Medication assisted therapy
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Medication-Assisted Therapy for Opioid Use Disorder: An Overview
Introduction to Medication-Assisted Therapy (MAT)
Medication-Assisted Therapy (MAT) is a comprehensive approach to treating opioid use disorder (OUD) that combines medications with counseling and behavioral therapies. This method aims to provide a "whole-patient" approach to the treatment of substance use disorders. The primary medications used in MAT include methadone, buprenorphine, and naltrexone, each with distinct mechanisms and benefits.
Effectiveness of MAT in Correctional Settings
Research has shown that MAT is particularly effective in prison and jail settings. A meta-analysis of randomized controlled trials (RCTs) and quasi-experimental studies found that methadone treatment during incarceration significantly increased community treatment engagement post-release and reduced illicit opioid use and injection drug use. However, it did not significantly reduce recidivism rates. Buprenorphine and naltrexone also showed effectiveness in reducing illicit opioid use post-release, either being superior to methadone or as effective as methadone.
MAT in Clinical Practice
MAT has been shown to double the rates of opioid-abstinence outcomes compared to psychosocial treatments alone. Methadone maintenance remains the gold standard, but combined buprenorphine/naloxone and buprenorphine monotherapy (especially in pregnant women) also demonstrate significant efficacy and safety. Extended-release naltrexone shows promise due to its non-diversion potential and lower risk of overdose, although oral naltrexone has poor adherence and higher mortality rates.
Addressing the Opioid Overdose Epidemic
The Department of Health and Human Services emphasizes the importance of MAT in tackling the opioid overdose epidemic. Greater use of MAT is seen as a key element in reducing opioid abuse while ensuring appropriate access to necessary medications. Integrated MAT programs that combine HIV prevention, care, and treatment services offer a comprehensive approach to addressing both substance abuse and co-occurring infectious diseases.
Reducing Stigma and Improving Care
The terminology used to describe MAT can impact its utilization. The term "Medication-Assisted Treatment" implies that medications are secondary to other treatments, which can contribute to stigma and underutilization . Advocates suggest using more precise language, such as simply "medication," to describe pharmacotherapy for OUD, similar to how medications for other chronic conditions are referred to .
Inpatient MAT and Readmission Rates
Inpatient MAT, particularly with buprenorphine, has been associated with lower rates of against-medical-advice discharges and reduced readmission rates. Patients receiving MAT had significantly lower 30-day and 90-day readmission rates compared to those receiving only supportive care. This highlights the importance of maintaining MAT at the time of discharge to improve patient outcomes.
Innovative Approaches to MAT
Innovative programs like Rapid Access to Medication Assisted Therapy (RAM) in Central Vermont demonstrate the effectiveness of cross-system interventions. RAM utilizes emergency department buprenorphine induction and a Hub and Spoke delivery system to facilitate care coordination and remove barriers to treatment. This transdisciplinary approach increases team capacity and improves care coordination, showcasing the potential of collaborative efforts in addressing the opioid crisis.
Conclusion
Medication-Assisted Therapy is a critical component in the treatment of opioid use disorder, offering significant benefits in various settings, including correctional facilities and hospitals. While methadone remains the gold standard, buprenorphine and extended-release naltrexone also show substantial efficacy. Addressing the stigma associated with MAT and improving care coordination through innovative programs can further enhance the effectiveness of this treatment approach. As the opioid crisis continues, expanding access to and utilization of MAT will be essential in improving public health outcomes.
Sources and full results
Most relevant research papers on this topic