Medications prescribed by a physician are the most effective, potentially lifesaving, treatment for opioid addiction. Medication-assisted treatment (also called MAT) reduces drug use and overdose rates and helps retain people in treatment longer, which is associated with better outcomes. MAT also reduces criminal behaviors and infectious disease risk and improves occupational, psychological, and family functioning. Studies suggest that combining MAT with therapy yields the best results.
Unfortunately, there is a widespread misconception among providers, policy makers and the public that “abstinence-based” or “medication-free” treatment – without MAT – is best. Given the evidence supporting MAT’s effectiveness, this philosophy is not supported by research and is potentially dangerous.
FDA-approved medications to treat opioid addiction include methadone, naltrexone and buprenorphine, which is often combined with naloxone. Naltrexone blocks the effects of opioids so people do not get intoxicated (high) or overdose if they use. Methadone and buprenorphine reduce cravings and withdrawal symptoms and allow individuals to improve their functioning in everyday life. When taken as prescribed, these medications do not cause the feeling of intoxication associated with opioid abuse. Because these medications have different mechanisms of action, different side effects and risks, and are available in different health service locations, the medication that is best for any individual will vary.
Methadone has been proven effective through over 40 years of research. The other medications are newer and therefore are less well studied, but data suggest that they may be as effective for many groups of people with opioid addiction.
The length of treatment with MAT depends on the duration and severity of the addiction, the patent’s physical and psychological health and preferences, and other factors affecting recovery. People with an earlier stage or less severe form of addiction may benefit from taking medication for a shorter period of time (for example 6-12 months), depending on their treatment progress. For people whose addiction has progressed to a chronic condition, they may need to take medication for many years or even the rest of their lives, just like people who have asthma, diabetes or heart disease.
The research supporting MAT is strong enough to conclude that MAT is an “evidence-based” treatment, meaning, it has been proven to work. All addiction treatment programs and providers should offer MAT directly or through referral; those that do not should not be considered “evidence-based” providers. Federal and state agencies that pay for addiction treatment services should require that MAT be made available to all patients treated in programs they support. Prohibiting or discouraging the use of MAT or denying reimbursement for this service is unethical, violates parity, and is inconsistent with acceptable medical practice.