The Ongoing, Complex Question of Medication Assisted Treatment

MAT: The use of MAT in treating opioid addiction is exploding — and controversial. A few facts… 

I’ve been fielding many questions regarding MAT lately…
…and it’s a topic that, despite the scientific evidence, is charged with opinion, emotion, and stigma. But the results are clear and undisputable: the use of medications in combination with counseling and support therapies can help many – but not all – addicts sustain recovery.
Agonists and antagonists:

A better understanding of MAT.
Today, MAT for opiate addiction employs drugs that either work as opioid agonists (methadone and buprenorphine) which produce the effect of an opioid in some capacity to ease cravings, or antagonists (naltrexone) which block the effect of the opioid completely. Because they do not mimic the effects of opioids, antagonists lack the potential for abuse.

Some facts on MAT
There are encouraging results from a number of studies, including The Prescription Opioid Addiction Treatment Study by the Cochrane Collaboration, entitled Methadone Maintenance Therapy versus No Opioid Replacement therapy for opioid dependence, which found in a long-term study that of the 300 patients participating (all began the study addicted to opioid pain relievers), 51.2% reported no use of the drug at the 18 month mark. See the details of the study here: http://researchonline.lshtm.ac.uk/5044/

One further note from this report. Patients who used the opioid agonist therapy were more likey to report abstinence than non-MAT patients.

Dr. Nora Volkow, the director of the National Institute on Drug Abuse stated in late 2017, “I don’t think that there’s any areas where the data is shaky. It clearly shows better outcomes with medication-assisted therapy than without it. Studies have shown that outcomes are much better when you are on medication-assisted therapy. For one, it decreases risk of relapse — significantly. Second, MAT has also been shown to be effective in preventing infectious diseases like HIV. Third, medication-assisted therapy has been shown to be effective in preventing overdoses.” The World Health Organization, back in 2016 declared buprenorphine and methadone to be “essential medicines.”

Medicaid unit payments for medication assisted treatment for addiction disorder increased by 183% between 2011 and 2017, with 26 states covering MAT for opioid addiction. And while MAT is being utilized more often, we’d all like to understand the full impact of MAT, and its long-term success or failure.

Is MAT trading “a drug for a drug?”
JAMA reports that “Patients who initiate MAT in the Emergency Department are more than twice as likely to remain engaged in treatment compared to patients referred for treatment.” Further, a recent study found treatment with extended-release naltrexone reduced relapse rates among criminal justice involved adults with a history of opioid dependence.

FACT: MAT decreases opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission. After buprenorphine became available in Baltimore, heroin overdose deaths decreased by 37 percent during the study period, which ended in 2009.

FACT: MAT Increases social functioning and retention in treatment. Patients treated with medication were more likely to remain in therapy compared to patients receiving treatment that did not include medication.

FACT: Treatment of opioid-dependent pregnant women with methadone or buprenorphine improves outcomes for their babies; MAT reduces symptoms of neonatal abstinence syndrome and length of hospital stay.

Statistics show that less than half of privately funded treatment programs offer any form of MAT. That number falls to 23% for publicly funded programs. According to the 2013 National Survey on Drug Use and Health, of the 2.5 million opioid-dependent or opioid abusing Americans, fewer than 1 million received MAT. There’s more work to be done; the federal government puts a cap on the number of patients to whom doctors are allowed to prescribe MAT.

In addition, many providers are unwilling to provide MAT, citing their opposition to the treatment method, while some patients simply lack access to MAT. Today, many providers consider MAT a treatment method of “last resort.” Yes, there is opposition, and it may be warranted. And more data must be collected and evaluated as the various studies continue.

In an effort to help…
KipuEMR currently supports OTP programs administering Suboxone, Vivitrol, and other antagonists within its robust medication management platform. We are currently in development of a new module for MAT facilities offering liquid Methadone, along with all the workflow tools to manage in-clinic and take-out dosing schedules. The new module will combine Kipu’s signature ease-of-use in medication administration and management, with our best in class clinical documentation and assessment tools. If you would like to become a part of our BETA program and contribute to this exciting new module, please contact us at 561.349.5901.