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Medication-Assisted Therapy at Eagleville Hospital

Using medication to treat opioid addiction is nothing new. Since the late 1960s, addiction specialists have offered medications to patients who are physiologically dependent on opioids.

This treatment approach is called medication-assisted therapy, or MAT. The goal of MAT is to keep someone who is addicted to opioids from continuing to use heroin, narcotics, or other drugs by managing withdrawal and cravings.

This is done by prescribing a medication—often another opioid—that’s taken under a doctor’s supervision.


Is MAT Effective?

Although some controversy persists, MAT has become the standard of care for opiate use disorder.

“Some people believe that MAT is a way of not providing more intensive, long-term treatment,” says Charles Folks, LCSW, Director of Community Integration and Strategic Partnerships. “Many addiction specialists used to agree. They subscribed to the abstinence-only model that has roots in the 12 steps of Alcoholics Anonymous and Narcotics Anonymous.”

By turning to medication, some have argued, patients are simply replacing one opioid with another. They argue that a person in recovery must completely abstain; otherwise, they aren’t truly “clean.”

This thinking, Folks says, has been fed by the stigma that addiction is a moral failing instead of a disease. Counseling alone has had a disappointingly low success rate.

In recent years, scientists have begun to better understand how opioids affect the brain. They’ve also studied various treatments and found that MAT is a valid—and often lifesaving—approach.

This is backed up by countless studies, including reviews of all the current research on MAT. Not only has it been shown to save lives, research demonstrates that when MAT is used under medical supervision and alongside other treatments, it cuts the mortality rate among patients in half.

That’s why most major public health organizations, such as the World Health Organization, the Centers for Disease Control, and the National Institute on Drug Abuse, acknowledge the usefulness of MAT.


How Does MAT Work?

When a person’s body becomes dependent on opioids, they need a certain level of the drug to stave off withdrawal symptoms. This can include:

  • Nausea and vomiting
  • Abdominal cramps
  • Body aches
  • Dilated pupils
  • Inability to sleep
  • Severe anxiety or agitation

To avoid these debilitating symptoms, some return to opioids, such as heroin and prescription painkillers. This increases the risk of overdose and death.

That’s where MAT comes in. Certain medications taken under a physician’s supervision can stop this cycle.

Not every doctor or treatment facility offers MAT. Special state and federal certifications are required to offer MAT, and they must be renewed annually or every three years.


Which Medications Are Used in MAT?

MAT typically involves one of three medications:

  1. Methadone
  2. Buprenorphine
  3. Naltrexone


Methadone

Methadone is the earliest form of MAT and is still used today. Methadone is offered only in clinics and is usually taken one time per day.

Eagleville Hospital is licensed to provide methadone and uses it mainly in detoxification. In some cases, patients begin methadone treatment while at Eagleville. Then, they can transfer to a local methadone clinic when they’re discharged.


Buprenorphine

Another common option, buprenorphine (also called Suboxone), is taken at home once or twice a day. Eagleville Hospital is licensed to provide buprenorphine.

“Because they’re opioids, methadone and buprenorphine can stop cravings and withdrawal symptoms,” says Robert Lennie MD, an Eagleville Hospital physician. “When used in a medical setting, they don’t produce the euphoric high that opioids can cause when misused. Even better, they reduce the risk of relapse because the patient no longer needs other opioids to avoid withdrawal.”


Naltrexone

Although they can be effective in reducing the risk of overdose, methadone and buprenorphine aren’t suited for every patient.

For instance, methadone requires finding and then getting transportation to and from a local clinic.

Buprenorphine requires a monthly prescription instead of a daily visit to a clinic. However, not all patients have access to someone who can prescribe it after discharge. This is has slowed the adoption of buprenorphine at Eagleville.

A third option—naltrexone—is more viable. In the last six months to a year, Eagleville Hospital has increasingly turned to naltrexone (also called Vivitrol) for its MAT program, according to Lennie.

Naltrexone doesn’t need to be taken daily. Instead, it’s injected once a month, and its effects last all month. Naltrexone blocks the effects of opioids up to certain doses, which makes it harder to experience euphoria—or overdose—on opioids.

Because it changes the body’s response to opioids, naltrexone requires full detoxification, (usually 3 to 10 days). An oral version of naltrexone can be prescribed before using the long-acting injected version to assess its safety and effectiveness.

“There’s no one-size-fits-all approach,” Lennie says. “When prescribing one of these medications, we must personalize treatment to each patient. Certain medications work better than others depending on the patient’s physiology and life circumstances. That’s why appropriate assessment and education is critical to the success of our MAT program.”


How Is MAT Used at Eagleville Hospital?

To start, Eagleville Hospital staff discusses the various forms of MAT available to patients. This helps them make an informed choice about treatment. Then, patients work with Eagleville Hospital staff to plan how they will keep using MAT—if appropriate—after they’re discharged.

“Our counseling staff works with patients to identify housing, a clinic, or a prescriber that will help them continue MAT if they need to,” Folks says. “We try our best to afford each person a choice.”

Patients given MAT also receive therapy to help them learn to deal with circumstances that can lead to relapse. Twelve-step programs and support groups are also used with MAT. Medication can help avoid relapse, but education and therapy are necessary to build a solid life in recovery.

“Here at Eagleville Hospital, we continue to support abstinence-based recovery when appropriate,” Folks says. “We offer up-to-date medical therapy to strengthen recovery and engender the growth that’s key to long-term recover.”