Medication Assisted Treatment (MAT) for Opiate Addiction
Medication-assisted treatment (MAT) for opiate addiction should involve more than just taking medicine. For MAT to be most effective, counseling and family/social support is recommended.
As the Substance Abuse and Mental Health Services Administration (SAMSHA) put it:
MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful. [1]
Both counseling and family/social support contribute to a “whole patient approach,” so when considering MAT, obtaining appropriate counseling and accessing family/social support should be part of the focus.
Drugs approved for treating opiate addiction include: methadone; naltrexone; naloxone; and buprenorphine.
As with all prescription medications, these drugs should never be taken or discontinued without the supervision of a doctor!
Methadone has been used as an opiate-maintenance therapy since the 1960s. Patients take daily doses (usually at a clinic so doses are consistent and to prevent abuse) which quells their cravings for opiates like heroin, vicodin and oxycontin.
Methadone is what’s called an “opiate agonist.” It binds with and activates the opioid receptors in the brain, like heroin would. However, methadone is metabolized differently than heroin, making it longer-lasting. While many heroin addicts need multiple doses per day, methadone can last 24-36 hours. At the proper dose (which can vary from person to person) methadone stimulates the opioid system enough to prevent withdrawal but not enough to produce a high.
Naltrexone is sold under the brand names Revia (in pill form) and Vivitrol (a once-a-month injectable). Naltrexone is an “opioid antaganoist.” It occupies, but doesn’t stimulate, opioid receptors. By preventing opiates from binding with their receptors, naltrexone blocks their ability to produce a high. Unlike methadone and buprenorphine, however, naltrexone does not block cravings, which limits its usefulness.
Naltrexone is prescribed only when someone has completed opiate withdrawal; 7-10 days after last use of an opiate. Using naltrexone while still under the influence of alcohol or opiates can INTENSIFY withdrawal (so don’t do it!).
Naltrexone is usually taken for 12-weeks. It’s also approved for treatment of alcoholism. (Alcohol also stimulates the opioid system.)
Naloxone is is sold under the brand name Narcan. It’s used as an emergency treatment to counteract opiate overdoses.
Naloxone, is an “opiate antagonist,” like naltrexone. It occupies opioid receptors without stimulating them. However, naloxone is a much stronger binder to opiate receptors than opiates are; naloxone actually “ejects” opiates from the receptors so it can bind, making it an effective antidote to heroin and other opiate overdoses.
Buprenorphine (“bupe”) is a “partial opiate agonist” marketed under the brand names Suboxone and Buprenex . It docks with and stimulates some opioid receptors in the brain, but not as many as opiates do. Buprenorphine also acts as an “antagonist;” it blocks other opioids. So it suppresses withdrawal symptoms and cravings while it also prevents a high.
Although buprenorphine is often useful as a detox tool and to help alleviate cravings in early sobriety, long-term use may be more problematic. Like with methadone, longer-term users have reported becoming addicted to it and suffering even worse withdrawal than would have been the case from the opiates they used bupe to get off of. Long-term effects haven’t been well-studied.
[1] http://www.dpt.samhsa.gov/patients/mat.aspx
Please correct the page on MAT for opioid addiction: NARCAN is the brand name for Naloxone – not Subutex.
I regret the error, thank you for pointing it out. The entry has been corrected.