Medication-assisted treatment (MAT) is the use of medications in combination with behavioral counseling to treat substance use disorders. There are FDA-approved medications for the treatment of opioid use disorder, alcohol use disorder, and tobacco use disorder.
Opioid Use Disorder Medications
Medications used to treat opioid use disorders are considered the “gold standard” of treatment. They stabilize brain chemistry, reduce or block the euphoric effects of opioids (the “high”), and/or relieve cravings so that the patient can engage in other aspects of treatment such as counseling, family therapy, and peer-support programs.
Research has shown that patients treated with these medications remain in therapy longer than those who don’t and are less likely to use illicit drugs. In addition, MAT dramatically reduces the risk of overdose death as well as the transmission of infectious diseases, including HIV and hepatitis C.
Despite MAT’s demonstrated effectiveness, most patients don’t have access to it. This is due, in large part, to a widespread misunderstanding among practitioners and the general public about how MAT actually works as well as its proven effectiveness.
Methadone is an agonist medication — an opioid that binds to the same opioid receptors in the brain and body as other opioids. Its longer duration in the body prevent the dramatic cycles of withdrawal and escalation that are part of developing an addiction. Methadone for the treatment of opioid use disorder can be dispensed only through federally-regulated Opioid Treatment Programs (OTPs).
Buprenorphine is a partial agonist — it binds to the same receptors as methadone and other opioids, but produces a less intense effect. Buprenorphine can be dispensed by an OTP or prescribed by physicians, nurse practitioners, or physician assistants in an office-based setting if the prescriber has completed required training and obtained a waiver from the DEA. It can be administered in multiple ways:
- under the tongue like Subutex® (buprenorphine) or Suboxone® which is a combination of buprenorphine and naloxone,"
- as an implant (Probuphine®),
- or a long-acting injectable (Sublocade®).
Naltrexone is an antagonist — it prevents opioids from binding to opioid receptors in the brain and body. Patients do not develop a dependence on naltrexone and it cannot be misused. Physicians, nurse practitioners, and physician assistants can prescribe and administer Naltrexone without additional licensure or regulatory approval. A long-acting injectable naltrexone formulation is available under the brand name Vivitrol®.
Alcohol Use Disorder Medications
There are three FDA-approved medications to treat AUD, all of which are non-addictive.
Acamprosate (Campral®) supports patients in recovery from AUD by lessening some of the negative symptoms of extended abstinence, such as insomnia, anxiety, restlessness, and depression. It is a pill taken three times per day. It may be most effective for patients with severe addiction.
Disulfiram (Antabuse®) interferes with the body’s breakdown of alcohol and causes unpleasant symptoms when a person drinks, such as nausea, irregular heartbeat, and face flushing. It is taken as a pill.
Naltrexone reduces cravings for alcohol and rewards from drinking by blocking certain receptors in the brain. It is available as a pill taken daily or as a monthly injection.
Tobacco Use Disorder Medications
Nicotine replacement therapies have several forms, including the patch, nasal spray, gum, inhalers, and lozenges. These products are available over the counter.
Bupropion (Zyban®) helps reduce cravings and withdrawal symptoms. It is also approved for the treatment of depression.
Varenicline (Chantix®) blocks the effects of nicotine to help reduce cravings and withdrawal symptoms.