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Under-utilization of MAT in opioid addiction treatment

by Ash Arjan

There is an old saying that goes, “use the correct tool for the job”.  While that may often refer to automotive repairs or woodworking or some other “hands on” task, the same advice can be applied to most other aspects of life, whether that be computer software, verbal negotiation or the treatment of opioid addiction.

Now, what if the correct tool was available, yet you were told to use an inferior, or worse, incorrect tool for the job? This is a situation often faced by those seeking addiction treatment.  Whether due to personal prejudice, lack of knowledge or substandard training, many agencies either fail to utilize, or underutilize one of the most effective tools in the addiction treatment toolbox, that of medication-assisted treatment, often referred to as MAT.

Currently, less than half, only about forty two percent, of the nearly 15,000 treatment facilities throughout the country, offer any type of MAT program.  Of those, only about 3% utilize the three medications used in MAT treatment; methadone, buprenorphine, and naltrexone. The question that must be asked is, why. Why would a center dedicated to improving the lives of its patients elect not to utilize such a useful, and effective tool? Why would judicial systems, jails and prisons or other agencies still resist adoption of a proven treatment method?

Addiction treatment was born somewhat as an extension of treatment for alcoholism, in the late 1800’s and early 1900’s, as doctors began to see chronic “drunkenness” as a disease rather than a social misbehavior. In 1879, Dr. Leslie Keeley started the first for-profit centers for the treatment of alcoholism and shortly thereafter, in the 1880’s, cocaine became a recommended treatment for both alcohol and morphine addiction, recommended by psychiatrists like Sigmund Freud.

Moving forward to the late 1940’s and early 50’s, Narcotics Anonymous was born. Using the 12-Step model developed by its predecessor, Alcoholics Anonymous, NA focused on addiction recovery.  Over the next several decades, the science of addiction treatment continued to evolve and mature. Unfortunately, much of the development of treatment regimens focus on behavior modification rather than on the physical dependency aspect, and almost all are abstinence-based in nature.  Many treatment programs of this time were modeled after The Synanon Movement, a program popularized in the early 70’ that utilized a non-pharmaceutical, tough-love approach.  Members were “detoxed” cold turkey and treated harshly during their time in the program with loud, confrontational group therapies.

With the limited success of these programs, and the growing issue with narcotics and other drugs other than alcohol, medical professionals began to use medication as a tool to help addicts deal with their cravings. In the mid-60’s, Methadone, an analgesic pain reliever, was found to be useful in the treatment of heroin addiction. By the spring of 1971, MAT (medication-assisted treatment), using Methadone, began to grow.

Doctors use one of the three FDA-approved medications to help those with opioid addiction reduce or eliminate withdrawal symptoms, or block the effects of drugs so when taken, often times both are achieved.  Both are useful in a treatment program designed to address the mental and physical aspects of addiction so that counseling can be used to address the causes and consequences of addiction.

As the use of MAT increases, arguments against its use are becoming less and less valid.  Early critics of MAT argued that this was only substituting one drug for another, to which Dr. Stuart Gitlow, former president of the American Society of Addiction Medicine replies, “the drug that we’re replacing is a dangerous one that will kill you, and we’re replacing it with a drug that allows you to go back to work, have money in your pocket, and allows you to live normally again.”

Others have stated that MAT is not right for every person.  Data, however, indicates that MAT is generally effective for a majority of the general population, although it will not be equally effective for every individual. The science behind MAT is substantial, with documented proof of better outcomes, decreased risk of relapse, more useful in preventing the spread of infectious disease such as HIV, and greater effectiveness in the prevention of overdose.

With a solid body of evidence pointing toward medication assisted treatment as the right tool for the job, there is little reason to accept an “old school” approach to achieving long-term success in the battle to overcome opioid addiction.

Learn More About MAT

Health Care Resource Centers offer counseling, information, and treatment for opioid misuse disorder. To find out more about MAT or recovery from opioid dependence, please contact us today.

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