Medication Assisted Treatment

The Treatment Process

Treatment for Opioid Use Disorder (OUD) starts after an initial assessment between the MAT treatment provider and patient, during which they can discuss all recommended treatment options. Every patient situation is different, so choosing the best options is a shared decision between the patient and the doctor. However, any prescribed MAT medications should be used along with counseling and other support.

Treatment Plan

After discussing the assessment and treatment choices with the clinician, it’s time to finish the treatment plan.

It is common for both the patient and clinician to sign an agreement that covers what to expect during treatment. This can include: treatment goals, which medications are used, treatment schedule, and a counseling plan.

The treatment plan may also include:

  • Regular visits to the treatment center/clinician.
  • Medications: usually methadone, buprenorphine or naltrexone.
  • Patient commitment to cooperate with treatment.
  • Risks of relapse and other safety concerns.

Patient Participation

Patient participation in treatment and recovery is shown to improve outcomes. Treatment will be ongoing, as addiction is a chronic disease. For this reason, an agreed upon treatment plan ahead of time is strongly recommended.

At the same time, a patient should expect to be treated with respect and dignity and have their concerns listened to when starting or changing the treatment plan.

To avoid health problems, patients must share with clinicians any other medications they are taking or if they drink alcohol regularly. This is very important—certain medications and regular alcohol use can cause major problems with certain treatment medications.

Common patient responsibilities include:

  • Keeping all appointments.
  • Agreeing to drug testing on a regular basis.
  • Taking medications as prescribed.
  • Only using drugs that are prescribed.
  • Allowing and encouraging the involvement of family and friends.
  • Avoiding persons, places, and situations that may cause a person to use a substance again after a period of not using—also known as relapse.

Medication

Most treatment plans will include medication. The type of medication chosen depends on a number of factors, including the patient’s different situations and the treatment setting.

The most common medications used in the treatment of OUD are methadone, buprenorphine, and naltrexone. For more information on these medications, please see Medications Used in MAT.

Counseling is recommended with the use of each of these medications.

Each medication works in a different way and has its own risks and benefits. They also have a special way to be started, and once started, they can be safely taken for years. The clinician and the patient should review the risks and benefits of each medication together.

When used properly, these medications will NOT create a new addiction—rather they help patients manage addiction so they can recover.

If the first medication selected does not work well, the patient and clinician can to find the right medication for the patient’s needs.

Counseling

Counseling is an important part of treatment and is usually required with all medications.

Counseling should be done with a qualified clinician or health professional—this person will play an important role with the care team. Counseling may be done in the same place the medication is given or by another clinician outside the treatment setting.

Counseling helps patients address personal, social, or other problems that may contribute to their addiction. Examples of these problems could be:

  • Improving feelings of self-worth.
  • Difficult situations at work or home.
  • Spending time with people who use drugs or alcohol.

In addition to counseling, patients are also encouraged to join support groups that include other patients who are also in recovery.

Counseling is not limited to the patient—there are also many support groups for the family and friends of those dealing with addiction. Remember, addiction affects friends and family as well.

Withdrawal

Opioid withdrawal refers to the wide range of symptoms that occur after stopping the use of opioid drugs. Withdrawal can last up to 10 days, but most often lasts between 3-5 days.

Although it can cause very troubling symptoms (such as vomiting, cramps, and sweating), withdrawal is rarely life-threatening.

Using medications to control withdrawal (also called withdrawal management) is almost always recommended over trying to quit “cold turkey.” When patients do try to quit “cold turkey,” it can lead to stronger cravings and continued use.

Withdrawal management on its own or with counseling is not treating opioid addiction and may increase the risk of relapse. When treating someone for opioid addiction, maintenance medication in combination with counseling and other support is recommended. Maintenance medication is defined as medication on a consistent schedule for persons with addiction.

Support from Family and Friends

Families and friends play a key role in a patient’s recovery and should try to learn as much as possible about addiction to improve the chances of a long-lasting recovery.

Places, persons, and events associated with addiction may contribute to a relapse. It is very important that a patient avoids persons, places, and other reminders of his/her drug use or learn how to respond to those reminders in ways that do not involve alcohol or drug use. This requires the continued support and encouragement of friends and family who are outside of that environment.

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MAT services can be provided in a variety of settings and accessed through a large network of physicians and treatment facilities, including many primary care physicians.

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