Medication Assissted Treatment (MAT)

Medications for Drug Withdrawal and Detox:

Medications can be extremely effective in helping clients to safely stop abusing drugs and alcohol. These medications often relieve withdrawal symptoms either by replicating the effects of the drug at a lower intensity or by treating symptoms like irritability, anxiety or seizures directly. Other drugs used in addiction treatment, like naltrexone and acamprosate are designed to reduce cravings rather than relieving withdrawal symptoms. It is critical to recognize that the use of these medications have been shown to dramatically prevent relapse because they alleviate withdrawal symptoms and cravings. Medical support improves outcomes for clients and may often prevent overdose deaths.

They might address the changes in the brain that occur due to chronic drug abuse or help to mitigate cravings. In some cases, they might even mimic the action of the addictive drug in the brain and help clients to avoid the bulk of withdrawal symptoms. Research is ongoing in this area. There are even vaccines in development that might one day help people to avoid experiencing the addictive high that often triggers addiction. Not all substances of addiction have medications that are approved for use during the withdrawal process. But according to the National Institutes of Health, the following drugs might assist with detox:

When clients seek help through a medically supervised detox and drug rehab or addiction treatment program such as Whiterock, they will have access to medications that can help them cope with withdrawal symptoms. These medications may include:

  • Methadone
  • Buprenorphine
  • Naltrexone
  • Acamprosate
  • Disulfiram
  • Clonidine
  • Haloperidol
  • Bupropion
  • Gabapentin
  • Librium, Tranxene, Valium (for alcohol detox)

Methadone

Used for the treatment of opiate addiction, methadone is highly restricted and must be taken in the presence of a medical professional when it’s prescribed for the treatment of addiction. Clients must go to a methadone clinic daily to get their dose. Over time, as long as they remain drug-free and come in daily, they can earn “take-homes” or doses of medication to take at home so they don’t have to come in every day. Advantages of methadone maintenance are that it:

  • Decreases drug cravings.
  • Alleviates withdrawal symptoms.
  • Has a long half-life, so its effects last anywhere from 24 to 36 hours.
  • Doesn’t elicit euphoric effects.

While methadone is an effective treatment for opiate addiction, it has some disadvantages as well. These include:

  • Its status as a Schedule 2 drug, which means it has a risk of diversion and abuse.
  • Side effects similar to that of other opioids, including vomiting, nausea, excessive sweating, constipation, sexual dysfunction, itchy skin, and respiratory depression.
  • Potential for physical and psychological dependence.

Methadone is the most commonly used medication for the treatment of opioid addiction. Up to one-fourth of opioid-addicted clients receive methadone maintenance.

Buprenorphine

Prescribed on its own or in combination with naloxone as Suboxone, buprenorphine is a partial opioid agonist drug approved for use in the treatment of opioid dependence and is available by prescription from doctors qualified to dispense the medication. There is some anecdotal evidence that buprenorphine may have antidepressant effects as well. According to the National Drug Intelligence Center, there’s a low chance for abuse of the drug among clients in recovery. Advantages to using buprenorphine to treat opioid addiction include that it:

  • Can be distributed by a physician in places such as health departments, community hospitals, doctors’ offices, and correctional facilities, unlike methadone.
  • Decreases cravings.
  • Diminishes withdrawal symptoms.
  • Has a ceiling effect, meaning the medication’s effects plateau at a certain dose in order to prevent overdose and abuse.
  • Can be combined with naloxone, as with Suboxone, to decrease the risk of abuse.

As with methadone, there are a few disadvantages to taking buprenorphine for an opioid addiction. These include side effects similar to those of other opioids, such as:

  • Sleep problems.
  • Constipation.
  • Nausea.
  • Vomiting.
  • Muscle cramps.

There’s also potential for diversion and abuse when buprenorphine is used in isolation (without naloxone added).

Naltrexone

Naltrexone binds to opioid receptors in the brain and blocks the effects of opiate drugs that would otherwise make the user feel high. Naltrexone is a non-addictive medicine that blocks the opiate receptors in a person’s brain, which means clients don’t crave drugs or alcohol when they’re taking it. And if they happen to relapse, the medicine prevents them from feeling high. This effect deters individuals from relapsing because the drug no longer produces rewarding effects. Naltrexone has also been shown to be effective in alcohol detox. In both cases it can help to reduce cravings.

Some advantages for using naltrexone include that it:

  • Is available as an extended-release injection that lasts for a month.
  • Helps to prevent relapse.
  • Doesn’t cause withdrawal symptoms with cessation of use.

A few disadvantages for using naltrexone are that it:

  • Cannot be used if opioids are present in the body because it would send that user into acute opioid withdrawal.
  • Can produce some uncomfortable side effects, such as muscle or joint paint, nervousness, diarrhea, vomiting, headache, and fatigue.
  • Is not safe for clients with liver damage to use.
  • Although clients can take Naltrexone orally, many people either forget or choose not to take it — so they’re more likly to relapse.

Naltrexone is an effect support for abstinence from opiates but when the Naltrexone wears off, clients will have very low opiate tolerance. Following Naltrexone therapy, it is easy for clients to use too much opiates and have an overdose, which can be fatal. Clients need to clearly understand that if they choose abstinence, their lowered narcotic tolerance means that any relapse could be fatal.

It is best practice for clients to be on Naltrexone therapy for months post detox in order to give the client an opportunity to restore the neurochemistry in their brain and recover from the damage of narcotic use. Naltrexone relieves craving for opiates so that clients can begin focusing on the psychological and behavioral challenges Recovery.  Naltrexone can help prevent clients from relapsing and gives them the chance to make changes in the way they interact with people, places and things while developing a support program.

 Acamprosate

This drug is prescribed when there are long-lasting withdrawal symptoms associated with drug and alcohol detox such as insomnia, restlessness, and anxiety. Advantages of acamprosate include that it:

  • Helps normalize brain activity.
  • Decreases cravings for alcohol.
  • Can be taken by those with liver damage.
  • Doesn’t have potential for abuse or dependence.

Disadvantages of acamprosate are that it:

  • Has side effects including muscle weakness, nausea, stomach cramps, dizziness, headache, and itchiness.
  • Shouldn’t be taken by people who have kidney problems.

Disulfiram

This drug might be prescribed to clients after alcohol detox when they’re stabilized and attending addiction treatment but are concerned about relapse. Disulfiram works by eliciting several negative effects when the individual drinks alcohol while taking it. These effects include:

  • Nausea.
  • Sweating.
  • Flushing of the face.
  • Hyperventilation.
  • Blurred vision.
  • Palpitations.
  • Vertigo.

Once the client experiences these unwanted side effects, they’ll likely be deterred from drinking alcohol while on the medication. A few other advantages of disulfiram treatment include that it:

  • Discourages drinking behaviors due to unpleasant physiological effects.
  • Is a successful tool for motivated clients.
  • Can be used before entering situations that might trigger unwanted behavior, such as a party.

There are some disadvantages of disulfiram treatment. These include that it:

  • Doesn’t decrease cravings for alcohol.
  • Doesn’t normalize brain function.
  • May not be effective if client isn’t motivated to stop drinking.
  • Can have severe side effects if excessive alcohol is simultaneously ingested, including liver damage, damage to peripheral nerves, delirium, and psychosis.
  • Shouldn’t be used in clients who have liver damage.

Scientifically Proven Benefits of Medication Assisted Treatment (MAT)

  • Higher levels of engagement in psychological and behavioral intervention
  • Increased rate of treatment compliance and retention in treatment
  • Decreased opiate use
  • Decreased criminal activities
  • Lower incidence of overdose
  • Minimization of overdose deaths and improved survival rate

It is important to note that Medication Assisted Treatment (MAT) for Substance Use Disorder (SUD) or addiction needs to be managed by a well trained, credentialed medical professional. There are known side effects associated with of MAT and drug-drug interactions with other medications have also been known to exist. Also, MAT may be counter-indicated for some clients with specific medical conditions. For example, anyone who suffers from kidney problems should not take the drug Acamprostate which is used in the treatment of alcohol dependence, while Naltrexone can be hazardous to anyone with preexisting liver damage. Because each individual can react differently to MAT, it is important that clients are instructed to contact their physician immediately if they are having any adverse side-effects as a result of these medications.

As part of Whiterock EHN-Canada’s Private Detox approach to addiction treatment and drug rehab, our treatment team works with each client to determine the care plan that will best meet their unique needs. Some clients may receive Suboxone for detox purposes in easing withdrawal symptoms while others may receive a recommendation for maintenance Suboxone therapy. Whiterock EHN-Canada is the only Canadian provider facilitating access to an extended-release injection of Naltrexone known as Vivitrol. Vivitrol is an MAT that is proven to dramatically decrease cravings for both opiates and alcohol. This medication has been a major advancement in the field addiction medicine in terms of preventing relapse.

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