Opioid Use Disorder and Medication-Assisted Treatment
Opioid Use Disorder (OUD) is a chronic, lifelong condition that affects quality of life, familiar relationships, and daily functioning. Unfortunately, much of the American public sees OUD as a moral failing, not a treatable medical condition. The reality is that OUD is a physiological response that develops after consistent use of opioids. Many opioid use disorders begin with a valid prescription to treat pain.
There are many reasons that a person experiencing OUD may find it difficult to stop, chief among them are the physiological and psychological pain of withdrawal. Medication-Assisted Treatment is a viable, evidence-based method of treating OUD that supports a long-term recovery.
What Is Medication-Assisted Treatment (MAT)?
Medication-Assisted Treatment, or MAT, combines psychosocial, behavioral interventions such as cognitive behavioral therapy (CBT) and medications approved by the Food and Drug Administration to treat Opioid Use Disorder. Medications used in MAT help address the physiological aspects of opioid addiction, while behavioral interventions address the other complex factors that contribute to the substance use disorder, such as trauma, family dynamics, or co-occurring mental health disorders. By addressing all factors simultaneously, providers can identify triggers, control cravings, and reduce the likelihood of relapse.
Medication-Assisted Treatment and Post-Acute Withdrawal Syndrome (PAWS)
Understanding the benefits of MAT first requires knowledge of how opioids affect the body and brain. An Opioid Use Disorder most often occurs when a person receives a prescription for a pain-relieving opioid following surgery or for a legitimate medical condition. When the affected individual takes the medication, it effectively controls pain because it works by blocking pain receptors. A side effect is a triggered sense of euphoria. Reliving this sense of euphoria is what may cause a person to misuse opioids for the first time. Over time, as the disorder progresses, the affected individual’s brain chemistry changes, such that it relies on the opioids to trigger the production of dopamine (the neurotransmitter responsible for the euphoria, but also in charge of several other important functions). This forms the basis for opioid dependence.
When the affected individual tries to abstain for opioids, withdrawal is the result, since the body no longer produces dopamine effectively on its own. Opioid withdrawal is notoriously painful and produces several troubling symptoms, such as:
- Diarrhea, nausea, and vomiting
- Muscle aches
- Mood swings
- Heart palpitations
- Heart palpitations
These symptoms are often very intense, so much so that a person with OUD will use again simply to make them stop. Even once a person physiologically detoxifies from an opioid – a process that can take around three days but typically lasts up to a week – the psychological effects persist for weeks or months. Medication Assisted Treatment works by managing the symptoms of withdrawal by reducing cravings and minimizing discomfort.
What Is Post-Acute Withdrawal Syndrome (PAWS)?
The process of initial detoxification varies, but the most intense feelings of discomfort occur within the first 72 hours. Within 7-10 days, a person may be physiologically detoxified from the opioids. After this period ends, a person with OUD is vulnerable to a condition called post-acute withdrawal syndrome (PAWS).
PAWS refers to the psychological and emotional effects of an addiction. The symptoms may persist for weeks and months, even up to two years after initial detox. Symptoms tend to occur in waves and may include:
- Difficulty sleeping
- Intense cravings for the drugs
- Emotional instability and irritability, quick to anger
One of the ways that Medication-Assisted Treatment can be beneficial is in the treatment of PAWS. People who utilize MAT report fewer cravings and reduced symptoms of PAWS, which can help support a long-term recovery by significantly reducing the risk of relapse.
Effective MAT Treatments for Opioid Use Disorder
Currently, only three FDA-approved medications exist for the treatment of Opioid Use Disorder: methadone, suboxone, and naltrexone. Here’s some information about each.
Methadone produces a similar effect to opioids, but to a lesser extent and with milder effects. It is longer lasting and does not have the same increased potential for misuse; it does not tend to affect a person’s ability to function normally. As an opioid agonist, it works to provide relief of some of the most painful symptoms of withdrawal and PAWS. A single dose of methadone lasts about a day and a half. Some potential for misuse exists; as such, it may only be dispensed by a licensed provider in a clinical setting. A person on methadone treatment must visit the clinic for a new dose every couple of days, so they must be willing to remain compliant to the protocol.
Buprenorphine is becoming a more popular choice amongst healthcare providers, as it is a partial opioid agonist and does not have a high potential for misuse. Suboxone is a combination of buprenorphine and naloxone (Narcan), a medication used to reverse the effects of an opioid overdose. While it is difficult to misuse, it still requires regular visits to a medical provider to receive. Providers who wish to prescribe suboxone must attend an eight hour training course to obtain a MAT waiver, so not all providers can prescribe it.
Naltrexone is available in two forms: a pill or an intramuscular injection lasting up to 30 days. When taken as an intramuscular injection (Vivitrol), it provides a convenient option, particularly for those looking for an intensive outpatient treatment option. The once-daily pill can be taken in the comfort of a person’s own home. It has little potential for misuse or diversion; as such, any provider who is licensed to dispense medication may prescribe it.
Naltrexone is an opioid antagonist, which means it works by blocking opioid receptors. It effectively reduces cravings in the person taking it because it no longer produces a feeling or euphoria or “high.” However, Naltrexone is only a suitable option after a person initially detoxifies from the physiological effects of opioids; starting it too early can make withdrawal symptoms worse.
MAT as an Effective Treatment Option
Numerous studies show that Medication-Assisted Treatment is more effective in preventing relapse and supporting long-term recovery compared to behavioral interventions alone. The National Institute on Drug Abuse supports the use of MAT as an integral part of an addiction treatment plan. According to their research:
- MAT is effective in decreasing overall opioid use and its associated harms, including overdose death, transmission of infectious diseases such as Hepatitis C, and illegal drug-related activity. When the city of Baltimore introduced an initiative to increase access to buprenorphine, overdose deaths in the city decreased by 37%.
- The use of MAT in pregnant women reduces the symptoms of neonatal abstinence syndrome, which occurs when a baby is born with a dependence on opioids.
- The use of MAT in treatment programs improves compliance to other protocol and follow-up. Patients who receive medications for their OUD are more likely to remain in treatment and receive holistic interventions that support a long term recovery. With increased comfort comes increased ability to develop compensatory mechanisms to manage their disorder and its possible triggers.
Facts and Myths About Medication Assisted Treatment
MAT has a large body of evidence supporting its use as a viable treatment option. Unfortunately, the public and even some clinicians continue to have misconceptions about the uses of MAT in the treatment of Opioid Use Disorder. These myths can work to keep people from utilizing MAT, when it could prove vital to their recovery process. For example:
- Some people and providers believe MAT is simply the act of substituting one addiction for another. In reality, MAT is only one aspect of a holistic treatment plan. Medications help manage the discomfort of withdrawal and PAWS, which allows the patient to focus on other aspects of recovery. Since some medications for OUD have potential for misuse, they must be administered in a supervised clinical setting (i.e., methadone).
- MAT is not, and never will be, popping a pill to cure an addiction. One essential aspect of MAT is the behavioral intervention, which allows people to explore and recognize the triggers for their addiction. Anyone in long-term recovery knows that a substance use disorder is not something that can be “cured;” rather, it is something that they work consciously on the rest of their lives.
- Despite popular opinion, medications for MAT do not pose much risk for diversion. They are heavily regulated and require extensive training to prescribe. The only formulation that does not require waiver training, Naltrexone, has very little potential for abuse, since using it in conjunction with opioids will send the person taking it into withdrawal.
The Use of MAT for Opioid Use Disorder
MAT can play a vital role in the treatment of OUD by reducing cravings and controlling long-term symptoms of withdrawal, including those for post acute withdrawal syndrome. When combined with other behavioral interventions, it can help a person with OUD sustain a long-term recovery.
Continuum Recovery Center provides intensive outpatient services, including MAT, for the treatment of opioid use disorder. Our protocols, which include psychosocial, evidence based mental health therapies, help individuals identify the many facets of their opioid use disorder to maintain sobriety.
About The Author
Geffen Liberman, staff therapist at Continuum Recovery Center, has been in the field for over 20 years, and has worked in every facet of substance abuse treatment. Using his own personal experience in recovery and the education he has learned while in the field, Geffen can relate and connect with clients in a way that promotes recovery, self-love and the desire for clients to achieve the best for themselves. Geffen is licensed in Arizona as a substance abuse counselor and has an IC&RC certification, as well as a life coaching certification.