Medication Assisted Treatment in the Opioid Crisis
What is Medication Assisted Treatment?
Medication Assisted Treatment (MAT)—the treatment of opioid use disorder with agonists like Suboxone or methadone—is an easy target considering the tremendous stigma already established against addictive behavior. This stigma remains despite the fact that “scientific research has established that medication-assisted treatment of opioid addiction increases patient retention and decreases drug use, infectious disease transmission, and criminal activity.”¹ Despite current stigma against MAT, we’re in the face of an opioid epidemic. It’s time to look at the facts, in order to offer people the best care possible and save lives. This means we must look at substance use disorder (SUD) treatment in a holistic manner: with both scientific and socioeconomic aspects considered.
First, let’s talk science.
What do the studies say? Cozzolino et al looked at buprenorphine treatment in Italy over a 3 year period. Of the 131 patients who previously received methadone treatment with an inadequate dosage, 60 patients remained in treatment (46%), 31 dropped out (24%), 13 shifted to methadone (10%), 16 completed treatment (12%), 8 went to prison (6%), and 3 were transferred to other services (2%). Also, 80% of the collected urine samples were negative for opioids.²
An interesting 2015 study looked at the efficacy of a Suboxone taper as a treatment option. While the people who received a long-term taper initially had positive outcomes (nearly 50% were abstinent by the last four weeks of therapy), that success immediately collapsed once they ceased MAT–fewer than 10% were doing well at the end of their 2 month follow up. However, an interview of 300 of the participants 30 and 42 months later revealed that over half had regained their abstinence. This may have something to do with the fact that many of the patients “re-engaged in opioid agonist therapy.” In fact, at the 18 month follow-up mark, those who were still using MAT were more than twice as likely to report abstinence as those who weren’t utilizing MAT (80 percent versus 37 percent).³
This study gives transparency to the topic of MAT: while detoxification has yet to perfected, maintenance on Suboxone is effective for many individuals. It has been shown that Suboxone can help individuals remain socially functional, especially in terms of regained productivity.⁴ The research telling us to consider MAT is there.
Just how effective are residential rehabilitation programs? Also referred to as therapeutic communities, the results on these programs are some what mixed and notoriously difficult to judge. In a 13 month study by Keen et al, the researchers found that the mean stay was 80 days, and that 87.5% of the program participants failed to achieve abstinence. 65% of patients who received in-house detoxification finished the detox program. However, upon departure, 68.1% were classified as failures and only 12% were classified as successes, meaning they either completed their treatment or had planned departures/transfers.⁵
Residential treatment for all SUDs can be an extremely effective treatment option under intense circumstances. Dupont (2009) looked at a program offered to physicians with SUDs. A five-year rehabilitation plan involving intensive treatment, extended support from the patients’ families, employers, and colleagues resulted in 71% of the doctors remaining licensed and employed at the five year mark.⁶ As of recently programs like this have popped up, providing long term support and a residential enclave of supportive staff and patients. Unfortunately, reality and its requirements keep most of the population from having the privilege of being swept away from responsibilities and into a separated facility. Not everyone has supportive families, employers, or colleagues.
A controlled study by Gossop et al compared inpatient to outpatient outcomes. In this experiment, individuals were given a choice of their group and those who had no preference were randomly assigned. Taken all together, the inpatient group did do significantly better. However, the researchers also found that people with their preferences met tend to do better: 53% of the patients in the preferred group completed withdrawal compared to 35% of patients in the randomized group. This indicates that perhaps the success of a treatment depends on the will of the patient. It is also worth noting that, unlike other studies, this study did not provide outpatient individuals with intensive methods like community availability.⁷ Those who get their needs met, succeed. We should meet those needs in any way possible.
And what’s a huge hangup to meeting a client’s needs, especially in this climate of healthcare unsurety? A huge, deciding factor in treatment is cost. Roebuck, et al. (2003) did a cost analysis on SUD treatment options and found that the mean weekly cost of Methadone Maintenance (a form of MAT) is $91 for 99 weeks, a total of $9009 (the Workit Clinic program is $75 per week with Suboxone MAT). On the other hand, the average weekly cost for long-term therapeutic communities is $587 with no medication-assisted treatment included. This is for an average of 33 weeks (a total cost of $19,371)⁸. The per capita income of a Michigan Resident is $26,607, or $511 a week⁹. From these figures we can clearly see that residential care is simply not affordable for the average citizen. It has already been shown that Suboxone can help individuals regain control over their life in terms of social functioning and productivity. Why should we stop individuals who can’t afford residential treatment from retaking control of their lives?
Regardless of which treatment style is “better” than the other, two things are clear: both methods can be effective, and one treatment is significantly less expensive than the other. It is also important to restate that some individuals with substance use disorder may have a preference of treatment. We at Workit Health believe that increasing the availability of MAT along with psychosocial care will have a positive impact on fighting the opioid epidemic. Let’s give people as many opportunities for success as possible, especially if studies show they do better when they get what they want. Not everyone can afford residential treatment, not everyone can afford to take time away from family and work, and not everyone can afford to sit on a waitlist.
Jai Ahluwalia is an undergraduate at the University of Michigan studying Biology and Economics. He is passionate about making science easier to understand and believes that access to this information can have a positive impact on the recovery process.
Olsen, Y., & Sharfstein, J. M. (2014). Confronting the stigma of opioid use disorder—and its treatment. Jama, 311(14), 1393-1394.
Cozzolino, E., Guglielmino, L., Vigezzi, P., Marzorati, P., Silenzio, R., Chiara, M., … & Cocchi, L. (2006). Buprenorphine Treatment: A Three‐Year Prospective Study in Opioid‐Addicted Patients of a Public Out‐Patient Addiction Center in Milan. The American journal on addictions, 15(3), 246-251.
NIDA. (2015, November 30). Long-Term Follow-Up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields “Cause for Optimism”. Retrieved from https://www.drugabuse.gov/news-events/nida-notes/2015/11/long-term-follow-up-medication-assisted-treatment-addiction-to-pain-relievers-yields-cause-optimism on 2017, July 12
Garcia‐Portilla, M. P., Bobes‐Bascaran, M. T., Bascaran, M. T., Saiz, P. A., & Bobes, J. (2014). Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack?. British journal of clinical pharmacology, 77(2), 272-284.
Keen, J., Oliver, P., Rowse, G., & Mathers, N. (2001). Residential rehabilitation for drug users: a review of 13 months’ intake to a therapeutic community. Family Practice, 18(5), 545-548.
DuPont, R. L., McLellan, A. T., Carr, G., Gendel, M., & Skipper, G. E. (2009). How are addicted physicians treated? A national survey of physician health programs. Journal of substance abuse treatment, 37(1), 1-7.
Gossop, M., Johns, A., & Green, L. (1986). Opiate withdrawal: inpatient versus outpatient programmes and preferred versus random assignment to treatment. British Medical Journal (Clinical Research Ed.), 293(6539), 103–104.
Roebuck, M. C., French, M. T., & McLellan, A. T. (2003). DATStats: Results from 85 studies using the drug abuse treatment cost analysis program (DATCAP). Journal of Substance Abuse Treatment, 25(1), 51-57.
QuickFacts. (n.d.). Retrieved July 28, 2017, from https://www.census.gov/quickfacts/MI