Effects of Medication-Assisted Treatment for Opioid Use Disorder 1

Effects of Medication-Assisted Treatment for Opioid Use Disorder

Lamont DuBose

School of Behavioral Sciences, Southern California Seminary

CO-774 Psychopharmacology

Dr. Judith Kaye Lawrence

12/06/2022
Effects of Medication-Assisted Treatment for Opioid Use Disorder 2

Overview

According to a data report conducted by the County of Los Angeles Public Health Department

(2022), the number of deaths linked to fentanyl in L.A. County rose from 109 in 2016 to 1,504 in

2021, amounting to a 1,280% increase. Medication-assisted treatment (MAT) is a combination of

psychosocial therapy and U.S. Food and Drug Administration (FDA)-approved medication and

has proven the most effective intervention to treat opioid use disorder (OUD). Kampman, K., &

Jarvis (2015) suggest that it is more effective than either behavioral interventions or medication

alone.  MAT significantly reduces illicit opioid use compared with nondrug approaches, and

increased access to these therapies can reduce overdose fatalities. Unfortunately, MAT is often

unavailable to those who need it most due to inadequate funding for treatment programs and a

lack of qualified providers who can deliver these therapies. This paper outlines OUD, the

function of MAT, the types of behavioral health treatments available, FDA-approved

medications and their mechanism of action, the route of administration, dosing indications,

misconceptions, and the benefits and barriers to receiving MAT.

Opioid Use Disorder

OUD is a chronic brain disease caused by the recurrent use of opioids, including prescription

drugs, such as oxycodone and hydrocodone, and illicit substances such as heroin and Fentanyl, a

powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. A

clinical diagnosis of an OUD is based on the presence of symptoms within a 12-month period on

a repeated or recurring basis as outlined in the Diagnostic and Statistical Manual of Mental
Effects of Medication-Assisted Treatment for Opioid Use Disorder 3

Disorders (DSM-5, 2013). OUD includes dysfunction of the brain reward system, motivation,

memory, and related circuitry and is reflected in individuals “pathologically pursuing reward

and/or relief by substance use and other behaviors.” (PCT, 2016). As with other chronic

relapsing conditions, the clinical course of OUD includes periods of exacerbation and remission,

but the patient is never disease-free. People with OUD can also experience severe withdrawal

symptoms when they stop or reduce opioid use, such as negative mood, nausea or vomiting,

muscle aches, diarrhea, fever, and insomnia (SAMHSA, 2015).

The Function of MAT

Opioid Use Disorder can be difficult to treat as it is similar to other chronic relapsing conditions,

such as diabetes, and can be difficult to completely control symptoms and fully adhere to

treatment. Medically-assisted treatment is one of the most effective treatment methods, involving

the use of FDA-approved medication in conjunction with behavioral or psychosocial therapy

(PCT, 2016). MAT pairs nondrug therapies, such as counseling or cognitive behavioral therapy,

with an FDA-approved medication to treat OUD. These drugs—methadone, buprenorphine, and

naltrexone—are available in various product formulations and doses. Each medication differs in

the way it works to relieve symptoms of opioid withdrawal and/or block the euphoric effects of

the drugs. 

FDA-Approved Medications and their Mechanisms of Action

As the above table illustrates, methadone is a full agonist, meaning it lessens symptoms of opioid

withdrawal and blocks the effects of other opioid drugs. Its effects last 24-36 hours. Even though

methadone binds to and activates the brain's opioid receptors like heroin or other opioids would,

methadone does not have the same euphoric effect because it binds much more slowly (NIDA,

2018). No optimal length of treatment for methadone has been established, but 12 months is

usually considered the minimum amount (PCT, 2016).

Buprenorphine is a partial agonist, meaning it binds with opioid receptors, but not as strongly as

a full agonist does. The medication's effects plateau after reaching a certain level, so people do

not get a greater effect even with repeated dosing. Buprenorphine reduces cravings and

withdrawal symptoms. It does not produce the euphoria of other opioids and has fewer

dangerous side effects. Buprenorphine is available as a tablet, a film that dissolves in the mouth,

or a subdermal implant that lasts 6 months. This can be a good option for people who struggle

with taking MAT medication daily. (NIDA, 2018).

Naltrexone is an antagonist. It prevents opioids from binding to opioid receptors. Naltrexone

does not create a euphoric feeling and therefore does not create dependence (PCT, 2016). If
Effects of Medication-Assisted Treatment for Opioid Use Disorder 5

someone takes opioids while on Naltrexone, the opioids have no effect. Naltrexone can only be

given to patients who have completely detoxed from opioids, so it is not an ideal option for early

treatment (AATOD, 2017). One advantage of naltrexone is that it comes both as a daily pill and

as a long-lasting injectable.

Behavioral Health Treatment

Psychosocial treatment is recommended in conjunction with MAT drug therapies as many

patients show greater improvement and better long-lasting outcomes than those that do no

behavioral health treatment. When an OUD patient comes to the therapist, they should begin to

formalize what their treatment goals are and create a time frame in which to complete them.

Some examples of those goals might be to modify underlying behaviors that may lead the patient

to misuse opioids. A therapist should encourage the patient to adhere to their prescribed

medications while treating any other existing psychiatric disorders. Psychosocial treatment

begins with an assessment of a patient’s psychosocial needs and the development of a patient-

specific treatment plan. Treatment may include one or more of the following: Individual or group

counseling; connection to family support systems, including family therapy; referrals to

community-based services; contingency management—an evidence-based intervention that

provides tangible rewards (often vouchers to exchange for retail goods and services) for positive

behaviors such as abstaining from opioids; and mutual help programs, such as the Narcotics

Anonymous 12-step facilitation therapy, may also be offered as an ancillary service (PCT, 2016)

Benefits of MAT

Evidence of the efficacy of MAT has been proven by extensive studies, and for most people, the

use of medications combined with psychosocial treatment is superior to drug or psychosocial

treatment on its own (ASAM, 2022). For example, research shows that MAT significantly

increases a patient’s adherence to treatment and reduces illicit opioid use compared with nondrug

approaches (AAOTD, 2017). By reducing risk behaviors such as injection of illicit drugs, they

also decrease the transmission of infectious diseases such as HIV and hepatitis C (Kampman and

Jarvis, 2015). However, despite MAT’s demonstrated effectiveness, many people are unable to

access its benefits.

Barriers to receiving MAT

One obstacle facing the widespread implementation of MAT is that treatment programs have

been slow to offer MAT drugs. Only 23 percent of publicly funded treatment programs reported

offering any FDA-approved medications to treat substance use disorders, and less than half of

private-sector treatment programs reported that their physicians prescribed FDA-approved

medications (Knudson et al, 2016). Two key barriers to the use of MAT are limited insurance

coverage and cost, and a lack of qualified medical personnel (certified OTPs and certified

buprenorphine prescribers). The National Center on Addiction and Substance Abuse (2016)

concluded that although the Affordable Care Act mandates that insurance companies pay for

OUD treatment, it does not specify which benefits must be covered. As a result, drug and

behavioral therapies that may be optimal for a specific patient are not always covered. In

addition, treatment services may be covered only for a specific period of time, creating harmful

limitations. The lack of authorized buprenorphine prescribers for the treatment of OUD is also a

critical factor in the treatment gap. In Illinois for example, Medicaid covers buprenorphine and

injectable naltrexone and recently received approval to allow Medicaid reimbursement for

Opioid Treatment Services (methadone maintenance) as of January 1st, 2017 (AAOTD, 2017).
Effects of Medication-Assisted Treatment for Opioid Use Disorder 7

Misconceptions of MAT

Some misconceptions persist regarding the effectiveness of MAT for sufferers of OUD,

especially when treating incarcerated individuals.  Friedman et al (2011) examined that the

limited use of MAT in criminal justice may be due in part to officials’ lack of understanding of

OUDs, how opioids affect the receptors in the brain, or how MAT medications work or their

proven effectiveness. In most settings, implementation of MAT in correctional facilities has

primarily been limited to naltrexone and is not available to all who have a diagnosis of OUD.

Some jails and prisons may prohibit the use of any controlled substances, lack qualified medical

staff, and/or prefer treatment that does not use medications. Some may have the misperception

that MAT is just substituting one addiction for another since some of the treatment medications

are also opioids. Medications for OUD are prescribed to people who have developed a high

tolerance for opioids. The dosage they receive helps prevent withdrawal and intense cravings,

but does not create a euphoric effect or "high." Generally, medications used in MAT are tapered

slowly over a period of months or years to give brain circuitry time to recover from prolonged

drug use (NIDA, 2018).

Conclusion and Implications

While MAT is the most effective treatment for OUD, patients may need to try more than one

drug to achieve their goals. An individual’s treatment plan may include multiple types of

cognitive therapies. Improving awareness of how MAT works, ensuring comprehensive coverage

of all services, and expanding access to eligible providers will all contribute to mitigating the

grave ramifications of the opioid epidemic and preventing its spread. Furthermore, NIDA (2021)
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concluded that the greater implementation of MAT will help address the growing public health

crisis with devastating consequences such as opioid-related overdoses, misuse during pregnancy,

rising incidence of neonatal abstinence syndrome, and increasing injection drug use contributing

to the spread of infectious diseases such as HIV and hepatitis C. Clinicians can use MAT as a

tool and a weapon to combat the epidemic and to help families and individuals gripped in their

own struggles, helping them to heal and recover. Drug overdose is preventable and state and

local governments must initiate primary prevention and harm reduction strategies, increase

access to naloxone (Narcan), provide safe consumption sites and clean needle exchange, and

distribute fentanyl test strips. Moreover, developing direct routes to treatment is paramount if

individuals suffering from OUD wish to have a long-lasting and healthy recovery.
Effects of Medication-Assisted Treatment for Opioid Use Disorder 9

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