Medications for Addiction Treatment (MAT)

Experts consider medications to be the gold standard of care for addiction.

FDA-approved medications can be used to treat addiction to alcohol, tobacco, and opioids—and they’re especially effective at treating opioid use disorders. Research shows that addiction medications are clinically proven to help prevent overdoses as well as the recurrence of symptoms (also known as relapse), while substantially increasing the odds of successful, long-term recovery.

Medications prevent overdoses and support long-term recovery.

Overall, the use of medications reduces the death rate among addicted populations by 50% or more. Many countries, including France and Russia, have made medications widely accessible with impressive results. 

MAT is endorsed by the FDA, World Health Organization, the Substance Abuse and Mental Health Services Administration, the Surgeon General, the American Medical Association, the American Association of Family Physicians, and many more experts.

The use of medications should be one part of a customized, comprehensive addiction treatment plan. Other elements of the treatment plan may include individual and group psychotherapy, the support of family and other loved ones, peer services (such as mutual aid or support groups), community services (such as housing, education, employment, and family support), and more. Treatment plans should always be respectful of the patient, taking their unique needs and circumstances into account. Patient-centered treatment approaches have proven very successful.

Addiction changes the brain. Medications can help.

To understand the importance of medications for opioid addiction, it’s good to have a basic knowledge of how opioids affect the brain. Opioids such as oxycodone, heroin, fentanyl, Percocet, and Vicodin attach to certain receptors in the brain, igniting neurotransmitters and sending signals that block pain, slow breathing, and promote a feeling of calm. 

When misused, opioids flood the brain with dopamine—the “feel-good” chemical that sends the brain feedback about rewards—creating a feeling of euphoria. Our brains are naturally wired to repeat behaviors associated with pleasure or reward. When that reward system is over-stimulated by the effects of opioids, the brain remembers that behavior and records it as something that should be repeated.

When misuse leads to addiction, a person continues to use these drugs despite negative consequences in their lives. 

Recovering from addiction requires more than just individual willpower.

It's important to seek a licensed practitioner to determine what the best treatment plan is in each case because each patient is unique.

There are several different types of medications.

Naltrexone (Vivitrol or ReVia), buprenorphine (Suboxone), and methadone are three effective, FDA-approved medications used to help treat opioid use disorder. 

Buprenorphine

Buprenorphine is a partial opioid agonist that replaces opioids in a patient’s system and blocks the effects of any additional opioids taken.

• What it does: Taken orally once daily, or via sustained-release forms like an implant or injection, buprenorphine reduces cravings and withdrawal symptoms.
• Pros and cons: It’s available by prescription, eliminating the need to go to an authorized clinic every day. But finding a provider who is licensed to prescribe buprenorphine can be challenging.
• Where to find: Via prescription from certified clinicians at ERs, general practice offices, and treatment clinics. Prescriptions can be filled at the pharmacy.

Naltrexone

Naltrexone is an opioid antagonist that binds to receptors in the brain in order to fully block the effects of opioids.

• What it does: Taken orally or via a monthly sustained-release injection, naltrexone reduces cravings and blocks the effects of opioids.
• Pros and cons: It does not require daily visit to authorized clinic. But, patients must be completely substance-free for 7 days prior to beginning naltrexone treatment.
• Where to find: Via prescription from certified clinicians at ERs, general practice offices, and treatment clinics. Prescriptions can be filled at the pharmacy.

Methadone

Methadone is an opioid agonist that bonds tightly to the body’s opioid receptors. It has the most long-lasting therapeutic effects.

• What it does: Taken orally once daily, methadone reduces cravings and withdrawal symptoms. It’s most often used for patients who have a more severe opioid addiction.
• Pros and cons: It’s highly effective. But using methadone requires the most hoop-jumping: patients must report to a methadone clinic every day to receive their medication.
• Where to find it: Authorized methadone treatment clinics.

Sources: New England Journal of Medicine + US Department of Health and Human Services

Every patient’s needs are different. 

While buprenorphine and naltrexone are very convenient and eliminate the need for daily dosing at a clinic, methadone is highly effective for many patients. Working closely with a coordinated care team, including family, friends, counselors, and clinicians to identify the best strategy will help ensure the chances of successful treatment and recovery.

MAT can be hard to get. There are 3 main hurdles.

#1: Stigma

From doctors to family members to recovery coaches, many Americans think of addiction medications as a crutch, a cop-out, or a way for people with addiction to continue using drugs.

It's not "replacing one drug with another." It's a lifesaving medication.

These misconceptions couldn’t be farther from the truth. The use of medications to treat addiction is not "replacing one drug with another." When used as directed, addiction medications do not trigger euphoria or have dangerous adverse effects.

In fact, these medications are designed to make it possible for patients to be productive, to become healthier, to secure employment, or to return to work or school. Having a happy, productive life is exactly what long-term recovery is all about.

#2: Training, authorization, and coordinated care

Even though most physicians in America can prescribe powerful and dangerous opioid painkillers with few restrictions, doctors must become specially certified in order to prescribe addiction medications.

There are many restrictions on where medications can be offered and who can administer them. And due to these restrictions, many clinicians and facilities have limited capacity for the number of patients they can accept at one time. In many communities, only some medications are available, which limits patients’ options.

Doctors and patients have to jump through countless administrative hoops.

Some clinicians refuse to administer medications—even when they are authorized to do so—because of personal beliefs, the lack of coordinated care with mental health professionals (especially in rural communities), the additional time commitment required, and the potential threat of raids by the Drug Enforcement Administration and the FBI.

What’s more, it’s hard to access medications even within traditional addiction treatment centers. Few inpatient treatment facilities offer all three FDA-approved medications for opioid use disorder. While the American Society of Addiction Medicine (ASAM) has defined detailed standards of care, there is no established national accreditation program for treatment facilities in the U.S.

Medicaid and CHIP Payment Access Commission has also detailed key obstacles to patient access, including finding prescribers who take Medicaid as payment for treating opioid use disorder, Medicaid drug formularies that only offer some of the medications, and time limits on MAT treatment.

#3: Insurance coverage for substance use disorders

Insurance coverage for addiction treatment varies by plan and by state. While the Affordable Care Act requires most insurance providers to cover addiction treatment, not all plans cover all three FDA-approved medications. Some limit the number of doses and prescription refills for MAT patients. 

Dose limits, high costs, and other restrictions limit access.

Many insurance companies limit what they cover. For example, some patients must pay out of pocket to see a psychiatrist and get prescriptions for their addiction medications. Each visit can cost upwards of $400.  

Substance use disorders are chronic, often lifelong medical conditions. In spite of this, some insurance companies restrict how long they will cover MAT, as well as any other care that patients need to support their ongoing recovery. The Mental Health Parity and Addictions Equity Act requires health insurance providers and group health plans to cover behavioral health just as they do any other medical conditions. Still, finding medical and behavioral health clinicians certified to prescribe is an obstacle to comprehensive treatment for substance use disorders. 

You can be your own best advocate.

Seeking addiction treatment can be overwhelming. Here are some important questions to ask treatment providers:

About MAT

• How do you define Opioid Use Disorder (OUD) medically? Do you agree it is a chronic condition?
• Do you specialize in OUD? How do you treat it? For how many years have you offered OUD treatment?
• Do you offer MAT? If so, which medications do you offer? In what forms do you administer them? How long does it take to get access to these medications?
• Do you offer ongoing medication treatment, even beyond an initial “detox” period?
• Are all your clinicians authorized to prescribe and qualified to monitor the effectiveness of MAT medications?
• How do you decide on an individualized MAT strategy for each patient? What steps do you take if a MAT strategy isn’t working for a patient?

About treatment

• How many days is your inpatient treatment program? What will my first days be like? What is the daily routine?
• What sorts of activities do you offer here?  
• How many patients are treated here at one time?
• Are there current and/or former patients willing to talk about their experiences here?
• What are your policies for phone use and visitors?
• Are there any safety or security issues? If so, how were they resolved?

About coordinated care and family involvement

• Who would be on my care team? I would like to have a psychiatrist, a licensed therapist credentialed in behavioral health and life coach as part of my care team. Would it be possible to interview members of the care team before making my decision?
• Are family members and other loved ones part of the treatment program? If so, how?
• Is there a patient advocate I can work with, a point person I can check in with and someone my family can stay in touch with?

About insurance and after care

• What insurance do you take? Do you have an insurance specialist I can work with to go over my policy with them to see just what my policy covers at your facility?
• What outpatient and/or referral programs do you offer once inpatient treatment is complete? Can I continue to work with the counselors I worked with here after I leave? If not, can someone on your clinical care team help me put together a coordinated care team with MAT experience before I check out?
• How do you help me manage my care after I check out?

Advocating for access to addiction medications

Want to advocate for access to addiction medications in your community? Nervous about having a conversation about medications with your doctor? Here are some helpful resources.

• Challenging the Myths, a one-page PDF from the National Council on Behavioral Health
• MAT Support Organizations, a list of nonprofits and government agencies from SAMHSA
• Advancing Access to Addiction Medications, a comprehensive guide from The American Society of Addiction Medicine
• MAT Saves Lives presentation, produced by the National Academies of Science Engineering and Medicine.
• Shatterproof’s Action Center, which features several petitions and advocacy campaigns. Take action now to join the movement!