When Does Medication Assisted Treatment (MAT) Become a Risk to Recovery?

The unparalleled spike in opiate abuse and related overdoses in recent years has demanded an unprecedented response. And while increased attention and concern have been seen in the form of everything from documentaries to demonstrations, the issue is finally being met with aggressive and concerted action. But with much of the effort – and current legislation – focused on crisis response, it is also raising significant, renewed concerns about the limitations of Medication-Assisted Treatment (MAT) as it relates to long-term addiction recovery. Extraordinary circumstances sometimes do call for exceptional measures. The unmatched rise in opiate use across the country has rightly been deemed an “epidemic” and has been chronicled in a previous blog of ours, Opiate Overdose Occurring at Lower Doses. And with more Americans now dying every year from drug overdoses than car crashes and the majority of those overdoses involving prescription painkillers and other opioid abuse, leadership from the White House, government agencies, the private sector, as well as health and law enforcement entities have been joining together to mount a collective effort to quell the problem. Much of great value is being done, including far-reaching education and PSA partnerships, increased training for those dispensing medications, and greater monitoring of opiate prescriptions. Yet, the key treatment focus that seems to be favored in this multi-faceted intervention involves the use of partial agonist and antagonist medications, like buprenorphine, to help more comfortably wean users off of drugs and block the highs that opiates usually provide. At virtually no other time in recent history, except during a similar heroin explosion in the 1970s, has a “harm reduction” approach to addiction been so eagerly embraced.

Essentially, MAT uses drugs like methadone and the much more popular buprenorphine (suboxone) to provide some mild stimulation of opioid receptors in the brain so that the pain of withdrawal from regular opiates is minimized. They also simultaneously block any euphoric effect, or “high,” that might come from ingestion of any non-prescribed opiates ingested to minimize pleasure associated with these drugs and, in turn, it is reasoned, the impulse to use again. In theory, it makes good sense and can be a very positive tool for those in the throes of strong physical dependence on painkillers. In practice, there are a number of potential pitfalls to prescribing one drug to help address addiction to another. The medications used as part of MAT are always intended when this treatment is approached ethically and responsibly, to be part of a more comprehensive approach to treatment and patient wellness.  Drugs like buprenorphine, and even pure antagonists like naltrexone which are solely designed to block any brain stimulation from opiate use (so the user simply can’t get high), should be one part of an integrative treatment strategy that also emphasizes longer-term therapeutic work, 12 step recovery support, and accountability, and counseling to address underlying psycho-social, emotional, and life skill issues to help addicts transition to a happy, productive life. Unfortunately, this combined approach often either cannot be ensured by those prescribing MAT drugs or the patients themselves are unwilling to participate in a “treatment system” which supports them while they do the more challenging work so important to full recovery.

When it fails (and it often can if not part of a multi-faceted treatment plan), many MAT participants fall through the cracks or manipulate the system in a way that can be harmful to their own health or dangerous to others. First off, MAT can be pursued as an inordinately long-term treatment that can take years to complete. Some addicts choose to remain on MAT their entire life and never delve into deeper emotional and spiritual therapy. MAT is also prone to abuse by addicts who sometimes use other drugs while participating in MAT or sell their prescribed medications to buy other street drugs. Many addicts have also overdosed while in MAT by taking it with other illegal or prescribed drugs which they abuse. Methadone, for example, is frequently combined with benzodiazepines which can be fatal. In short, when people approach MAT as an easier, softer way to the hard work of recovery and independence from substances, the results are often undesirable.

It is not the argument here that MAT is misguided, or inappropriate, but rather that it is not a “silver bullet” to recovery and it certainly cannot supplant or replace a more integrative, whole-person, approach. The trouble with Medicated Assisted Treatment is that, for a variety of reasons, it sometimes becomes Medication AS Treatment – long-term use of medicines as the sole and front-line defense against the continued abuse of one’s drug of choice. For most, to get and remain sober, they must acknowledge underlying issues, arm themselves with new tools and resources, and put into place healthy habits that, together, make abstinence from drugs and alcohol not only possible – but desirable and easier – one day at a time. At BTG, we work very successfully with opiate-addicted clients to move individuals from the earliest phases of detoxification into a program that utilizes a wide range of treatment modalities  – including cutting-edge IV amino acid therapy, targeted nutrient replacement, neurofeedback training, and meditative practices – that specifically make early recovery healthier, safer, and more comfortable. But we do believe that clients deserve, and are served best, by approaches that replace drugs and alcohol with effective resources and therapy that support rich and rewarding lives free from substances that previously held them back. It has been working since our inception more than 15 years ago, and we hope you’ll consider how it can help you or your loved one.