone clinic daily. There are a number of online resources to find local methadone clinics. [1]

Buprenorphine

Similarly, to Methadone, Buprenorphine is a long-acting opioid-derivative used to help people reduce or quit their use of heroin or other opiates. It is also said to eliminate opiate withdrawal symptoms and cravings in many patients without inducing euphoria.[1]

Unlike methadone treatment, which must be performed in a highly structured clinic, buprenorphine, according to SAMHSA, can be prescribed or dispensed in physician offices. It is often regulated with month-long prescriptions in allowing areas. If recovery is stable, Buprenorphine must be stopped slowly, over time. This is called tapering and is often done with the assistance of a physician or substance abuse treatment provider.[2]

Suboxone

Suboxone is a medication used to treat opioid dependence, containing buprenorphine and naloxone. One of the advantages of using Suboxone is that it cannot be taken to achieve a full opioid effect, making it difficult to abuse. Suboxone can be prescribed in a doctor’s office however if a Suboxone tablet is crushed and snorted, the added naloxone will block opioids from the brain’s receptors, preventing any sort of high from the suboxone. The naloxone discourages users from snorting Suboxone to get high. [8]

Naltrexone

Naltrexone blocks the euphoric and sedative effects of drugs such as heroin, morphine, and codeine. It works differently in the body than methadone and buprenorphine, which activate opioid receptors in the body that suppress cravings. Naltrexone binds and blocks opioid receptors, and is reported to reduce opioid cravings. There is no potential for abuse with naltrexone.[5]

If a person relapses and uses the problem drug, naltrexone prevents the feeling of getting high, diminishing the appeal of drug user.[5] Naltrexone treatment results in a reduction in heroin use and criminal behaviour, and can be useful in preventing relapse in those who have withdrawn from opioids or are already motivated to abstain from opioid use. [3] 

Before starting Naltrexone, a user must have no opioids in the body otherwise withdrawal symptoms will be extra strong. [6] Treatment can last up to days, months, or years, depending on effectiveness and how long it is needed to prevent relapse. Naltrexone does not cause withdrawal when you stop taking it and if recovery is stable, there is no need to taper off of the drug. [6]


Counselling

Medication is often one part of treatment for opioid addiction, but for many people, counselling could be just as important. [2] Through counselling, individuals learn about the motivations and behaviors that led to opioid addiction and how to commit to a more healthful lifestyle. Counselling can provide encouragement and motivation to stick to treatment by gaining support and skills through working with others to manage long-term recovery. Users can challenge the psychological aspects of addiction and learn how to make healthy decisions, handle setbacks and stress, and move life forward. [2]

Group counselling allows individuals to connect with others in treatment or make friends that are not fellow drug users. Benefits of group counselling could also be achieved through informal support groups. [2]


Support from Family and Friends

Addiction is complex and can translate pain, anger, or feelings of shame and hopelessness to surrounding individuals. Some treatment programs offer counselling for the loved ones of opioid users to teach them more about addiction, how to help, and how to handle associated problems that may have reached them. [2] There are also support groups for family and friends to provide safe places to share information and encourage others who have loved ones who are dealing with addiction. [2] Equipping loved ones with the tools to handle and understand addiction strengthens support for opioid users in recovery and can empower treatment.


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