Medication-Assisted Treatment (MAT) FREEDOM NOW

Medication-Assisted Treatment is something that needs attention. Many people do not understand what it is or how it works. Let alone its success rates. This is due to many reasons such as bad information or myths surrounding it. Medication Assisted Treatment (MAT) is a way to treat substance abuse with the use of medications. It is important to note that counseling along with this type of treatment is imperative, which we will go over in this article. This is an effective type of therapy with successful rates. Here is more about Medication Assisted Treatment. We will look at what it is, what is involved, a few of the myths and facts, and statistics on the rate of opioid use in America.

The Opioid Epidemic

According to an article by CNN posted on 5 News:

Heroin-related deaths increased 439% from 1999 to 2014. As of 2014, heroin-related deaths had more than tripled in five years and quintupled in 10 years.

In 2014, opioids were involved in 28,647 deaths — 61% of all US drug overdose deaths — and 10,574 were related to heroin, in particular.

Data from 2014 reflects “two distinct but interrelated trends,” the CDC notes, a long term increase in overdose deaths due to prescription opioids and a surge in illicit opioid overdose deaths, mostly related to heroin.

The opioid epidemic in America has become severe. As stated on the Centers for Disease Control and Prevention:

• From 1999 to 2017, more than 700,000 people have died from a drug overdose.

• Around 68 percent of the more than 70,200 drug overdose deaths in 2017 involved an opioid.

• In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was six times higher than in 1999.

• On average, 130 Americans die every day from an opioid overdose.

Much of the problem started in the 1990s. Back then pharmaceutical companies assured physicians that opioids were not addictive so doctors prescribed them freely. Sometimes something as simple as a troublesome teeth cleaning warranted an opioid prescription. And why not? They helped with pain and were not addictive - or so it was thought. It turns out that opioids are highly addictive.

In 2010, the latest surge in deaths from drugs was related to heroin use. Then in 2013 the fatalities came from synthetic opioids. These include things like counterfeit pills and manufactured heroin and fentanyl.

In 2017, there were over 47K deaths from overdosing on opioids with almost 2 million people who are suffering from substance abuse disorders.

According to Drug Abuse:

• Up to almost 30 percent of patients misuse their opioid prescriptions

• An average of 10 percent develop a disorder related to opioids

• An average of five percent transition to a heroin addiction

• Almost 80 percent of heroin users first had an opioid problem

• In just a year's time, in 45 states the amount of opioid overdoses increased by 30 percent

• In the Midwest, this increase was by 70 percent

• In large cities in 15 states, the overdose percentage went up by over 50 percent

What Do the Experts Say?

There are two models of addiction. One is the moral model which is exactly how it sounds. That belief is that the person who is addicted made their own choices through a lack or morality or conviction. The second model is the disease model. In this model, the belief, which is backed by ASAM (the American Society of Addiction Medicine, is that addiction is a disease. It should be treated the same way that other diseases are treated and it is addiction as a primary, chronic disease of brain reward, motivation, memory and related circuitry. The US Surgeon General backs this model and agrees addiction should be treated as a disease, not a choice.

Clinical evidence, including medication assisted therapy dictates that treatment is imperative for this chronic disease. It has even reached the White House where Obama budgeted $1.1 billion to support cooperative agreements with States to expand access to medication-assisted treatment and the current administration budgeted $1.8 Billion in funding to states to continue combating the opioid crisis.

As professionals, we care. It is the treatment that is given that helps make the different. A good example is treating an overweight person. The doctor can suggest that the person lose weight but their needs are still met as far as medication. If they need insulin they are not denied this due to their life choices. Medication assisted treatment is similar in helping someone become free of their addiction while using the medication they need.

What is Medication Assisted Treatment?

Medication Assisted Treatment (MAT) is a way to help sustain recovery in treating opioid use disorders (OUD). This is also known as addiction antagonist therapy. There are three particular medications used in this program:

According to the FDA:

There are three drugs approved by the FDA for the treatment of opioid dependence: buprenorphine, methadone, and naltrexone. All three of these treatments have been demonstrated to be safe and effective in combination with counseling and psychosocial support. Everyone who seeks treatment for an OUD should be offered access to all three options as this allows providers to work with patients to select the treatment best suited to an individual’s needs.

How Do These Medications Help?

First, we should understand how opioids work. Opioids attach to proteins called opioid receptors on nerve cells in the brain and other parts of the body. The dopamine levels in the brain is what is called the "feel good" transmitters and activities that feel good create a surge in these dopamine levels. They work well to relive pain and in the 90s, doctors were not informed by pharmaceutical companies that these drugs were highly addictive. This led to a surge in them being prescribed.

The problem is that they are indeed addictive. The reason is that this dopamine, as mentioned, make us feel good. Other things that are addictive do the same thing such as someone who is addicted to gambling and how they feel when they go to a casino or track. Or a person who is addicted to food and feels that good feeling when eating.. When someone does something that gives them a euphoria, these dopamine surges are rampant. Some studies even mention the high people get from social media likes. Whatever makes us feel good gets the dopamine going - just like opioids.

The activities that cause the dopamine levels to increase are both behaviorally oriented and substance based. It's that feeling of a high that you get that causes you to want to repeat whatever it is that caused it in the first place.

Like any addiction though, that high gets harder and harder to get. This leads to more use of the drug just to get the same feeling the person once had. Once the person is taking too much of the drug, they risk side effects or even death.

Even if a person wants to stop taking the drug it can be difficult. This is because the withdrawals are sometimes severe and at the very least, unpleasant. Yet, using the drug makes the person feel good, which is a positive reinforcement.

About the Medications With the MAT Program

These medications allow for a way to get off of the opioids without the euphoria that opioids give them. This takes away any positive reinforcement and helps with cravings.

The first group includes what are known as Opioid Antagonists.

Antagonists work due to binding to the mu receptors in the brain. They do this stronger than opioids so that the opioids that the patient takes do not cause the dopamine levels to strengthen. In layman's terms, patients simply do not get the euphoria from the opioids, which means that they may find it easier to quit since the whole point is to feel that good feeling they normally get.

The second group includes Opioid Agonists and Partial Agonists

Methodone is a common drug used for this purpose. According to the government's Drug Abuse site:

Methadone is a synthetic opioid agonist that eliminates withdrawal symptoms and relieves drug cravings by acting on opioid receptors in the brain—the same receptors that other opioids such as heroin, morphine, and opioid pain medications activate. Although it occupies and activates these opioid receptors, it does so more slowly than other opioids and, in an opioid-dependent person, treatment doses do not produce euphoria. It has been used successfully for more than 40 years to treat opioid use disorder and must be dispensed through specialized opioid treatment programs.

Buprenorphine is a partial opioid agonist, meaning that it binds to those same opioid receptors but activates them less strongly than full agonists do. It is similar to methadone in relieving cravings and withdrawals and like methadone, it does not produce a euphoric experience. This one was the first to be eligible to be prescribed by certified physicians through the Drug Addiction Treatment Act. What this means is that someone does not have to visit a specialty clinic in order to be prescribed. Instead, they can see their doctor. This ensures that the help is expanded to those who need it and has a better reach of access.

As part of the Freedom Now MAT program, we utilize Suboxone as the supportive medication to help treat patients suffering from opioid use disorders. Suboxone is a combination of buprenorphine and naloxone and blocks the effects of opioids and reduces cravings.

How naloxone works is that it blocks the opioid receptor's activation. So where the opioid agonists and partial agonists help with cravings, this one does not. Instead, it makes it so that the opioids do not give the pleasure that they usually do. There are no rewards or euphoria when you take them in conjunction with Naltrexone. In the past it was not well-tolerated but in recent years there has been a more long-lasting, injection form. This was originally used to treat alcohol addiction and garnered approval from the FDA for use with opioid addiction treatment.

What is Suboxone Like?

Suboxone is an approved medication for MAT. As stated on the Harvard Health Blog:

Suboxone, a combination medication containing buprenorphine and naloxone, is one of the main medications used for medication-assisted therapy (MAT) for opiate addiction. Use of MATs has been shown to lower the risk of fatal overdoses by approximately 50%. Suboxone works by tightly binding to the same receptors in the brain as other opiates, such as heroin, morphine, and oxycodone. By doing so, it blunts intoxication with these other drugs, it prevents cravings, and it allows many people to transition back from a life of addiction to a life of relative normalcy and safety.

There are a few myths concerning Suboxone that we can dispel for you.

One of the myths is that by taking Suboxone, you are not really in recovery. This is far from the truth. Just because you are using an FDA approved medication does not mean you are simply trading one drug for another. Abstinence is not the only way to recovery even if some believe so. If a person who has Type 2 Diabetes is on insulin, it does not mean that they are not trying to maintain their blood glucose levels. The Suboxone is a medication just like any other.

Some people are under the impression that many people abuse the Suboxone. While it is like an opiate and can be abused, there is a difference. Suboxone is a partial antagonist. What this means is that it does not create the same level of euphoria as an opioid such as heroin. For the most part, some may "abuse" it to manage their withdrawals better.

You can overdose just like with an opioid. While an overdoes may be possible under the right circumstances, it is extremely rare that someone would. This is because as mentioned above - it is only a partial antagonist. Not only are there a limited number of opioid receptors but it does not create the same slowed breathing as other opioids. It has its own ceiling effect due to its composition as a partial antagonist.

You should take it briefly. Just like someone on any type of medication, you take it as long as you needed. There is no discernible research stating that it can only be taken for a short period.

An obstacle in treatment is that not everyone can afford it or has insurance. Some people are only able to receive the Suboxone without counseling and therapy. This is where we come in to help. Combined, the MAT program works best along with counseling, therapy, and a good support group.

Now there is a drawback with taking medication used to help control withdrawals and make recovery easier. This is the wait time between the drug and the medication.

One of the issues is that a patient has to be off of any and all opioid or opioid-type products typically for one week or up to two full weeks. This also includes the use of methadone.

Let's say a patient is addicted to oxycontin and is on methadone. They cannot immediately be placed on another type of medication or product. Nor can a person come right out of detox and be immediately put on a Medication Assisted Treatment. There is a specific reason for this. The antagonist has much more of a correspondence for the mu receptors in the brain. What this means is that if the person does not wait the full time and there are opioids occupying those receptors, when the antagonist is used it kicks off the opioids. This means that the person suffers from extreme withdrawal symptoms.

And therein lies the problem for some people. They feel they cannot or will not choose to not use for the time needed, whether it's a week or two weeks. They may not want to go through the withdrawal symptoms of doing without for even a day or so, let alone up to two weeks. So that is why although the program is successful, it is sometimes a challenge for patients to accept.

The good news is that suboxone has a shorter wait time. It depends on the type of drug being used but the longest time is a week. The shortest time wait is 8-12 hours for morphine. Each type of drug has a different wait time. For example:

• Morphine: 8-12 hours

• Heroin: 12-24 hours

• Oxycodone and hydrocodone: 12-24 hours

• Oxymorphone: 24-30 hours

• Methadone: 36 hours to a week

There is something called precipitated withdrawal. This is the rapid onset of opioid withdrawal symptoms brought on by taking a medication such as Suboxone before the last of the other opioids are completely out of your bloodstream. And this is why the wait time is important so that these precipitated withdrawal symptoms do not occur.

We Care

Medication-Assisted Treatment should be tailored to the individual. Not everyone is the same, nor does everyone respond to the same treatment. Yet, by reducing the stigma about treatment and finding the support that is needed for those with an opioid disorder, help can successfully be achieved.

Freedom Now cares about you and getting you the help you need. We know how busy and hectic life can get. Our unique, individualized treatment programs are designed to fit your lifestyle while getting you the immediate help you deserve. Our board-certified addiction psychiatrist and team of medical and clinical professionals will help get you started on a plan geared toward long term freedom.

Free to Work

We offer open, flexible hours that fit in with most work schedules so you don't have to sacrifice time away from work.

Free to Play

Without the restrictions of standard treatment, you're free to do the things you enjoy most while getting the help you need.

Free to Live

When you're in a good place mentally and physically, you're able to enjoy your life and feel good about yourself.

Giving you the care you need, when you need it. Find your Freedom Now!

SUBSTANCE ABUSE & MENTAL HEALTH TREATMENT OPTIONS:

• Medical & clinical evaluations

• Medication-Assisted Treatment (MAT)

• Unique outpatient program

• Individual & group therapy sessions

• Social & life skill services

• Medication management

• Flexible scheduling

• Laboratory testing & services

• Telehealth options available

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