Medication-Assisted Treatment: Which Drugs Are Used And Why?

At GateHouse Treatment, we offer medication-assisted treatment (MAT) in conjunction with several behavioral health therapies to combat opioid use disorders (OUDs) and other substance use disorders (SUDs). The primary objective of MAT is to prioritize a full recovery and provide the ability for individuals to continue a self-directed life. By utilizing this treatment approach, MAT helps:

  • Decrease opiate use among patients with substance use disorders
  • Increase retention in treatment and therapy
  • Improve survival rates of patients
  • Increase the ability for patients to gain and maintain employment
  • Lower instances of risky behavior associated with substance use disorders

MAT is one of the most effective treatments for opioid, alcohol, and prescription pain medication addictions. When implemented in combination with therapy, MAT lessens withdrawal symptoms and drastically reduces cravings for alcohol or opioids. These therapies usually include nondrug approaches such as counseling and cognitive behavioral therapy (CBT), among other family and community-driven programs. According to the Substance Abuse Mental Health Services Administration (SAMHSA), using FDA-approved medication-assisted treatment and evidence-based therapy in treating opioid use disorders is more effective in achieving long-term sobriety than therapy alone.

As the name suggests, medication-assisted treatment utilizes various pharmaceuticals to bring long-lasting patient recovery results. Each of these clinically-driven medications differs in how it affects a patient, whether the goal is to relieve symptoms of withdrawal or block out the effects of opiates entirely. These treatment plans are also patient-specific and created with input from both the patient and prescriber for a fully-tailored approach.

Other prescriptions to treat addiction are currently under review to allow for medication-assisted treatment of cocaine and benzodiazepine use disorders.

Medication-Assisted Treatment: Medications

The most commonly used medications for MAT are Methadone, Vivitrol (naltrexone), Suboxone, and Subutex. At GateHouse Treatment, we use Vivitrol due to its higher reliability when treating OUDs. Most harm reduction methods aim for opiate abuse, while some work better for alcohol abuse. The main difference in the medications is that only some are considered narcotics. Subutex and Suboxone are both classified as narcotics and have the potential for abuse. Vivitrol and naltrexone are non-narcotic and safe to use in medically supervised situations such as GateHouse Treatment’s programs.

MAT: How is Buprenorphine Used?

To understand the difference between Suboxone, Subutex, and other medications like Vivitrol, you must know how they work in the body. Subutex is a brand name for buprenorphine, while Suboxone is a combination formulation of buprenorphine and naloxone. Both of these work as partial opioid agonists; this means they stick to the opioid receptors in the brain, activate the opioid receptors and make the body think that it has enough opioids so as not to withdraw. They also stick to the receptors for much longer than abused opiates such as heroin or prescription opioid medications.

Buprenorphine presents a danger when these medications are subject to abuse. Their misuse can derive from taking more than the prescribed dose or taking them in any way other than sublingually, such as snorting or injecting them. Another aspect to consider is that while Suboxone contains naloxone and Subutex does not, both can bring about withdrawal symptoms.

This precipitated withdrawal occurs from taking Suboxone or Subutex when withdrawal symptoms either aren’t present or are not at the proper threshold to avoid the onset of withdrawal. The buprenorphine removes any remaining full agonist opioids on the opioid receptors and replaces them with itself. Being a partial agonist doesn’t satisfy the brain as full agonists do, so naloxone in Suboxone is prescribed mainly to deter people from abusing it. Although they don’t produce the same euphoric effect as a full agonist, the user can still get a “high” from these medications.

MAT: Vivitrol/Naltrexone, The Maintenance Medication

Naltrexone is a non-narcotic opioid antagonist, meaning it has no potential for abuse. It is administered either in a once-monthly shot or as a pill (Vivitrol) taken daily, which a doctor can prescribe. Vivitrol requires that you have been detoxed from all opioids for at least 7-14 days to avoid extreme opiate withdrawal.

Furthermore, Vivitrol, Subutex, and Suboxone are all used as anti-craving medications. The difference is that while Subutex and Suboxone bind to the opioid receptors as partial agonists, they still activate the opioid receptors. Vivitrol instead attaches to the opioid receptors and blocks any opioids from producing a euphoric effect. It isn’t a maintenance medication that you become physically dependent on, like Subutex or Suboxone. Vivitrol and naltrexone have also helped patients struggling with alcohol abuse.

The Role of Therapy in MAT

Behavioral health treatment is highly recommended in conjunction with the various drug therapies of MAT. Research shows that patients who receive psychosocial treatment have better outcomes than those who do not. These treatments help patients from returning to opioid dependence while also addressing underlying issues. Some common goals of this dual approach include:

  • Encouraging patients to adhere to their medications
  • Modifying underlying behaviors that contribute to substance use
  • Treating existing psychiatric disorders
  • Offering both individual and group counseling
  • Utilizing contingency management to reward positive behaviors
  • Providing referrals to community-based services
  • Connecting individuals to family support systems such as family therapy
  • Facilitating entry into mutual help programs as needed

Often, untreated psychiatric conditions and mental illnesses such as depression, anxiety, and PTSD are underlying causes of addiction. Since nearly half of the individuals who suffer from substance abuse have received a dual diagnosis in some form of a co-occurring mental illness, these therapeutic interventions also address the root causes of such conditions. Some, but not all, of these interventions also provide resources for individuals with physical health conditions such as hepatitis, HIV and AIDS.

Medication-Assisted Treatment and GateHouse

Our goal at GateHouse Treatment is to provide all the necessary tools for recovery from opioid use disorders, including counseling and behavioral therapies, an introduction to 12-step programs and aftercare plans to give clients the best chance at avoiding relapse.

While certain medications used in MAT can cause dependency, GateHouse Treatment only uses Vivitrol or naltrexone (the generic oral version) for our treatment plans. We understand that using Vivitrol and naltrexone as anti-craving medications is an effective addiction treatment methodology, especially when combined with therapy and a 12-step foundation. However, we highly recommend speaking with a licensed and certified addiction treatment provider or doctor before using Vivitrol in your MAT plan. As with any serious medical condition, a doctor’s supervision (or similar clinician level) is essential to remain safe.

We use Vivitrol and naltrexone because they’re demonstrably safer approaches to MAT, and there is no potential for abuse. There have been many instances where patients sell their Suboxone or Subutex prescriptions and continue using illicit drugs. Suboxone and Subutex can become risky for many people when not administered in a safe, supervised, and clinical environment such as GateHouse Treatment.

If you or someone you love has been struggling with opioid dependence and is interested in harm reduction methods and MAT, contact us today. You can reach GateHouse Treatment at (855) 448-3588. We are here for you 24/7. Your addiction doesn’t have to continue endlessly.

GateHouse Treatment Editorial Staff
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