What is medication assisted therapy (MAT) and why it might be important to me?

By Dr. Joe Savon, New Life’s Medical Director & Co-FounderMedication Assisted Therapy

MAT is medication assisted therapy.  It allows for continued medical care for a condition that has truly become a medical issue with diseased circuitry in the brain making good decision difficult to impossible.  There are several options for treatment of opioid use disorder using medication assisted therapy.

#1.   Methadone is a full opioid agonist.  The patient would be receiving a narcotic on a regular basis.  They would have to attend a Methadone clinic.  This cannot be offered outside of approved clinics.  It is a potentially dangerous drug and accounts for a disproportionate amount of opioid deaths.  It suppresses the respiratory drive for a longer period of time than the analgesic effects.  Use of other products such as heroin during this period can be deadly.

#2.  Buprenorphine.  This can be given as the brand name Suboxone which is buprenorphine and naloxone or Subutex which is buprenorphine alone.  This is a partial agonist which means that the full effect on the opioid receptors cannot be achieved.  This can be given with a DEA waiver by qualified prescribers.  Both Methadone and Suboxone will increase success rates from about 15% at one year to about 40%.  This allows the patient the time to have an orderly reduction in the narcotic load at a personal rate.

#3.  Vivitrol.  This is a narcotic antagonist.  It is given as a monthly injection after 7 days free of narcotics, so as not to precipitate a withdrawal.  Naltrexone is also given in an oral formulation but compliance is enhanced if given by the depot route.  Vivitrol has achieved similar results to Methadone and Buprenorphine in one large study however Tramadol was not considered to be a narcotic.  The danger to this approach is maintaining the relationship with the patient during the wash out period.

#4.  Medical marijuana.  This is a consideration in the State of New Jersey.  It is not FDA approved and the literature regarding success is less available.  With proven efficacy it would be considered to a greater degree when compared

#5 Sublocade Doctor Near Me. Sublocade is the newest injectable that releases Buprenorphine slowly over a period of time and takes out the daily process of taking a suboxone strip or pill

Options with Alcohol

Alcohol is a major issue in this country.  It has resulted in innumerous loses with respect to relationships, occupations and lives.  There are three different medications used in  medication assisted therapy that are FDA approved but seldom used.

#1.  Naltrexone.  This can be used for alcohol as well as narcotics since alcohol has affinity for a wide range of receptors.  It does not suppress the urge to drink but it does decrease the dopamine surge associated with imbibing.  Dopamine is our reward neurotransmitter.   People may find it easier to stop at and earlier point.  It is safe and can be used even with minor elevations of liver tests.  Liver tests should be monitored though.

#2.  Acamprosate.  Since alcohol is an inhibitory drug on the brain’s circuitry when it is withdrawn the excitatory glutamate receptors go into overdrive.  This accounts for many of the unpleasant effects of withdrawal.  Acamprosate will staunch the process of “over excitation”.  It is secreted through the kidneys and can be used with a damaged liver.

#3.  Disulfiram.  This blocks the conversion of alcohol and causes a build up in acetaldehyde.  People will become violently ill if they use alcohol with this product on board.

Alcohol works on the GABA receptors in the brain.  Gabapentin (Neurontin) and Pregabalin (Lyrica) do not work directly on the GABA receptors however they work in the same area of the brain that is disrupted by alcohol.  Although not FDA approved Gabapentin.

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