Medication-Assisted Treatment

Medication-Assisted Treatment (MAT)*, including opioid agonist treatment (OAT) with methadone and buprenorphine, is the use of FDA-approved medications for the treatment of substance use disorders (SUD). There are three FDA-approved medications for opioid use disorders – methadone, buprenorphine, and naltrexone. There are also approved medications for the treatment of alcohol use disorder and tobacco cessation.?

There are currently no FDA-approved medications for stimulant use disorders. However, there is promising research that suggests a number of medications may be helpful for some patients.

*Although MAT?is a widely used term, it is problematic because it implies the medications themselves are not the treatment. People receiving OAT are often stigmatized as not being in "true recovery" while taking medications like methadone. In fact, OAT is the safest and most effective method for treating opioid use disorders.

Methadone and Buprenorphine (OAT)
Methadone and buprenorphine are widely recognized as the gold standard treatments for opioid use disorders. Methadone is an opioid agonist, meaning it acts like an opioid in the brain. Buprenorphine is a partial opioid agonist, meaning it acts similar to an opioid in the brain although it has limited effects.?

In the U.S., methadone can only be dispensed at highly regulated Opioid Treatment Programs (OTPs) where the majority of patients must take observed doses of their medication on a daily or near-daily basis. Although buprenorphine can be prescribed by medical professionals in other settings, they must undergo additional training and get a special DEA waiver, commonly called the X-waiver.?

Less than 10% of primary care physicians are waivered to prescribe buprenorphine.

Naltrexone
Naltrexone (commonly known by the brand name Vivitrol?) is the third medication approved for opioid use disorder and is an opioid antagonist, meaning it blocks the effects of opioids in the brain. Evidence is still mixed about its long-term efficacy and its effect on overdose risk. Naltrexone has no additional requirements for prescribers.

Benefits of Methadone and Buprenorphine (OAT)

Decades of evidence demonstrates the positive impacts of methadone and buprenorphine, including:

  • Increased treatment initiation and retention
  • Reduced drug use
  • Reduced overdose risk by 50%
  • Reduced criminal legal system involvement
  • Improved functioning and economic outcomes
  • Reduced spread of communicable diseases
  • Reduced healthcare costs associated with acute care for SUD-related issues such as emergency department admissions
  • Improved birth outcomes for pregnant people with opioid use disorders

Although often paired with psychosocial treatment, these medications can still lead to many of the same benefits when used alone. Methadone and buprenorphine are most effective when tailored to the individual needs of the client, including the dosage that is most helpful to them and when the course of treatment is for as long as the patient would like to remain on the medication.

Barriers to Methadone and Buprenorphine (OAT)

Despite the evidence showing the many benefits of these medications, multiple barriers restrict access, including:

  • Stigma and lack of knowledge about medication benefits among clinicians, treatment providers, referral sources, the public, and patients
  • Limited or no insurance coverage, costly co-pays or out of pocket expenses, or imposed restrictions on access
  • Many burdensome laws and regulations that deter providers from prescribing and dispensing both buprenorphine and methadone
  • Limited buprenorphine prescribers and few Opioid Treatment Programs, particularly in rural areas
  • Regulations and program policies that make medication access contingent upon compliance with requirements such as frequent observed dosing, minimal take-home doses, counseling requirements, and negative urine drug screen results
  • Racial disparities in prescribing buprenorphine for communities of color
  • Laws limiting buprenorphine provider patient caseloads
  • Treatment program policies that do not allow or discourage methadone or buprenorphine, or that only utilize them for short-term detox purposes

Increasing access to these medications is essential to ensuring people with opioid use disorders are able to get the most effective treatments.

How DPA is Advocating to Increase Access to MAT/OAT

The Drug Policy Alliance (DPA) advocates for federal and state policies that increase access to MAT/OAT for opioid use disorder and allow patient choice in all settings. We continue to lead efforts to remove client caps on providers and eliminate health insurance restrictions.

We are committed to making these medications readily available to all who could benefit and will challenge the stigma and barriers that prevent access.?


MAT/OAT and COVID-19?

The COVID-19 pandemic has resulted in several public health measures and recommendations that impacted access to substance use disorder treatment. Primary among these is the need to maintain social distance, which greatly reduced availability and use of in-person treatment, including medication access. DPA is fighting to remove barriers that were hindering treatment access prior to the COVID-19 emergency but have now become especially visible and more dangerous due to the current pandemic.

See our COVID-19 policy recommendations.

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