The Health Fund has invested in projects that attack the opioid epidemic from every angle, but one common focus is the use of medication-assisted treatment (MAT). Our collaborative work with the Michigan Opioid Partnership is helping people begin MAT even while in hospitals and jails. Another 2018 Health Fund grant is helping Michigan Department of Health and Human Services provide incentives for physicians to institute MAT in the highest-need counties in the state. And a 2018 grant to the Greater Flint Health Coalition included funding for Know More Genesee, a one-stop-shop for information about both prevention of and treatment for opioid use disorder (OUD), including MAT.
We continue to fund medication-assisted treatment programs because experts tell us it is a critically important tool available for opioid use disorder, and yet it continues to be widely misunderstood and underutilized. We want to dispel some myths and explain why this rapidly developing treatment is a game-changer in the field of substance use disorder care.
Key Terms
Let’s start with some expressions that are helpful to know when discussing this topic:
- Harm reduction – a philosophy of care that focuses on reducing morbidity and mortality rates and acknowledges that abstinence is not always feasible (NCBI).
- Maintenance medication – a medication used for long-term, chronic conditions like opioid use disorder.
- Warm handoff – a recommended approach in integrated care, in which the primary care provider introduces the patient to a behavioral health specialist, face-to-face (SAMHSA).
- No wrong door – a recommended approach in opioid care, in which no matter where a patient first seeks treatment, the system secures treatment for them with minimal hassle.
But what is medication-assisted treatment?
What it is
Medication-assisted treatment (MAT) is a form of care that has proven to be effective for people with OUD. It involves the use of one of three FDA-approved medications: methadone, buprenorphine, and naltrexone. The FDA considers all three to be safe and effective in combination with counseling and behavioral therapy, with duration of treatment ranging from months to life. Each medication has advantages and disadvantages, which patients should discuss with a doctor (FDA).
Naloxone, or Narcan, is a life-saving emergency medication that reverses opioid overdose. Naloxone is also a component of some opioid maintenance medications.
This table provides a helpful summary of the three maintenance medications:
From NEJM
What it’s not
Medication-assisted treatment isn’t:
- Replacing one addiction with another. Opioid use disorder prevents people from completing day-to-day functions and puts them at risk of death by overdose. Medication-assisted treatment does the opposite—it allows people to return to daily functioning and helps them stay away from potentially lethal drugs. Like insulin for a diabetic patient, MAT medications can provide effective treatment for a deadly, biological health condition.
- Inferior to abstinence. Abstinence-only treatment, formerly the standard approach to OUD care, does not fully treat the biological effects of addiction on the brain, such as dopamine deficiency. The re-wiring of the brain’s reward system caused by OUD puts patients at a high risk of relapse if they are treated without medication (California Correctional Health Care Services).
- A cure-all. Experts don’t recommend treating patients with medication without also providing them with counseling and behavioral therapy. Biological and behavioral elements both come into play in addiction, and therefore both should be involved in treatment. With the combination, the brain gets crucial chemical healing time while the patient gains new insights, habits, and strategies in therapy.
How it can help
Studies have shown that medication-assisted treatment can cut the opioid mortality rate by 50% or more. Tens of thousands of people are dying of overdose every year, including 2,599 in Michigan alone in 2018—more than deaths by car accident. An effect anywhere close to that percentage would be a gamechanger (Michigan.gov).
In fact, that difference has already started to be visible. That 2,599 number from 2018 is actually a reduction from the opioid overdose mortality rate of 2017—the first decrease we’ve seen since 2011. The growing implementation of MAT deserves some credit for that progress. The creation of the Opioid Health Home program and the Michigan Opioids Task Force has brought more attention to this important treatment than ever before.
Still, a third of those with opioid use disorder in Michigan aren’t receiving treatment. Add to that the fact that only 40% of Michigan treatment centers (174 of 439) currently offer medication-assisted treatment, and you can see why MAT is nowhere near its full potential for impact.
Barriers to Implementation
Why isn’t MAT used more often?
For one, stigma is still a huge issue. Many people—including some within the treatment and OUD communities—see abstinence-only recovery as the most “pure” form of treatment. Terms like “opioid replacement” lead others to see MAT as a substitution rather than a medication, a crutch rather than a form of care (MDHHS). Such myths get in the way of the basics: that over 100 Americans die every day from opioid overdoses, and we are underutilizing a treatment that has been proven to prevent many of those deaths.
Other structural barriers complicate the matter further. Unfortunately, it remains easier for doctors to prescribe opioids for pain relief than medications like buprenorphine for OUD treatment. Caps on these medications limit how many patients doctors can prescribe to, the treatment is not always covered by insurance, and limited providers lead to long waiting times for patients (Vox, NEJM). Methadone, on the other hand, can only be dispensed by federally approved centers, severely limiting patient access.
In Conclusion
Medication-assisted treatment is one of the most effective ways to treat opioid use disorder and reduce overdose deaths, but restrictive policy, lingering stigma, and a lack of timely access to care are holding us back. Although promising programs in Michigan and elsewhere are helping to slow the epidemic, the underutilization of this tool has devastating costs.
Our behavioral health access study said it loud and clear: Michigan residents with substance use disorders are overwhelmingly going without treatment. We need to connect people with care, and medication-assisted treatment needs to be one of their options. Increasing access, combatting stigma, and removing barriers to this type of treatment could prevent thousands of needless deaths.
The information surrounding opioid use disorder and its treatment is constantly changing, and this blog post provides only the most basic overview of the topic. For up-to-date MAT coverage and detailed information, visit SAMHSA’s MAT page.