Evidence for Group Medication-Assisted Treatment (MAT) Prescribing
Group MAT prescribing is not supported by current evidence in clinical guidelines, as the standard of care for opioid use disorder (OUD) treatment involves individualized medication management with either methadone or buprenorphine.
Current Standard of Care for MAT
The standard of care for treating perinatal opioid use disorder (OUD) includes medication-assisted treatment (MAT) with either methadone or buprenorphine administered on an individual basis 1. This approach is considered the gold standard for OUD treatment, focusing on:
- Suppressing symptoms of cravings and withdrawal
- Preventing illicit opioid use
- Increasing adherence to prenatal care
- Reducing infection associated with intravenous drug use
Evidence Gap for Group MAT Prescribing
The current clinical guidelines from the American Society of Addiction Medicine (ASAM) and the American College of Obstetricians and Gynecologists (ACOG) do not specifically address group MAT prescribing models 1. This represents a significant evidence gap in the literature.
What We Know About MAT Effectiveness
MAT has demonstrated effectiveness in:
- Reducing risk of overdose in incarcerated individuals 2
- Lowering rates of hepatitis C transmission 2
- Decreasing rates of re-incarceration 2
- Improving functional outcomes compared to no treatment, though evidence quality is low to very low 3, 4
Implementation Models in Primary Care
While group prescribing is not specifically addressed in guidelines, there is emerging research on expanding MAT delivery models:
- Primary care providers are well-positioned to provide MAT, particularly in rural settings 5
- Supplemental training programs beyond the standard DATA 2000 waiver training have shown promise in increasing provider confidence and willingness to implement MAT 6
Considerations for MAT Implementation
When implementing any MAT program, several key factors should be considered:
- Medication selection: Methadone, buprenorphine, or naltrexone based on individual patient needs 1
- Treatment setting: Outpatient treatment programs, primary care offices, or specialized addiction clinics 5
- Monitoring protocols: Regular visits and appropriate drug testing when medically indicated 1
- Addressing comorbidities: Treatment of concurrent mental health conditions and physical health issues 1
Potential Benefits of Group Models (Theoretical)
While not explicitly supported by current guidelines, potential benefits of group models might include:
- Increased access to care in resource-limited settings
- Peer support opportunities
- More efficient use of provider time
- Reduced stigma through shared experiences
Conclusion
The current evidence base does not specifically address or support group MAT prescribing models. The standard of care remains individualized medication management with either methadone or buprenorphine. Further research is needed to evaluate the safety, efficacy, and outcomes of group MAT prescribing approaches before they can be recommended for widespread implementation.