MAT drugs can prevent or reduce withdrawal symptoms from cessation of opioids. Drugs approved for MAT for OUD are buprenorphine, methadone, and extended-release naltrexone (XR-NTX).
MAT drugs can also prevent or reduce withdrawal symptoms from reducing or stopping alcohol use. Drugs approved for MAT for AUD are acamprosate, disulfiram, and naltrexone (oral and XR-NTX).
Some medications can cause side effects, pose health risks, and interact with other medications. Work with a medical provider to design the most effective MAT program for you.
MAT can reduce your withdrawal symptoms and cravings and work alongside behavioral therapies and counseling to sustain your recovery.
Recovery is possible, and MAT may help.
For many people diagnosed with OUD, it’s hard to stop using opioids and stay in treatment. These are highly addictive substances — when you try to quit, you may still crave them and/or experience painful withdrawal symptoms. MAT is a treatment approach to OUD that combines medication and behavioral therapies to aid your recovery. The Food and Drug Administration (FDA) has approved the medications buprenorphine, methadone, and extended-release naltrexone as safe and effective in MAT for OUD, when taken as prescribed.
Uses and benefits. With MAT for OUD, a medication is prescribed to prevent or reduce withdrawal symptoms from cessation of opioids such as codeine, fentanyl, heroin, hydrocodone, morphine, and oxycodone. The medications can also reduce your cravings for opioids, block their effects, and prevent an opioid overdose. MAT also incorporates short-term or intensive counseling and/or behavioral therapies to assist in your adjustment to life in recovery and motivate you stay in treatment, follow prescribed therapies, and, if needed, address other physical and mental health issues. The length and type of MAT are tailored for you by your medical provider, although that some treatments are more effective for certain minimum lengths of time. Most MAT drugs for OUD are safe for long-term use (see Precautions, below).
Specific drugs approved for use in MAT for OUD are:
Buprenorphine, a synthetic opioid that helps people with OUD manage symptoms and cravings in part by simulating the euphoric effects of opioids such as morphine and fentanyl, but at lower and safer levels. Buprenorphine is most often taken as a film or tablet that dissolves in the mouth but can also be delivered by injection or implant. Buprenorphine is the first medication for OUD that can be given out or prescribed at the doctor’s office, with ongoing dosing and treatment compliance overseen by a pharmacist. Therefore, this treatment is an option for patients who have trouble accessing a certified methadone clinic. Buprenorphine is also sometimes recommended for those who have trouble tolerating methadone or who have a shorter history of OUD.
The following are examples of brand-named drugs approved for MAT that rely on buprenorphine alone or in combination with the opioid agonist naloxone, a formulation that reduces the potential for buprenorphine abuse:
Methadone, a synthetic opioid, helps people manage OUD treatment and remain in recovery by targeting the same opioid receptors as the opiate a person was dependent on, but lasting longer, acting more slowly, and not generating a “high.” Known by the brand names of Dolophine and Methadose, methadone is only available through certified opioid treatment programs or methadone maintenance programs (often referred to as “methadone clinics”). It is typically taken daily by mouth in tablet or syrup form.
Extended-release naltrexone (XR-NTX), an opioid agonist medication, assists in OUD treatment by blocking the euphoric and relaxed feelings that people get from opioids such as codeine and morphine, and therefore reducing cravings. Brand-named Vivitrol and Alkermes, XR-NTX is administered monthly by an intramuscular injection given by a trained medical provider. Naltrexone is also used in medications to treat alcohol use disorder (AUD).
Naloxone is also sold in a product available without a prescription can stop an opioid overdose and save a life. If you or someone you know is using opioids, carry this medication, which can safely reverse the toxic effects of an overdose. Learn more.
MAT for alcohol use disorder (AUD) works similarly to MAT for OUD — approved medications are used to help you manage the effects of reduced or no alcohol use and counseling and/or behavioral therapies assist you in sustaining your recovery. The FDA has approved acamprosate, disulfiram, and naltrexone (oral and XR) for use in MAT for AUD.
Uses and benefits. MAT drugs for AUD can help you cut back on the amount of alcohol you drink or stay alcohol-free if you’ve completely stopped drinking. Certain MAT drugs work by lessening the painful withdrawal symptoms that can occur right after you cease using alcohol. Another one makes you want to avoid alcohol by causing you to become physically ill if you drink. MAT for AUD also incorporates short-term or intensive counseling or behavioral therapies to help you stay in recovery, adhere to therapy, and attend to other physical and mental health issues.
Specific drugs approved for use in MAT for AUD are:
Acamprosate, marketed under the brand-name Campral, can ease withdrawal symptoms such as sleeping problems and mood issues from stopping alcohol use and make you less likely to relapse to drinking. Taken as a two-pill dose taken three times a day starting on the fifth day of abstinence from alcohol, this medication is for people who are alcohol-free and want to remain that way.
Disulfiram, marketed under the brand-name Antabuse, deters drinking because people who take a small amount of alcohol while on the drug feel ill almost immediately. These side effects, which include an upset stomach, nausea, or other symptoms, can last for an hour or longer. The one-pill, once-a-day-dose can be taken by mouth or crushed it into a food or beverage. Experts caution that this drug should never be given to someone who is intoxicated.
Oral naltrexone, marketed under the brand-names ReVia and Depade, and extended-release (XR) naltrexone, marketed under the brand names Vivitrol and Alkermes, both block the euphoric effects of alcohol and reduce cravings for it. The oral version is a one-pill dose taken once a day; the XR version is a 380 milligram injection that a patient gets once every four weeks.
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MAT is a research-based treatment effective in some patients who are diagnosed with OUD or AUD. that MAT’s integration of counseling and/or behavioral therapies makes the treatment more effective; however, federal law requires you to receive this therapy if you’re in a certified opioid treatment program (OTP).
Talk to your medical provider about your health history and life situation, which can help them develop a MAT program that meets your treatment goals. And if you take a MAT drug home, lock it away from children.
Review the following other precautions and considerations related to MAT and MAT drugs:
Most MAT drugs are considered safe when taken as prescribed. However, some of these medications can cause side effects and, especially if misused, pose other health risks, including serious harm or death by overdose.
Dependency and/or overdose. You can become dependent or overdose on some MAT drugs, especially if they are misused. Start or stop this therapy under the care of a trained medical provider and take any medication exactly as prescribed. Work with your medical provider to develop a MAT program tailored to your needs.
Pregnancy or breastfeeding. Both opioid and alcohol use can harm mothers and fetuses and the babies of moms who are breastfeeding. That’s why, unless there is a specific warning against taking a drug if you’re in this population, the risks of MAT drugs should be weighed with the potential benefits to maternal and newborn outcomes in patients diagnosed with OUD or AUD. For pregnant people with AUD, one study reviewed evidence that suggested that pregnant people with AUD are best treated with acamprosate and naltrexone, but said more study is needed.
Interactions. Most MAT drugs have adverse interactions when taken with certain other medications, and so be sure to tell your medical provider about the non-MAT prescriptions you’re taking.
Cost. Some or all components of MAT may be covered by private insurance, state Medicaid programs, or Medicare. If you’re uninsured, underinsured, or otherwise have trouble paying for treatment, check to see if your MAT program offers assistance that would help you pay for care or receive it for free.
Other considerations. Consult with a licensed medical provider before taking any medication and for the best way to taper off a prescribed therapy or to switch to a different MAT drug.
Medications to Treat Opioid Use Disorder Research Report, How do medications to treat opioid use disorder work? Opioid Agonists and Partial Agonists (Maintenance Medications), National Institute on Drug Abuse, Aug. 10, 2022