Medication Assisted Treatment
It all started when…
Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.
When approaching the topic of Medically Assisted Treatment (MAT), we are often faced with stigma’s and judgment from nearly all sides. “It’s just replacing one drug for another,” they often say. It is important to note, however, that everyone’s situation is drastically different, and there are times when transitioning to a drug like Buprenorphine from illicit street drugs can be life saving. The question of whether or not it is safe, or beneficial, however, for long term use is still up in the air.
When trying to make sense of Medically Assisted Treatment as a possible option, it is important to know the ways in which heroin works in the brain. Painkillers and opiates produce their highly addicting effects by crossing the blood-brain barrier and attaching to a synapse known as a “receptor.” Once the drug and the synaptic site have come in contact with each other, a flood of what are known as neuro-transmitters are released, in turn causing the person who took the drug to feel high. When someone continuously ingests opiates over and over, the brain eventually realizes it doesn’t have enough synaptic landing spaces to match the level of the drug in the brain, in turn causing it to create entirely new receptors. Yes, the brain actually grows new parts in order to keep up with an addict’s intake of substances, that is, in the case of opiates or heroin. This is one of the reasons why opiate addicts experience withdrawal, because when you take the substance away, there are still an unnatural amount of receptors, leading them to go into a process known as down-regulation.
“MAT can work in one of two ways. Doctors can give people opiates that activate
the same receptors but are absorbed into the blood over a longer period of time —
staving off withdrawal symptoms and breaking a psychological link between taking
a drug and immediately feeling high. Doctors can also give someone an opioid
antagonist — a non-opioid drug that sits on those same receptors and blocks them
— so that if someone relapses, he or she won’t feel anything. (If someone goes off
the drug and relapses, however, that can have deadly consequences. A person’s
tolerance for the drug decreases after long periods of sobriety — especially
after antagonist treatment.) Source.
With this information, we can begin to see the bigger picture of what is at work here. An addict can attempt to get off of any controlled substance, go through the pain of detox, and take their chances at recovery from a non medically assisted standpoint. On the other hand, however, they can choose to begin a maintenance drug such as Suboxone or Methadone, which will most likely help in keeping them alive, yet have to go to a clinic daily or weekly for the rest of their life. While people do get off of maintenance drugs, they are much harder to discontinue as opposed to a short-acting opiate like heroin, and often leads to relapse if their is a disturbance in their ability to procure the medication.
Treatment for opioid addiction includes detoxification (or “detox”) programs. However, this alone is often not enough; many people will relapse and use again without additional treatment such as counseling and long-term medications. There are three FDA-approved long-term medications for treating opioid addiction:
Methadone. This is an “agonist” drug that binds to the body’s opioid receptors and activates these receptors as the opioid drug would. It is offered at certified treatment facilities, usually as a liquid medication taken every day.
Buprenorphine. This is a “partial agonist” drug that binds to the body’s opioid receptors and partly activates them. It is prescribed by trained physicians, most often as a combination pill with antagonist naloxone (Suboxone), and is taken every day.
Naltrexone (Vivitrol). This is an “antagonist” that binds to the opioid receptors but does not activate them, and thus blocks the action of other opioid drugs. It can be prescribed by any health care provider who is licensed to write prescriptions, and is available as either a daily pill or a monthly injection.
The most versatile of the three is Buprenorphine, as it comes in numerous different forms and makes. The most common of them is known as Suboxone. Just the word “Suboxone” has become a source of controversy and polarizing opinions online. Some other brand names that utilize the active ingredient Buprenorphine are Subutex, Zubsolv, and Sublicade. Each variation of the drug can be used for different people who have different needs and unique situations. Buprenorphine can play an important role in the disruption of negative behavior and patterns and can be tapered off of, if done correctly of course, so one experiences minimal withdrawal.