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Medication-assisted treatment (MAT) can be a beneficial intervention in substance use disorder treatment to help with withdrawal symptoms, cravings, and relapse prevention. It is an effective and commonly used treatment for opioid use disorder. Different medications can have different benefits and side effects, and they should always be used as part of an individualized treatment plan.
- Medication-assisted treatment (MAT) is a common substance use disorder intervention to reduce withdrawal symptoms and relapse risk.
- MAT is used in opioid use disorder treatment, and it includes buprenorphine, methadone, and naltrexone.
- There are some risks and side effects associated with MAT options, although the benefits of treatment often outweigh the risks of the medication or of not utilizing treatment at all.
Understanding medication-assisted treatment (MAT)
Medication-assisted treatment (MAT) is the use of approved medications alongside other evidence-based interventions to treat substance use disorders. MAT can be used in various stages of addiction treatment, including in the stages of withdrawal, initial treatment, and long-term maintenance. [1]
MAT is used on a case-by-case basis and as part of a comprehensive, individualized treatment plan.
Conditions treated by MAT
While MAT can be used to treat opioid use disorder (OUD), alcohol use disorder (AUD), and sometimes other substance use disorders, MAT is most commonly used to treat OUD. [2][3]
FDA-approved medications
MAT for OUD includes: [3]
- Buprenorphine
- Methadone
- Naltrexone
MAT for AUD includes: [2]
- Naltrexone
- Acamprosate
- Disulfiram
The major benefits of medication-assisted treatment
Medication-assisted treatment (MAT) can provide several benefits for people with opioid use disorder (OUD), from reducing cravings and withdrawal symptoms to supporting long-term recovery. Research has also linked MAT with improved treatment retention, quality of life, and survival outcomes.
Reduce opioid use and relapse risk
MAT can help people remain abstinent from opioids. One study indicates that buprenorphine and methadone can help up to 60% of those utilizing the medication remain opioid free, compared to 20% who are not using a treatment. [3]
Reduce cravings and withdrawal symptoms
Buprenorphine, methadone, and naltrexone can reduce opioid cravings, helping people to maintain abstinence and recovery. Buprenorphine and methadone work by activating mu-opioid receptors, like other opioids, but the two agents work differently. Buprenorphine is a partial mu agonist and can be self-administered in many cases. In contrast, methadone is a full opioid agonist and must be administered in a certified outpatient treatment program. As opioid agonists, both agents can prevent the onset of opioid cravings without creating the same euphoric “high”. [4]
These medications require specific timelines for administration, which vary in their impact on withdrawal symptoms. Methadone can be commenced at any time and will be titrated slowly to reach a therapeutic dose. Because of this, it can be used early to reduce withdrawal symptoms. [1]
Buprenorphine can also be used to manage withdrawal symptoms, but it should be started once moderate withdrawal has begun. Naltrexone can only be commenced after 7–14 days of no opioid use, as it can precipitate severe withdrawal symptoms. [1]
Reduce the risk of mortality overall
The risk of death among those with OUD can be associated with various issues, including contaminants in the drug supply, overdose, and drug-related health issues. Research shows a significantly reduced risk of mortality among people with OUD using MAT compared to those not using these medications. [5]
Improve quality of life
Treatment involving a MAT medication can support abstinence from opioids, which can assist in repairing aspects of life that have been affected by addiction. MATs help stabilize physical and mental well-being, allowing the individual to engage in psychosocial interventions that can lead to improvements in general well-being, employment, housing, and relationships. [6]
Improve treatment retention
It is common among SUD treatments for people to struggle with adherence and retention, often for a range of reasons. MATs can improve treatment retention, helping people to maintain their recovery with consistent engagement in interventions. [1]
Potential side effects and risks of MAT
Like any medication, there can be some side effects and risks associated with different MATs. Typically, these will be mild, manageable, and less severe than the risks associated with opioid misuse and illicit opioid use. The prescribing doctor should monitor for side effects during treatment and provide any interventions required. [7][8]
Common side effects across MAT medications
Serious but less common risks
In some cases, serious effects can occur. In the event of the following, consult the prescribing doctor immediately, as intervention or treatment changes may be required: [7]
- Rash, hives, or other signs of allergic reactions.
- Low blood pressure.
- Severe withdrawal symptoms.
The following risks can occur with the use of MAT and may warrant treatment discontinuation or MAT avoidance:
- Existing liver disease or elevated liver enzymes.
- History of cardiac conditions.
- History of overdose while taking MAT or after stopping MAT. [5]
Dependence and physical adaptation
The MATs for OUD are still opioids, which means that physical dependence can occur with prolonged use. However, these medications are used to treat opioid addiction by replacing the dangerous substance with a safer substance, used under careful monitoring and in therapeutic doses. When treatments are stopped, the dose will be gradually reduced to help prevent or reduce withdrawal. [7][8]
Risk of diversion and misuse
MAT medications are sometimes misused and diverted. However, the reasons for this are not always related to a desire to achieve a “high”; other intentions are to self-medicate when treatment services or medications can’t be accessed due to availability, costs, or other barriers. [9]
Medication interactions
MAT medications can interact with other medications and substances. In particular, because they act as central nervous system (CNS) depressants, the use of MATs alongside any other CNS depressant can cause dangerous sedation, respiratory depression, and cardiac risks. People using MATs should discuss the safety of using concurrent medications with the prescribing doctor beforehand. [7][8]
Pros and cons comparison: Buprenorphine vs. Methadone vs. Naltrexone
| Buprenorphine | Methadone | Naltrexone | |
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| Pros |
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| Cons |
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Managing MAT side effects
Common MAT side effects, such as nausea, dry mouth, or constipation, can be managed easily at home. For example, medications can be taken with food to reduce nausea. Regular hydration throughout the day, light exercise, and a consistent sleep schedule can help with various side effects.
Serious side effects
Serious side effects might require professional intervention and careful monitoring. For example, individuals who have a history of heart conditions should be aware of concerning signs to look out for and should engage in regular reviews with a clinician to ensure their heart health. People with physical health conditions might also require a reduced dosage or a more gradual titration.
Overdose risk
If someone has been on MAT for some time or frequently stops and starts MAT, they may experience an increased risk of overdose if they use illicit opioids. Sometimes, people return to opioid use after MAT and use the same dose that they would have previously used. If their tolerance has reduced, this could cause a dangerous or fatal overdose. [5]
The safest way to avoid this is to not return to illicit opioid use and maintain MAT. However, should an individual relapse, they should be aware of this risk and select a dose accordingly.
Recovered does not advise using illicit drugs.
Discontinuation
When discontinuing MAT, a gradual dose reduction is recommended to reduce the risk of withdrawal symptoms. This can be safely managed by the prescribing doctor over several months.
Addressing misconceptions, stigma, and costs
Misconceptions can prevent people from wanting to utilize MAT. This might include the belief that MATs are as bad as other drugs, that using them is just replacing one substance with another, or that their use cannot be considered part of recovery.
However, MATs do not create the same euphoric “high” and are used to help prevent or reduce drug use, withdrawal symptoms, and cravings. They help the individual to start and maintain recovery, and they allow them to focus on the various aspects of their lives that have been affected by addiction. [4][10]
Similarly, stigma and discrimination can be a barrier to treatment. It can be helpful to engage in group support and peer-led services that include others in recovery who can share their experiences and advice. [10]
Financial costs of MAT can also prevent people from receiving this support. However, MATs are often included in medical insurance programs and might be accessible through state-funded programs in certain areas. It is also worth noting that the cost of MAT is likely to be significantly lower than the cost of funding daily, chronic drug use and its consequences.
Who should consider MAT?
MAT should be considered by anyone with a current substance addiction, particularly opioid use disorder. Deciding which type of MAT to use will be discussed and considered on a case-by-case basis, depending on individual circumstances and motivations for treatment.
Weighing the pros and cons of MAT
MAT can be a highly beneficial intervention for initial or long-term substance use disorder treatment. People who are motivated to reduce and stop substance use and are committed to recovery can benefit from MAT.
However, people who are not willing to engage in a comprehensive treatment plan might be more likely to experience risks and side effects of MAT for reasons like poor or sporadic medication adherence and increased risks of overdose. It is important to consider these factors and to weigh them against the risks of not engaging in any treatment.
Conclusion
People with SUDs, particularly OUD, can utilize medications to support their withdrawal and long-term abstinence from substances. MAT can provide many benefits, particularly when it is used as prescribed, carefully monitored, and as part of a comprehensive treatment plan.
However, there are risks associated with MAT, and some individuals may experience a higher risk than others. People considering this type of treatment should discuss the available options with a medical professional or substance use disorder specialist.
