Myths vs. Facts: The truth about medication assisted treatment for opioid addiction
By Mark O’Brien, Senior Criminal Justice Policy Associate
What is Medication Assisted Treatment for opioid addiction?
Medication assisted treatment (MAT) for opioid addiction is the use of medications such as buprenorphine, naltrexone, and methadone (in combination with counseling and behavioral therapies) to provide a whole-patient approach to treatment. MAT works to:
- Stabilize brain chemistry
- Block the euphoric effects of opioids
- Relieve physiological cravings
- Normalizes body functions
Studies have shown that MAT reduces illicit drug use, disease rates, and related harmful behaviors, including criminal activity. People in MAT are up to 75% less likely to die from a cause related to their addiction. Despite what the National Institute of Health says is “unequivocal” evidence of MAT’s effectiveness and safety, many myths persist about MAT. As a result, people are denied potentially life saving addiction treatment.
Here, we explore those myths and invite your questions and comments at the end. In fact, we try to respond to all questions with a personal and prompt reply.
Myths and facts about medication assisted treatment
The following are some common myths about MAT and the facts that can give people a better understanding of these powerful addiction treatments.
Myth #1: MAT is just substituting one addiction for another.
Facts: There are three types of medications for the treatment of opioid addiction: agonists (Methadone), partial agonists (buprenorphine), and antagonists (injectable naltrexone).
Agonists turn on the same receptors as other opioids but their lower intensity and longer duration prevent the withdrawal and escalation that are part of addiction. Partial agonists work similarly but produce a weaker effect. Antagonists work by blocking the opioid receptors in the brain so that opioids have a diminished or completely eliminated effect on them.
Although people treated with agonist medications are physically dependent on them, agonists are different from short-acting opioids such as heroin and prescription painkillers. That’s because misused opioids cause sedation and the euphoria known as a “high.” Appropriately prescribed agonist addiction medications reduce drug cravings and prevent relapse without causing a “high.” Vivitrol, an antagonist medication, does not cause physical dependence.
Both agonist and antagonist medications are proven to help people disengage from drug seeking behavior and criminal activity, and become more receptive to behavioral treatments.
Myth #2: Medications are a crutch that prevents true recovery from addiction.
Facts: People in MAT can and do achieve “true recovery.” Science shows that people whose addictions are treated with MAT:
are less likely to use illicit drugs,
do not experience euphoria, sedation, or other functional impairments, and
do not meet diagnostic criteria for addiction, such as loss of volitional control over drug use.
As the name medication assisted treatment implies, medications are only one part of MAT. The medication normalizes brain chemistry so people have more success participating in counseling and behavioral interventions that support their recovery.
Myth #3: MAT should not be used long-term for the treatment of opioid dependence.
Facts: There is no one-size-fits-all duration for medication assisted treatment. For some patients, MAT could be indefinite. The National Institute on Drug Abuse describes addiction medications as an “essential component of an ongoing treatment plan” for people to “take control of their health and their lives.” Further, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends three phases:
- PHASE 1: A beginning stabilization phase (withdrawal management, assessment, medication induction, and psychosocial counseling)
- PHASE 2: A middle phase emphasizing medication maintenance and counseling
- PHASE 3: A third phase of “ongoing rehabilitation,” during which the patient and provider can taper off medication or pursue longer term maintenance based on the patient’s needs
Myth #4: Courts are in as good of a position as a doctor to determine the appropriate treatment for a person’s addiction.
Facts: Determining the appropriate treatment for an opioid addiction is a health matter that should be between a doctor and patient. Doctors know the relevant medical standards and can assess and respond to the individual characteristics of the patient. Just as judges would never decide that a person must treat her diabetes through exercise and diet alone rather than with the insulin her doctor prescribed, courts should avoid making medical decisions with respect to medically-accepted substance use disorder treatments like MAT.
Denying access to MAT in the criminal justice system is unwise. It may also be illegal. Courts are in a position to motivate people to succeed in treatment and help them access it, but they should leave assessments and treatment planning and execution to addiction professionals.
Myth #5: Overdoses from methadone used for the treatment of opioid dependence are common and increasing.
Facts: Methadone used in MAT is highly regulated and results in little diversion and few deaths. Methadone prescribed for pain, rather than for MAT, has been shown to be the cause of the increase in overdoses from methadone. According to the CDC,
“Methadone has been used safely and effectively for decades to treat drug addiction, but in recent years it has been used increasingly as a pain reliever. As methadone prescriptions for pain have increased, so have non medical use and associated fatal overdoses. Methadone carries more risks than other painkillers because it tends to build up in the body and can disrupt a person’s breathing or heart rhythm. CDC results showed that methadone used for pain posed a greater risk than painkillers such as oxycodone and hydrocodone.”
For more information, read Legal Action Center’s new report, Confronting an Epidemic: The Case for Expanding Access to Medication-Assisted Treatment to Address the Heroin and Opioid Epidemic and its 2011 report, Legality of Denying Access to Medication Assisted Treatment in the Criminal Justice System. Also visit our website to learn about LAC’s work and resources.
About the author: Mark O’Brien is a Senior Criminal Justice Policy Associate at Legal Action Center advocating to expand access to addiction treatment in the criminal justice system and opportunities for people with criminal records and addictions.
Photo credit: The Clinic by Dr H