We’ve spent a lot of time on medically-assisted treatments for opioid addiction. We’ve debunked some of the assumptions about MAT, and we’ve examined some of the science which supports the idea that MAT is gold-standard opioid treatment. Do you feel MAT-literate yet?
You see, we wanted to take it one step further and break down the different medications used in medically-assisted treatment. Tomorrow we’ll have an article about who might benefit most from these medications in a broader context. But for today, here’s our breakdown of how the three most-popular MAT medications work.
First: A Refresher on Opioids
Opioids are natural or synthetic chemicals that interact with nerve cell receptors to reduce feelings of pain. This class of drugs includes prescription painkillers, synthetic opioids and heroin. Doctors usually provide prescription opioids to treat acute pain (in injury or post-surgery recovery), chronic pain, active-phase cancer treatment, palliative care, and end-of-life care. Many people rely on prescription opioids under medical supervision to help manage their conditions. But others can keep needing prescription opioids after their treatment ends, and so they become dependent on the drugs’ euphoric feeling (the “high”).
This trend of opioid misuse, along with heroin availability, has led to an opioid crisis in the United States. Psychiatry.org reported that in 2017, more than 72,000 Americans died from drug overdoses, including illicit drugs and prescription opioids, a two-fold increase in a decade. The Centers for Disease Control and Prevention reported that synthetic opioid-related deaths (primarily from fentanyl and fentanyl analog drugs) increased the most that year, with 30,000 overdose deaths.
The harm of the opioid crisis is part of why so much time and research has gone into medication-assisted treatments. First up on the list of the three medications approved for treating opioid use: methadone.
Methadone is a long-acting opioid medication that reduces cravings and eases withdrawal symptoms. Many consider it a highly-effective treatment for opioid addiction. Opioid treatment patients usually receive methadone orally or in liquid form in single, daily doses.
Methadone works to block the intense euphoric effects of heroin and other short-acting opioids. It also calms withdrawal symptoms, reduces drug cravings and has “leveling effect” that lessens both highs and lows. All these effects enable people to carry on everyday tasks – such as going to work, driving and maintaining relationships. Accordingly, the medication is particularly effective for people with extensive histories of opioid use.
By law, methadone can only be dispensed at certified opioid treatment programs. This regulation demands daily access to a treatment facility for those taking methadone. Despite methadone’s efficacy, patients with pre-existing heart conditions or a history of heart disease should consult their physician before taking methadone, because it can cause or worsen heart problems. Side effects include constipation, impotence, swelling, and sweating.
Next up is buprenorphine, a popular alternative to methadone. It is also taken daily, when patients usually dissolve it under the tongue in tablet or film-form. The difference between buprenorphine and methadone is that, for certain patients, buprenorphine can be taken at home or in doctors’ offices – which eliminates the need for daily trips to a treatment facility. However, with at-home treatment programs, there’s also an elevated risk for abuse of at-home treatment regimes. Because of this risk, patients must get approval from their physicians and counselors before taking the medication outside of a treatment facility.
Buprenorphine works similarly to methadone, as it helps to block craving and reduce withdrawal symptoms.
Risk of overdose is overall lower with buprenorphine than with methadone, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). However, there’s still the risk that high dosages may stop a person’s breathing. There’s also a high risk of overdose when combined with benzodiazepines such as Valium, Ativan or Xanax. Most people taking buprenorphine can experience side effects including nausea, headaches and constipation.
Last up? Naltrexone, the medication which blocks the nerve receptors targeted by opioids, reducing cravings and helping people stop using. However, it doesn’t relieve withdrawal symptoms (it’s not a lesser opioid like methadone and buprenorphine). People usually start naltrexone seven to ten days after stopping opioid use, when withdrawal symptoms have passed.
Naltrexone is available in tablet form for daily doses, and also in extended-release injectable form administered every 30 days. The extended-release form of naltrexone has been proven the most effective of the two forms for addiction treatment, and it appeals to people who can detox from opioids but don’t want to go through withdrawal when they stop MAT. It is also a desirable option for people who have a hard time taking pills or making frequent appointments, along with those being treated for alcohol addiction.
Naltrexone best suits patients who can fully detox from their opioid use before they start the medication. There is a high overdose risk if people use opioids to override its blocking effects. The higher risk happens because patients’ tolerance has decreased (due to naltrexone use) over the detox period. Many people experience fewer side effects with Naltrexone than with other MAT medications; however, they may feel soreness where they are injected. Other people can experience nausea, diarrhea or difficulty sleeping.
Keep learning about opioid addiction treatments. You can do that by going to SAMHSA and the other sources below, or by visiting In The Rooms today. We have more opioid content, along with online recovery meetings when you sign up for free!
“Drug Overdose Deaths” – Center for Disease Control and Prevention
“Methadone” – SAMHSA
“Buprenorphine” – SAMHSA
“What is Buprenorphine?” – Buprenorphine Doctors
“Naltrexone” – SAMHSA
“Opioid Use Disorder” – American Psychiatric Association
“Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings” – Agency for Healthcare Research and Quality