What is Medication Assisted Treatment (MAT)?

From the Guidelines

Medication-assisted treatment (MAT) is the recommended approach for treating opioid use disorder, combining medications with counseling and behavioral therapies. The primary medications used in MAT include methadone, buprenorphine (often as Suboxone which includes naloxone), and naltrexone (available as monthly injectable Vivitrol) 1. For optimal outcomes, patients should remain on MAT for at least 12 months, though many benefit from longer or indefinite treatment. Methadone requires daily dosing at specialized clinics starting at 20-30mg and typically stabilizing between 80-120mg daily. Buprenorphine can be prescribed in office-based settings, usually starting at 2-4mg and increasing to a maintenance dose of 16-24mg daily. Injectable naltrexone (380mg) is administered monthly after a 7-10 day opioid-free period.

Key Considerations

• MAT works by reducing withdrawal symptoms and cravings while blocking the euphoric effects of opioids, significantly decreasing overdose risk and improving treatment retention 1.
• The combination of medication with counseling addresses both the physical dependence and psychological aspects of addiction, making MAT substantially more effective than either approach alone or abstinence-based treatments for opioid use disorder.
• Clinicians should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder 1.
• Oral or long-acting injectable naltrexone can also be used in nonpregnant adults, particularly for highly motivated persons 1.

Barriers to Treatment

• Treatment need in a community is often not met by capacity to provide buprenorphine or methadone maintenance therapy 1.
• Patient cost can be a barrier to buprenorphine treatment because insurance coverage of buprenorphine for opioid use disorder is often limited 1.
• Policymakers should evaluate and consider lifting restrictions on office-based distribution of methadone and address the barriers that contribute to underutilization of medication-assisted therapy within the criminal justice setting 1.

Recommendations

• Clinicians should prioritize MAT as the first-line treatment for opioid use disorder, given its effectiveness in reducing morbidity, mortality, and improving quality of life 1.
• Clinicians should work together to ensure sufficient treatment capacity for opioid use disorder at the practice level and identify treatment resources for opioid use disorder in the community 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Medication-Assisted Treatment (MAT) for Opioid Use Disorder

• MAT is a highly effective treatment for opioid use disorder, with medications such as methadone, buprenorphine, and naltrexone showing significant efficacy in reducing opioid use and cravings 2, 3, 4.
• Methadone and buprenorphine are opioid agonists that reduce mortality, opioid use, and HIV and hepatitis C virus transmission while increasing treatment retention 2, 3.
• Naltrexone is an opioid antagonist that can reduce opioid use and craving, but its effectiveness is limited by poor adherence and increased mortality rates 4.
• The choice of medication depends on patient preference, local availability of opioid treatment programs, anticipated effectiveness, and adverse effects 2.

Effectiveness of MAT

• Studies have shown that MAT can double the rates of opioid-abstinence outcomes in randomized, controlled trials comparing psychosocial treatment of opioid use disorder with medication versus with placebo or no medication 4.
• Methadone maintenance remains the gold standard of care, but combined buprenorphine/naloxone and buprenorphine monotherapy also demonstrate significant efficacy and favorable safety and tolerability 4.
• Extended-release naltrexone has shown promise in reducing opioid use and craving, but more research is needed to fully understand its effectiveness 4, 5.

Barriers to MAT

• Lack of access to MAT is a significant barrier, particularly in rural settings 6.
• Stigma surrounding opioid use disorder and MAT can also limit access to treatment 6.
• The COVID-19 pandemic has led to changes in the way MAT care is managed, with a need for novel point-of-care approaches to obtain care 6.

Future Directions

• Increasing the availability of MAT treatment is crucial to combating the opioid epidemic 6.
• More research is needed to guide future efforts in expanding the role of MAT in primary care settings and to develop new therapeutic options for OUD 6, 5.
• Recent advances in therapeutic options for OUD, such as office-based methadone maintenance and implantable and monthly injectable buprenorphine, show promise in the fight against this ongoing health crisis 5.