MAT: Medication Assisted Treatment
June 24th, 2024
By P. Casey Arrillaga, LCSW, LCDC
Medication Assisted Treatment, or MAT, is a form of addiction
treatment that involves prescription drugs such as methadone and buprenorphine that
are intended to help people get off opioid drugs including heroin and fentanyl.
It has been a topic of hot debate for decades, because for some, MAT makes the
life-saving difference that helps them achieve their recovery goals, while for
others it is a placeholder until they start using their drug of choice again.
Because of this, it is seen by some as enabling or even “fake sobriety.” In
this post, we’ll explore the world of MAT, how it can be used most effectively,
and what it means for you or someone you love.
What We Know So Far
Opiates are drugs that are either derivatives of the opium
poppy or imitate its chemical structure. For thousands of years, these
substances have been known to be highly effective at reducing pain and
suffering, but they have also been known to be highly addictive. Various
societies have tried countless things to deal with this dilemma. Opiates have
been considered to be both wonder drugs and a scourge. Wars have been fought
over them.
Humankind has learned to purify them more and more over time,
making them both more effective, more addictive, and thus more deadly. We have
moved from opium, to morphine, to heroin. More recently, science has developed
synthetic versions that are many times more powerful, such as fentanyl. This
medication has helped many people who were suffering, while simultaneously
virtually wiping out entire communities.
Given how much these drugs reduce pain, they are not going
away anytime soon. Many people use them safely, yet a certain percentage of the
population finds them irresistibly euphoric beyond any other human experience.
They will spend their lives chasing that high to the point that they ruin their
lives, cause pain to those they love, overburden the health care system and
other social services, and often die from overdose.
Many people realize they are getting caught in this trap and
want to get out. Unfortunately, they quickly find that not only are they going
to miss the high, which has often become less and less over time due to developing
tolerance, but they quickly find the withdrawals from opiates are brutal. The
brain has become dependent on the opiates and thus has stopped producing enough
of the natural chemicals that reduce pain, produce motivation, and make life
seem enjoyable. Thus, the user finds that they are miserable and in pain very
quickly if they don’t keep a steady supply of opiates flowing into their
system. These withdrawals can feel like hell on earth.
This is where MAT comes in. These medications get the brain
sufficient levels of opiate effects but don’t hijack the user’s motivational
system the way that opioid drugs do. MAT
works as a place holder of sorts and fills the area in the brain that produces
craving. But do not be mistaken,
although MAT reduces craving significantly, some still find that the
medications have milder euphoric properties. Thus, the temptation of addiction
is reduced, but withdrawal effects are also avoided. This gives an addicted
person the chance to live the type of engaged productive life that is often out
of reach for people who are regularly using opiates.
The oldest and best-known of these medications is methadone.
It was discovered in Germany near the end of World War II, but it wasn’t
recognized as a potential part of treatment for opiate addiction until 1947. It
came into more widespread use for MAT in the early 1960’s, at which time all
addiction had much heavier stigma, and opiate addiction was considered one of
the worst. As a result, there was a tug-of-war between those who favored
stronger punishment as a deterrent against opiate use and those who saw the
people with addiction as needing medical treatment. Federal and state policy
around methadone was a compromise between the two.
Thus, by state law under federal guidelines, methadone could
be prescribed, but the user had to check in daily at a methadone clinic to pick
up that day’s dose as a way to have accountability. It is hard to think of any
other medication that has such restrictions. This requirement has acted as a
deterrent to using it both because of the inconvenience and the potential
lingering stigma around having to be seen going in and out of such a clinic
every day indefinitely.
Proponents of MAT saw an opportunity during COVID to ease
some of these restrictions, but since lockdown ended, each state has made its
own decisions about whether have to come to a clinic every day or not. As of
2024, the federal government has finally recommended that previous restrictions
placed on methadone be lifted, allowing patients to take it home and take the
pills on their own.
While these difficulties were being worked out, other
options have been brought to market for MAT, chiefly buprenorphine in the early
1980’s. This medication works similarly to methadone without as much legal
restriction. It was made popular under the brand names Subutex (which is no
longer sold) and Suboxone (which combines buprenorphine with naloxone). Beyond daily dosing, it is now available as a
long-acting injection, implant, patch, or short-acting injection.
Like many aspects of addiction treatment, there is
controversy around MAT. Studies show that MAT can be lifesaving, presenting a
way to manage opiate addiction for people who cannot do it any other way. Both
professionals and people who have the addiction look at MAT as a natural and obvious
treatment. However, there are many for whom this treatment does not work. In fact, some use this as a tool to withdraw
off opioids when they are unable to find drugs either legally or
illegally. We have treated many that
want to get off MAT and were unsuccessful on their own, because most report a
worse withdrawal from MAT than from opioids. There are some people in recovery
who see MAT as “not really sober,” and are thus highly critical of anyone who
goes to recovery meetings while using it. Some professionals have become jaded
by seeing too many people who seem to use MAT as a crutch until they can get
back to using heroin or fentanyl. As with the opiates themselves, there are
points to be made on both sides, and no easy answers.
One important fact that cannot be ignored is that there are
many factors that contribute to an addictive pattern. This is why at Windmill
we always ask, “Why did this person want to change the way they felt in the
first place?” There are many that build
a biochemical dependence, but most also used it to escape. We know that MAT alone
will not be able to “fix” that. That’s where treatment comes in. This is where
we can address the feeling or potential trauma that needs to be processed,
something that no medication can do.
How Do We Use This Information Effectively?
At Windmill, we recognize that there is not a
one-size-fits-all answer to this debate. Instead, we evaluate every client who
is addicted to opiates as an individual when it comes to whether MAT is
appropriate. This means close collaboration between the medical and clinical
teams to see if MAT is likely to be the factor that leads to success or if it
will be abused. We cannot predict the future or read minds any more than anyone
else can, but our experienced team has access to world-class information and
experience. Objective and subjective reporting from Trac9, family/friends
(patterns of use), our Brain Frequency program, along with genetic testing, allow
us to make the best possible assessment of each client. This gives us the
ability to match each client with the treatment that is most likely to work for
them.
The Bottom Line
Opiate addiction is extremely difficult to beat and often
deadly for those who don’t. MAT is not perfect for everyone who uses opiates,
but it can make all the difference when matched with the right client. At
Windmill, we use our depth of experience and ability to gather accurate
information to make sure that each client who uses opiates gets the best
possible chance of success.
About The Author
P. Casey Arrillaga is the Team Leader for Education at
Windmill Wellness Ranch, and he is the author of books including “Realistic
Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.
