What is medication-assisted treatment (“MAT”) for opioid use disorder?

The Food and Drug Administration (FDA) has approved three medications that safely and effectively treat opioid use disorder (OUD) to improve the health and wellbeing of people living with OUD. MAT is defined by on-going, long-term treatment with one of these three medications.

How does MAT with medications for opioid use disorder (MOUD) work?

OUD is characterized by continued opioid use — or feeling incapable of controlling one’s opioid use — despite negative consequences such as injury, illness, fractured relationships, arrest or incarceration.

Opioid cravings can pose challenges to people who want to stop or reduce their opioid use. When they do stop, people with OUD may experience withdrawal symptoms, including vomiting, diarrhea, fever, muscle aches, tremors, insomnia, anxiety or depression. Fear and avoidance are normal responses to withdrawal experiences and can be an obstacle for people who want to use less or stop using entirely. The FDA has approved three medications for treating OUD: methadone, buprenorphine and naltrexone. Methadone and buprenorphine work by reducing cravings and preventing withdrawal. Naltrexone works by blocking the effects of opioids in the body.

Methadone

• Methadone reduces cravings and controls withdrawal symptoms because it is an opioid.
• Methadone must be taken daily, though some people need to take methadone twice daily.
• When used to treat OUD, methadone can only be dispensed by federally registered Opioid Treatment Programs (OTPs).

Buprenorphine

• Buprenorphine, sometimes referred to as “bupe,” reduces cravings and controls withdrawal symptoms because it is a partial opioid.
• Buprenorphine can be taken at home daily OR administered by a clinician as a long-acting injection.
• Buprenorphine can be prescribed by any qualified clinician.
  • As of December 9, 2022, any practitioner with current DEA registration that includes the authority to prescribe Schedule III medications may prescribe buprenorphine as allowable by state law. The DATA waiver (X waiver) requirement has been removed.

Naltrexone

• Naltrexone is an opioid blocker. It prevents opioids from affecting the body.
• Naltrexone can be taken at home daily OR administered by a clinician as a long-acting injection.
• Naltrexone can be prescribed by any clinician licensed to prescribe medication.

How does an opioid treat opioid use disorder?

Methadone and buprenorphine are opioid medications that reduce cravings and withdrawal. Unlike many illicit opioids, these medications have a stabilizing effect which helps to end the constant cycle of craving and withdrawal.

All three medications can be used alone or in conjunction with cognitive or behavioral therapy, intensive outpatient treatment, inpatient (residential) treatment, psychiatric care or other social and healthcare services — as appropriate for each individual person according their needs and circumstances.

Treating OUD with opioid medications (methadone and buprenorphine, specifically) has long been considered the gold-standard of care. However, no single medication works well for all. Equal access to all three supports finding the treatment that works best and patient preference remains one of the most important factors. All things being equal, the best medication choice may be the one a person is interested in trying or the one they will continue to take.

MOUD can help people living with OUD prevent overdose, achieve abstinence and “feel normal” again.