Opioid use disorder (OUD) is defined as a problematic pattern of opioid use that leads to severe impairment or distress. Medication-assisted treatment is one of the leading treatment regimens that is used to combat the opioid epidemic and to help treat opioid use disorder. Medical professionals use a specific set of criteria to determine if an individual has a substance use problem and to diagnose an opioid abuse disorder. The individual must have two or more of the following symptoms within 12 months. A mild opioid use disorder is characterized by having 2-3 of these symptoms, a moderate opioid use disorder is described as having 4-5 of these symptoms, and a severe opioid use disorder is characterized by having 6 or more of these symptoms.
Loss of control
- Taking too many opioids or using opioids for longer than necessary
- Persistent but unsuccessful effort to cut down or control the use of opioids
- A large amount of time spent obtaining or using opioids
- Cravings for opioids
- Opioid use that causes failure to fulfill social obligations including work, school, or home life
- Continued opioid use desire causing social or personal issues
- Social, occupational or recreational activities are reduced because of opioid use
- Recurrent opioid use in dangerous situations
- Continues opioid use despite related or psychological problems
- Physical dependence
Medication Assisted Treatment for Opioid Use Disorder
Medication-assisted treatment (MAT) is the use of medications in addiction to counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose. MAT is primarily used for the treatment of addiction to opioids but is also used to treat alcohol abuse and nicotine addiction. The medications that are approved by the FDA for opioid abuse include naltrexone, methadone, and buprenorphine. These medications are known to stabilize brain chemistry, reduce or block the euphoric effects of opioids, relieve cravings, and normalize body functions. Without treatment, individuals with opioid use disorder have seven to 10 times the mortality rate of the general population. With treatment, their risk of death drops to just two times the risk of the general population.
Unfortunately, there are barriers to MAT for opioid use disorder, the most common ones being cost and stigma.
- Price: One report found that every $100,000 spent on treatment saves $487,000 on health care and avoids $700,000 in expenses related to crime. But Medicaid restrictions limit the availability of MAT, such as prior authorization rules, quantity limits, and lifetime treatment limits. As a result, many Medicaid clients cannot be approved for MAT, thereby potentially decreasing their treatment recovery rate.
- Stigma: Just like any other mental health or substance abuse treatment, individuals in need of MAT for their opioid abuse disorder feel as though others may judge them, treatment is too expensive, or they will be labeled by society at weak.
Methadone and buprenorphine are opioid agonists known to decrease withdrawal symptoms and cravings by acting on the same receptors on the brain as opioids. As a result, these medications are given immediately during the detoxification process to ease the unpleasant withdrawals.
Naltrexone does not ease the withdrawal symptoms or cravings, but instead, it takes away the euphoric high that an individual would typically get when they use opioids, and therefore naltrexone is an excellent medication to use to prevent relapse but should not be used during acute withdrawals or if there are any opioids in the body.
Suboxone is a combination of buprenorphine and naloxone. Naloxone is a drug that rapidly treats opioid overdose by kicking the opioids off of their receptors in the brain, pushing the individual into active withdrawals. As a result, when a client is on Suboxone and attempts to use opioids, the naloxone will cause mild withdrawals. Therefore this combination of buprenorphine and naloxone helps alleviate opioid cravings and withdrawal symptoms and can be used in both the withdrawal phase and the maintenance phase.