Medication-Assisted Therapy (MAT) for Substance Abuse Recovery Providers
The use of medication in the substance abuse disorder recovery process has always been controversial. While well-established methadone maintenance programs correctly assert the benefits which many users have experienced from methadone maintenance treatment, there are other accounts which are less reassuring. The effects of methadone in an individual’s system can far outlast its analgesic and euphoric benefits, a fact which has led to numerous fatal overdoses from cardiac arrhythmia and respiratory depression. This represents a rising trend: methadone is currently the culprit behind almost 40% of fatal overdoses involving prescription painkillers, a rate far higher than that of any other individual medication.
From 1999 through 2014, the rate of fatal methadone overdoses increased by more than 500%; during this same period in time, fatal overdoses involving prescription opioids in general increased by approximately 300%. The overall trend is disturbing, but a comparison of these two figures suggests that much of this increase falls squarely on methadone. MMT providers, in cooperation with the CDC and other agencies, have made adjustments to both dosage and policy in an effort to compensate, but there are other alternatives to the use of methadone, LAAM, and other potentially dangerous agonists.
SAMHSA’s MAT guidelines
Since 1992, the Substance Abuse and Mental Health Services Administration has maintained guidelines and protocols for providing care to a wide range of individuals, including people with mental health concerns and addiction disorders. The growing recognition of co-occurring disorders (in particular, of the possibility that they may be informing substance abuse disorder in the majority of individuals who present with it) has led to an increase in the general public awareness of SAMHSA and its policies.
Under the agency’s regulations, MAT-based therapies (which include, but are not limited to opioid treatment programs, or OTPs) strongly emphasize the role of medication as a support mechanism, rather than placing it in a more central role. Medication is used to assist a user with overcoming their psychological cravings, so that they might focus more deliberately on the counseling and behavioral therapies which comprise the remainder of their treatment. To this end, SAMHSA-approved OTPs frequently involve buprenorphine. The effects of this partial agonist are gentler, and much more widely dispersed over time, than those of methadone.
Who May Administer MAT-based Therapy?
Under SAMHSA guidelines, various government agencies and nonprofit organizations are in charge of opioid treatment program accreditation. A physician may write a prescription for buprenorphine-based medication, such as Suboxone and Subutex, provided they meet all prerequisite qualifications. Nurse practitioners and physician assistants may also qualify, after receiving relevant training. There is a forum, maintained by SAMHSA, which physicians and other qualified buprenorphine dispensers may join. This provides a platform for submitting queries about official policy, and for discussing the clinical use of buprenorphine in general.
Individuals seeking the appropriate training and certification are strongly encouraged to view SAMHSA’s regularly updated list of webinars and events, including seminars and workshops, relating to the implementation and maintenance of medication-assisted therapy. There are also training materials for buprenorphine, and courses available regarding the proper procedures for prescribing opioids in general. For additional information on the use and effects of buprenorphine, and on the proper implementation of MAT protocols, there are professional associations and other privately-maintained support organizations which can provide additional resources and perspective.