Medication-assisted treatment (MAT) relies on the use of pharmacological medications to treat substance use disorders. Neurobiological changes that may occur in people in detoxification from substances can increase the risk of relapse. MAT can help prevent relapse and facilitate longer periods of abstinence when used with integrated treatment plans that take other health considerations into account.
SAMHSA’s Division of Pharmacologic Therapies has published two guides for primary care and specialty providers. The guides can lead to healthier outcomes for patients with opioid or alcohol use disorders. Clinical Use of Extended-Release Injectable Naltrexone in the Treatment of Opioid Use Disorder: A Brief Guide – 2014 addresses how to assess and monitor patients during treatment with naltrexone. Medication for the Treatment of Alcohol Use Disorder: A Brief Guide – 2015 discusses how MAT may be used to treat alcohol misuse in clinical practice. According to SAMHSA’s guides, people with an opioid use disorder or an alcohol use disorder should be offered MAT on a routine basis.
The Food and Drug Administration (FDA) has approved three medications for opioid use disorder and four specifically for alcohol use disorder. Each medication has different precautions and important considerations for medical providers, based on a patient’s unique needs and circumstances.
A key advantage of MAT is that it can be offered in primary care practices and not just specialized treatment programs, making treatment more accessible to people with substance use disorders. According to SAMHSA’s National Survey on Drug Use and Health (NSDUH) – 2013, only a small percentage of people with alcohol and illicit drug use disorders receive treatment at a specialty facility.
An American Society of Addiction Medicine (ASAM) report found that MAT is substantially underutilized, possibly due to misunderstandings about the purpose and mechanisms of the medications. The report, Availability Without Accessibility: State Medicaid Coverage and Authorization Requirements for Opioid Dependence Medications, was sponsored by SAMHSA.
SAMHSA’s guides present an opportunity to increase practitioners' understanding and promote best practices. The guides provide technical explanations of the medications and best practices for medical providers to initiate MAT. Doctors must adequately screen and assess a patient’s need for MAT, develop a comprehensive treatment plan, select a medication, monitor patient progress, and ensure the patient fully understands the information conveyed. Although MAT requires careful consideration, the SAMHSA guides offer a roadmap to success.
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