Medication-Assisted Treatment (MAT) for Opioid Use Disorder
Addiction to prescription opioids can be treated with medications including buprenorphine, methadone, and naltrexone. These drugs can prevent other opioids from affecting the brain (naltrexone) or relieve withdrawal symptoms and cravings (buprenorphine and methadone), helping the patient avoid returning to use.
There has been a popular misconception that methadone and buprenorphine replace one addiction with another. This is not the case. For people addicted to opioids, these drugs do not produce a high but simply prevent withdrawal and craving so that they can function in life and engage with treatment while balance is restored to brain circuits that have been affected by their disorder.
Medications for the treatment of opioid addiction are often administered in combination with psychosocial supports or behavioral treatments, known as medication-assisted treatment (MAT). A medication to reduce the physical symptoms of withdrawal (lofexidine) is also available.
Methadone
Methadone is a synthetic opioid agonist that prevents withdrawal symptoms and relieves drug cravings. It works by acting on the same mu-opioid receptors as other opioids such as heroin, morphine, and opioid pain medications but at lower intensity and for longer duration. Methadone has been used successfully for more than 40 years to treat heroin addiction but is generally only available through specially licensed opioid treatment programs.
Buprenorphine
Buprenorphine is a partial opioid agonist—it binds to the mu-opioid receptor but only partially activates it—and it is generally prescribed through an opioid treatment program but there are certain exceptions for certified providers to prescribe it in an office setting. Like methadone, it can reduce cravings and is well tolerated by patients. In 2016, the U.S. Food and Drug Administration (FDA) approved the NIDA-supported development of an implantable formulation of buprenorphine that provides 6 months of sustained medication delivery; and in 2017, a month-long injectable formulation was approved. These formulations eliminate the need for daily dosing and will give patients greater ease in treatment adherence, especially if they live far from their treatment provider.
Individuals can also receive buprenorphine by itself or in combination with naloxone (Suboxone®) to further prevent the effects of opioids; adding naloxone also discourages the misuse of buprenorphine.
Naltrexone
Naltrexone is another type of medication, an opioid antagonist that blocks the euphoric highs and sedative effects of opioids as well as reducing cravings. An injectable, long-acting form of naltrexone (Vivitrol®) can be a useful treatment choice for patients who do not have ready access to health care or who struggle with taking their medications regularly. Naltrexone can be prescribed outside of an OTP; any provider with the ability to prescribe medication can prescribe naltrexone.
Growing Research on Medication for Opioid Use Disorder
Recent work has shown that buprenorphine maintenance treatment is more effective than tapering patients off of buprenorphine. Also, starting buprenorphine treatment when a patient is admitted to the emergency department, such as for an overdose, is a more effective way to engage a patient in treatment than referral or brief intervention. Finally, data have shown that treatment with methadone, buprenorphine, or naltrexone for incarcerated individuals improves post-release outcomes.
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