By | October 30, 2019

The opioid epidemic has received a lot of national attention in recent years between the deaths of high-profile celebrities and the lawsuits against pharmaceutical companies. And while progress has been made in legislation and funding initiatives to help health care providers address the opioid epidemic in their communities, opioid-related deaths have increased steadily every year since 1999.

A 2018 study by the National Center for Health Statistics showed that there were over 47,600 deaths related to opioid overdose in 2017, which is six times higher than it was in 1999. It was also in 2017 when the Department of Health and Human Services (DHHS) declared the opioid epidemic a public health emergency. One thing learned for certain over the past two decades is that medication-assisted treatment programs work in helping patients struggling with opioid addiction. MAT is a lifesaving option for the over 2 million people in the U.S. who have an opioid use disorder.

But First: What Are Opioids, Anyway?

With all the talk about opioids and their effects, many people still do not know which types of drugs would be classified as an opioid. Common opioid prescriptions include fentanyl, codeine, morphine, oxymorphone, hydrocodone, and oxycodone. These are still being used by patients across the U.S. every day for issues ranging from chronic pain and cancer treatment to post-surgical recovery. Heroin is never used as a medicine in the U.S. and is considered one of the most dangerous opioids.

Methadone and Buprenorphine, which are commonly used in medication-assisted treatment (MAT), are classified as opioid agonists, meaning they stimulate the same opioid receptors in the brain. While it may seem counterintuitive to use opioids as part of a MAT program, these medications can actually help prevent withdrawal symptoms from and cravings for other opioids because they have to be taken using a strict regimen, they typically work slower than other opioids like heroin, and they do not produce the same sense of euphoria.

Why Medication-Assisted Treatment?

For individuals struggling with opioid dependence, MAT can provide relief from withdrawal symptoms, opioid cravings, and in many cases, can treat and prevent opioid overdose. MAT has also been shown to help many of these individuals lead healthier, more productive lives. The four types of medications approved for use in MAT programs are:

Methadone

The most widely known MAT medication, methadone has been used for decades to treat opioid addiction, particularly heroin. It is almost always administered in a controlled clinic setting under the supervision of a prescribing provider. Methadone can be addictive and must be taken as prescribed to prevent overdose or misuse.

Buprenorphine

Approved by the Food and Drug Administration in 2002, buprenorphine can be prescribed to a patient by a qualified physician or prescribing practitioner in a variety of treatment settings, which has significantly expanded access to treatment. Buprenorphine has a “ceiling effect,” meaning that beyond a moderate dose, the effects of the medication do not increase, which minimizes the risk of misuse or dependence.

Naltrexone

Unlike methadone and buprenorphine, naltrexone does not activate opioid receptors in the brain, rather it reduces opioid cravings by blocking the experiences of euphoria or sedation—essentially preventing the feeling of getting high. Naltrexone also has no potential for abuse, but for it to work patients must be opioid-free for at least seven to 10 days.

Naloxone

More popularly known as Narcan, naloxone is used in emergency situations for an opioid overdose. It can be prescribed by a provider and is commonly carried by first responders. Naloxone can be a lifesaving intervention by reversing the effects of an opioid overdose. Naloxone is only effective if there are opioids present in the patient’s system but is not effective for non-opioid overdoses.

Importance of Whole-Person Care

As the name implies, medication intervention should only be one component of MAT. It is widely accepted in the healthcare community that attending counseling and community support groups along with medication is the gold standard for treatment, and this is strongly advocated for by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Under federal law, MAT patients must also receive other medical, counseling, and social support services including educational and vocational support. This combination of services helps give patients the best chance at full recovery and a meaningful life. An integrated care approach is the best way to promote the whole-person treatment needed to help patients stay in recovery. There is a growing trend across the country of delivering these services in the same clinic using a comprehensive treatment team including physicians, therapists, social workers, nurses, and peer support specialists.

Outcomes and Effectiveness

Studies show that for many patients MAT programs can help them stay in recovery longer and have better health and quality of life outcomes. While relapse is always a risk for patients with opioid dependence, MAT intervention substantially decreases this risk. And at the forefront of the fight against the opioid epidemic, MAT intervention can even be lifesaving.

Advocacy groups, professional mental health organizations, and even state and federal legislation have all continued to push for more access to and funds for MAT programs, resulting in an increase in MAT services across the U.S. However, there are still gaps between the treatment needed and the capacity to provide treatment.

Access Challenges

There is a large gap in the U.S. between the number of individuals who meet the clinical criteria for opioid addiction and those who receive MAT due to challenges that prevent access to care. These challenges include stigma and insurance coverage, but also training and coordinated care:

  • Restrictions on who and where MAT can be administered may result in a treatment center’s inability to accept new patients.
  • Some treatment centers do not carry all MAT medications, which limits options.
  • Some patients are refused administration of MAT medication, particularly in rural communities, due to a lack of coordinated care with mental health professionals.

The Need for Competent Care

The complicated nature of opioid addiction means that individuals struggling with opioid dependence are often the most vulnerable and most in need of care. These individuals need competent, compassionate health care providers and communities who are equipped with the knowledge to support them throughout the treatment process and connect them to resources needed for the best possible outcomes.

If you have provider staff who address, prescribe or treat clients who use and/or misuse opioids and you’d like to improve their competence in these areas, read the fact sheet below.

Rola Aamar, PhD, LMFTA

Rola Aamar, PhD, LMFTA is currently the clinical effectiveness consultant at Relias for behavioral health, bringing her clinical and operational knowledge of integrated care, data analytics, and behavioral healthcare to support client use of analytics to improve clinical performance and patient health. In this role, she provides clinically-informed, data-driven consulting to clients to promote performance improvement. Rola began her career as a behavioral health clinician in integrated care working with multidisciplinary healthcare teams to develop comprehensive treatment programs for comorbid chronic health and mental health condition. Rola completed her PhD at Texas Tech University, where she focused her clinical research on the importance of treatment alliance between patients and healthcare providers to address treatment attrition and treatment adherence. Prior to Relias, she developed and managed integrated care programs in primary care clinics, specialty clinics, community health centers, schools, and hospitals.

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