Concern about opioids – especially the growing threat of overdose posed by illicit fentanyl – has created heightened awareness about treatment options for people with substance use disorders. One of the oldest and most effective is medication-assisted treatment (MAT).
Also frequently called medications for opioid use disorder (MOUD), MAT is a proven treatment approved of by all major medical organizations, including the Texas Medical Association. It has faced stigma and misunderstanding, even among many health care professionals. But physician experts in addiction say it is a key tool in combating substance use disorder, especially for opioids.
What is MAT or MOUD?
MAT is the use of medications and counseling to treat people with substance use disorder. People addicted to alcohol and tobacco can benefit from MAT. But historically, the approach has been used to treat opioid use disorder treatment, so MAT is commonly referred to as MOUD, says Austin addiction psychiatrist Carlos Tirado, MD, a member of TMA’s Subcommittee on Behavioral Health. The medications used are approved by the Food and Drug Administration. Their use is coupled with counseling to help the patient deal with the psychological aspects of substance use disorder.
Is MAT, or MOUD, effective?
Yes. Several studies show that compared to no treatment or treatments not involving medications, MOUD decreases risk of drug-related death and suicide by over 50%. The three medications used – methadone, buprenorphine, and extended-release naltrexone – are consistently associated with improved health outcomes, including reductions in opioid use and transmission of HIV and hepatitis C. MAT is similarly effective in treating alcohol use disorder, and smokers who receive a combination of behavioral treatment and cessation medications quit at higher rates than those who receive minimal intervention, according to the National Institute on Drug Abuse.
“We know this is the standard of care for opioid use disorder,” said Ann Marie Case, MD, an Austin addiction specialist. “We’ve known that since the 1970s and we’ve known that it works.”
And since physicians no longer must obtain an X waiver to prescribe buprenorphine, physicians who are not addiction specialists can more easily offer MOUD to patients, she says.
Why is there stigma about MAT?
Perhaps the most common misconception about MAT is the patient is switching one addiction for another.
“That’s a huge component of the stigma that I see among my colleagues when I get phone calls or get asked to consult,” Dr. Case said.
However, that belief is not founded in truth. These medications normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative and euphoric effects of the substance used, according to the Substance Abuse and Mental Health Services Administration.
Like any medication, those used in MAT can be misused. But in the overwhelming number of cases, it’s not, Dr. Tirado says. And the stigma against medication assistance for opioid use disorder, in particular, means that at least 87% of people who need this treatment are not getting it, according to a recent study.
“Most of my patients know there’s a treatment from what they’ve heard on the street from other people, not from a health care professional,” Dr. Case added.
How important is the counseling aspect for MAT?
Just like other chronic conditions, substance use disorder requires that medication be coupled with other types of treatment to maximize its effect, Dr. Tirado says. In the case of MAT, that other treatment is counseling, which helps people learn how to resist drug use and build healthier relationships.
“Psychosocial interventions, addressing comorbidities – be they physical or psychiatric – those are all part of what we call a plan of sustained recovery,” he said. “It does require a comprehensive approach.”
Here are several physician resources for MAT and MOUD: