Medication-assisted treatment (MAT) is the use of medications with counseling and behavioral therapies to treat certain substance use disorders and prevent opioid overdose. MAT is primarily used for the treatment of addiction to opioids such as heroin and prescription pain relievers. Because the FDA-approved medications are themselves opioids, MAT is controversial in the addiction treatment community. Many people in recovery do not regard MAT patients as “clean and sober” if they are still taking opioids, even as a prescription.
The medical community is increasingly convinced of the benefits of this treatment approach. “When used appropriately, medications used to treat addiction are not addicting, as they do not cause patients to use them compulsively or in an unhealthy way. Rather, these medications support patients in their recovery,” we read on the factsheet of the American Society of Addiction Medicine (ASAM).
In his presentation as part of the Williamsburg Place Lecture Series, the founder and chief medical officer of the Virginia Center for Addiction Medicine, James Thompson, MD, gave an overview of the basics of medication-assisted treatment (MAT).
Dr. Thompson linked the rise of MAT to the increasing involvement of medical doctors in addiction treatment, a field previously dominated by counselors, therapists, and also peers—people trying to overcome substance use disorders themselves.
The fact that opioid overdoses quadrupled between 1999 and 2014 prompted more serious attention by the medical field. According to Thompson, his profession was partially to blame for the crisis since it was doctors who flooded the market with pain pills after pain was declared the fifth vital sign. The opioid epidemic represents a “failure of healthcare policy. Over-prescribing sparked the crisis but is not responsible for all of the tragedy,” Thompson clarified. At the same time, “public and political leaders are still blinded by stigma and misinformation. There is not a lot of sympathy out there for people with addiction.”
A Complicated Brain Disease
“Addiction is not about drugs; the problem is deeper than that,” Dr. Thompson said. “In popular culture, we like to focus on the latest ‘evil drug’ and talk about it as if it is the cause of all the harm that’s caused.” Thompson views addiction as a brain disease: “to cure addiction, we have to change the human brain. Unfortunately many doctors like to think in mechanistic terms: give them a pill, or perform procedure and on to the next patient—obviously, it is more complicated. However, treatment has to be the main focus of our strategy combating this crisis.”
Treatment needs to improve, but how do we even know what’s working? Thompson suggested this checklist of indicators for successful addiction treatment:
- Physical and mental wellness
- Knowledge of addiction and recovery
- Accountability for effort
- Emotional support and understanding
- Practical help and guidance
- Experience - the joy of connection and acceptance (often pain of relapse)
- Development of recovery habits and skills
Thompson believes MAT can play an important role here but fears a certain rift developing between proponents of harm reduction and defenders of a more traditional “drug-free” recovery from addiction. Thompson hopes for an eventual reconciliation of the two approaches. “MAT saves lives, attracts people not normally interested in recovery, and increases retention of voluntary patients,” he said. It is buying time for the addicted person. “The value to me is engagement over time. It is not a magic bullet but done right, MAT can be a sure and steady pathway to recovery,” Thompson said. “Treatment ultimately works if the patient shows up, and engages with you in an honest way over time. However, recovery must remain the ultimate goal of treatment. The universal key to successful treatment is engagement over time.”