Medication assisted treatment, also known as MAT, is a way to treat opioid addicted patients with one of three FDA approved drugs; naloxone, suboxone and methadone. Naloxone is an injectable drug that blocks opiate receptors for thirty days, and is the newest form of MAT. Suboxone and methadone have been FDA approved since 2002, both are taken orally and daily to block opiate receptors. These are the only FDA approved ways to treat opioid-addicted patients. According to SAMHSA, the Substance Abuse and Mental Health Services Administration, in 2013 an estimated 1.8 million people reported having an opioid use disorder. MAT patients, under federal law, must also receive counseling making the treatment clinically effective as well. The goal of combining counseling and medication is to improve patient survival rates and retention in treatment, decrease the illicit use of opiates and other criminal activities and to help those addicted to gain and maintain employment.
Suboxone and methadone treatment come in different milligrams sometimes to be used more than once a day, which is dependent on how much a person used opioids and for how long. The average person uses suboxone for six months to a year, according to Choosehelp.com, anything less than six months often ends in relapse. Suboxone and methadone withdrawal can last over a month, which is why it is important to be under a doctor’s care as they begin to wean off the medication, which is done one to two milligrams at a time.
However since 2002 when the FDA approved the three different MAT models of addiction treatment, people started questioning the idea of replacing one drug for another. This caused a seven percent decrease in MAT from 2002 to 2010. Since 2010 treatment providers are willing to try anything to get patients off of heroin and fentanyl, bringing medically assisted treatment back to the frontline. Then in the first long-term follow-up of patients treated with buprenorphine and naloxone, two of the three FDA approved MAT for addiction to opioid pain relievers, half reported that they were abstinent from illicit drugs 18 months after starting the therapy. After 3.5 years, the portion who reported being abstinent had risen further, to 61 percent.
In Phillipsburg, New Jersey, everyone is trying to combat the opiate epidemic. Saint Luke’s Hospital led the way when they stopped prescribing opioids to patients in the emergency room, according to town officials. This is following St. Joseph’s Hospital, in Paterson, New Jersey, who was the first hospital to stop presbringing opioids to patients. Saint Luke’s Hospital Crisis clinician Vinny assesses patients who come with mental health issues, one of the biggest being substance abuse. Vinny works with CARES (Center for Addiction Recovery Education and Success), a New Jersey program that helps get people into drug detox and rehab.Vinny said when he calls Amanda Bridge, community outreach specialist at CARES, she is at the hospital within fifteen minutes to get paperwork started on the road to recovery. Among Phillipsburg’s different programs is Stateline Medical Center, a methadone and suboxone clinic that has been open for about 17 years. Stateline Medical, owned by Pinnacle Treatment, offers outpatient therapy for $92 a week if a patient doesn’t have one of their in-network insurers. Outpatient therapy is medication maintenance, one group therapy session and one one-on-one therapy session a week. The facility has a specific level system ? to assure patients won’t be able to abuse their medication. Gerald Mistal, the receptionist and financial advisor at Stateliner, said there is no data to show patient success rate. Mistal, who has been there for 13 years, says some patients have been there as long as him. Standing outside the Stateline by six a.m is a line of anywhere between 100 and 300 patients.
One patient, who asked to remain anonymous, said she has been at Stateline for over a year and has been on the same dose, 16 milligrams, of suboxone for that year, and rarely received her one-on-one therapy due to the “short staff.” I reached out to Stateline without any response.
Many treatment centers across America even stopped using the MAT model, and instead had patients detox in a separate facility for three to ten days, then focused on the 12-Steps and therapy when reentering the rehabilitation centers.
The National Institute on Drug Abuse states that between 40 and 60 percent of recovering drug addicts will eventually relapse on opioids. Technically, Suboxone and methadone are opioid medications, both block cravings and drug seeking without producing a high or impairing functioning when properly prescribed. So why aren’t people using a treatment model that is proven to work? Many treatment centers will tell you they are “abstinence-based,” and their success is getting to the underlying issues, or that it Suboxone is a temporary solution for a permanent problem.
I spoke to James Bailey, Certified National Drug and Alcohol Interventionist and Outreach Coordinator at Holistix Treatment Centers, a drug and alcohol rehabilitation center with two locations in Margate, Florida and Philadelphia, Pennsylvania, about why they began using the MAT model this past August.
Bailey said that the Hazelden Betty Ford Center in Minnesota had previously invited Holistix CEO to the center to show them how MAT could be used effectively. Shortly after that visit Holistix began using the MAT model.
Bailey said, “Working in the addiction field I had to witness countless patients go in and out of treatment over and over and I have seen a lot of individuals pass away due to their disease of addiction. In the south Florida region especially, we have seen the epidemic take over and we knew we had to try something different. We knew there would be a debate if MAT program would be effective or not. However, at the end of the day people are dying every day and it is not getting any better so we had to do something different. After seeing the results from the Hazelden facility we knew if administered properly it could help thousands of people suffering from addiction.”
Bailey says he personally believes part of the reason MAT isn't used more by treatment centers is because of the stigma suboxone has in the rooms of AA and NA.
“I also believe many treatment centers wanted to stay away from the suboxone, which is what we use, due to the fact of some patients coming in for help from using opiates have abused suboxone in the past. Working in the addiction field for multiple years I have heard countless stories of individuals abusing suboxone. Suboxone can be a very hard medication to come off if not tapered the correct way from a doctor. I also believe back in the last 5 years or so many treatment centers just did not do research on the positives of Medically assisted treatment but that also goes back to the stigma MAT programs.”
Bailey also explained to me how he has seen a positive impact from MAT. He explained that “many individuals that we have seen go to 3-5 treatment centers a year, go to treatment start a MAT program and complete the program and engage in treatment. They take advantage of having a therapist and work on things they have going on. I have witnessed many individuals who simply can’t stay in treatment longer than a week without leaving against medical advice stay in treatment and complete a program. I myself am in recovery, when I was in my addiction I have been to 16 treatment centers in 5 years. I have left against medical advice from most of them. I truly believe if I had an opportunity like a MAT program back than I could have possibly got recovery earlier than I did. The end goal in our MAT program is abstinence. A Mat program can be that bridge to get a struggling individual to that point.”
Kayce Waltz, a 20 year old from Saint Louis, Missourri, has used both suboxone and naltrexone to try to get a grip on her addiction. Kayce began using heroin and was put on suboxone, 8 milligrams 3 times a day for 30 days. Waltz said, “I hated it because I was physically sick from it. I couldn’t stay awake throughout the day. I was like a zombie. I felt worse than I did from the heroin alone. As far as counseling goes I was doing IOP 3 times a week but no one on one therapy.”
Waltz decided to try something different, “I switched over to the naltrexone because I had taken it before and stayed clean for 5 months on it, didn’t want to do the shot because I hate shots and didn’t want to be around a needle. I definitely think the naltrexone is helping me to stay sober more than suboxone because I couldn’t get high even if I wanted to. I think all treatment centers should offer these options because what works for me might be different than what works for someone else but it’s important for people to be able to choose what works for them. I have my energy back. I feel now like recovery is possible.”
Waltz isn’t the only MAT success story, Daniel Jones a 26 year old from Baltimore, Maryland was using heroin for five years and was prescribed two 8 milligram strips of suboxone daily after 60 days of inpatient treatment. Jones said it has definitely made his recovery easier by making cravings for the drug dissipate. Jones explained the only negative thing about suboxone, “It is difficult to wean off of. I'm currently tapering off suboxone and it has been hard.” Suboxone detox can be just as bad opioid detox for individuals who have used the drug long-term.
The debate on medically assisted treatment and abstinence based treatment rages on throughout the United States as we try to figure out what to do to combat the opioid epidemic. Some treatment centers, like High Sobriety in Los Angeles, California, have even tried using medical marijuana alongside traditional therapy to help patients deal with opioid addiction.