What is Medication-Assisted Treatment?
Medication-assisted treatment (MAT) is the treatment of opioid use disorder with agonists like Suboxone or methadone. The tremendous stigma already established against addictive behavior makes it an easy target for critics. 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 consider both the scientific and socioeconomic aspects of treating substance use disorder (SUD).
What does the science say about the effectiveness of buprenorphine treatment?
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 two 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).
This study shines a light on 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.
MAT can help in residential treatment.
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.
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 Programs like this have popped up recently, 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.
Treatment cost often stands in the way.
And what’s a huge hang-up to meeting a client’s needs, especially in this climate of healthcare uncertainty? 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 $9,009 (Workit Health may be a more affordable MAT option). 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. In 2017, the annual household income per capita was $29,429. These figures clearly show that residential care is simply not affordable for the average citizen. Suboxone can clearly help individuals to be more productive and more socially successful. Why should we stop individuals who can’t afford residential treatment from retaking control of their lives?
“The average cost for long-term therapeutic communities is $587 per week. The per capita income of a Michigan resident is $26,607 or $511 per week.”
Which works better—Inpatient care or MAT?
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. At Workit Health, we believe that increasing the availability of MAT along with psychosocial care will have a positive impact. 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.