A primer on medication-assisted treatment (MAT) for opioid use disorder

This article was published on PENDING, 2022

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The problem is that only a small fraction of persons with opioid use disorder who should be receiving medication-assisted treatment (MAT) are getting it.

So, please remember the following rule of thumb and tell others about it too:

All persons with opioid use disorder should be offered medication-assisted treatment (MAT)

Medication-assisted treatment (MAT) has convincingly been shown to be a very effective intervention that reduces both morbidity and mortality in persons with opioid use disorder.

Note: The treatment approach is called “medication-assisted” treatment because medications are used along with psychosocial treatments.

Which medications?

Which medications are we talking about? As of July 2022, the medications used in MAT are (alphabetically):

1. Buprenorphine-containing products

2. Methadone

3. Naltrexone-containing products.

Buprenorphine-containing products

Here is the menu of options:

– Buprenorphine sublingual tablet (generic only; previously available as brand name Subutex®), which has an FDA indication for the “treatment of opioid dependence and is preferred for induction” (Prescribing Information). It is recommended for induction only. By that, they mean that, usually, after 2 days on buprenorphine sublingual tablets, patients are started on buprenorphine and naloxone sublingual tablets or film (see below).

– Buprenorphine and naloxone sublingual film, for sublingual or buccal use (generic only; previously available as brand name Suboxone® sublingual film), which has an FDA indication for the “treatment of opioid dependence” (Prescribing Information).

– Buprenorphine and naloxone sublingual tablet (generic only; previously available as brand name Suboxone® sublingual tablet), which has an FDA indication for “the maintenance treatment of opioid dependence” (Prescribing Information).

– Buprenorphine extended-release injection, for subcutaneous use (Sublocade®; no generic is available as of July 2022), which has an FDA indication for “the treatment of moderate to severe opioid use disorder
in patients who have initiated treatment with a buprenorphine-containing product, followed by dose adjustment for a minimum of 7 days” (Prescribing Information).

Methadone

Naltrexone-containing products

– Naltrexone for extended-release injectable suspension, for intramuscular use (Vivitrol®; no generic is available as of July 2022), which has an FDA indication for the “prevention of relapse to opioid dependence, following opioid detoxification” (Prescribing Information). Note: Naltrexone for extended-release (Vivitrol®) also has another FDA indication—”for the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment with VIVITROL” (Prescribing Information).

Since there are limits to how much buprenorphine can be prescribed by one clinician, there is an urgent need for more clinicians to become certified to prescribe buprenorphine

Fentanyl

Why we MUST know about fentanyl and fentanyl analogs

Special tests are needed to identify fentanyl in the urine

Special issues in using naloxone for overdoses involving fentanyl

Special points about managing fentanyl opioid use disorder

Fentanyl analogs and why they are so important

Opioid use disorder

Opioid use disorder is a VERY serious condition

Opioids in the urine drug screen

Opioid use disorder—Management

Clinical pearls on prescribing buprenorphine (Suboxone®)

Clinical pearls about prescribing buprenorphine: Part Two

Buprenorphine (Subutex®, Suboxone®)

Buprenorphine extended-release injection (Sublocade®)

Naltrexone (Revia®, Vivitrol®): Basic information

Tips on using naltrexone extended-release injectable (Vivitrol®)

Naltrexone extended-release injection (Vivitrol®): The how to

News: July 7, 2016. Buprenorphine prescribing limit raised significantly

Tips for our opioid-dependent patients

Loperamide abuse: Tips for mental health clinicians

NeuroStim System-2 (NSS-2) BRIDGE

Substance use disorders

Practice guidelines for substance-related and addictive disorders

How to learn addiction psychiatry

SAMHSA National Helpline (Treatment Referral Routing Service)

Tips on dealing with “slips” in recovery

Never crave alone

References

American Society of Addiction Medicine. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020 Mar/Apr;14(2S Suppl 1):1-91. doi: 10.1097/ADM.0000000000000633. Erratum in: J Addict Med. 2020 May/Jun;14(3):267. PMID: 32511106.

Bruneau J, Ahamad K, Goyer MÈ, Poulin G, Selby P, Fischer B, Wild TC, Wood E; CIHR Canadian Research Initiative in Substance Misuse. Management of opioid use disorders: a national clinical practice guideline. CMAJ. 2018 Mar 5;190(9):E247-E257. doi: 10.1503/cmaj.170958. PubMed PMID: 29507156; PubMed Central PMCID: PMC5837873.

Crotty K, Freedman KI, Kampman KM. Executive Summary of the Focused Update of the ASAM National Practice Guideline for the Treatment of Opioid Use Disorder. J Addict Med. 2020 Mar/Apr;14(2):99-112. doi: 10.1097/ADM.0000000000000635. Erratum in: J Addict Med. 2020 May/Jun;14(3):267. PMID: 32209915.

Fairbairn N, Ross J, Trew M, Meador K, Turnbull J, MacDonald S, Oviedo-Joekes E, Le Foll B, Goyer MÈ, Perreault M, Sutherland C. Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline. CMAJ. 2019 Sep 23;191(38):E1049-E1056. doi: 10.1503/cmaj.190344. PMID: 31548191; PMCID: PMC6763328.

Korownyk C, Perry D, Ton J, Kolber MR, Garrison S, Thomas B, Allan GM, Bateman C, de Queiroz R, Kennedy D, Lamba W, Marlinga J, Mogus T, Nickonchuk T, Orrantia E, Reich K, Wong N, Dugré N, Lindblad AJ. Managing opioid use disorder in primary care: PEER simplified guideline. Can Fam Physician. 2019 May;65(5):321-330. Erratum in: Can Fam Physician. 2019 Oct;65(10):687. Erratum in: Can Fam Physician. 2019 Oct;65(10):687. PMID: 31088869; PMCID: PMC6516701.

Rieb LM, Samaan Z, Furlan AD, Rabheru K, Feldman S, Hung L, Budd G, Coleman D. Canadian Guidelines on Opioid Use Disorder Among Older Adults. Can Geriatr J. 2020 Mar 30;23(1):123-134. doi: 10.5770/cgj.23.420. PMID: 32226571; PMCID: PMC7067148.

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