The MAT Conversation Shifts from ‘If’ to ‘How’
It wasn’t long ago that the conventional wisdom in treating substance use disorders (SUDs) shunned the use of medications as a cornerstone of care. While some evidence of that traditional thinking remains, science has led most of the field to conclude that medication treatments are critical to saving lives, maintaining patient engagement, and helping individuals build the recovery capital needed to sustain good health.
Research evidence continues to demonstrate that while medications to treat SUD aren’t a cure-all, they serve for many as a critical component of early success. A study published in JAMA Psychiatry in 2021 found that medication-assisted treatment (MAT) for opioid use disorder (OUD) was associated with substantial declines in overdoses (a 10.7% decrease attributed to methadone, and double that number associated with buprenorphine and injectable naltrexone). When these medications were combined with psychotherapy and incentives for patients to stay in treatment, overdose reductions and cost savings were even greater.
The data have convinced most of the stalwarts in addiction treatment to embrace MAT’s crucial role. The National Association of Addiction Treatment Providers (NAATP) states on its website, “Evidence-based practices for addiction treatment include therapeutic approaches (such as cognitive-behavioral therapy or dialectical behavioral therapy) and the use of medication, as well as a combination of these.”
And the power of MAT isn’t limited to the much-discussed medication treatments for OUD. Federal leaders consistently cite the benefits of the three medications that have long been available for treating alcohol use disorder. They attribute the disappointing lag in uptake of these treatments less to a reading of the evidence and more to gaps in the medical community’s knowledge about alcoholism, its causes and its treatment.
A more sophisticated analysis
Rarely today will you hear the question, “Do medication treatments for SUD work?” Providers and researchers now are much more likely to ask, “For whom does a particular medication option work best, and under what conditions?”
Research in this area remains in early stages, so definitive answers are hard to come by. But it’s becoming clear that continuity of care and therapeutic support both can make a huge difference in enhancing MAT outcomes. We see a prime example of this in the justice system. A growing number of individuals in custody have gained access to MAT in recent years, but many still face the risk of interrupted care and adverse outcomes when released. Managing that transition has proven critical. States such as Rhode Island have set the pace: Shortly after Rhode Island became the first state with a federally recognized prison-based opioid treatment program (OTP), it saw overdose deaths among the recently incarcerated plunge by 61%. The state’s program requires careful coordination of care to ensure continuity of medication when inmates return to a community setting.
The COVID-19 crisis also has taught us much about optimal delivery of MAT. OTPs received unprecedented flexibility to initiate medication treatment virtually and to offer take-home dosing of methadone during the pandemic, in order to avoid interrupted care during the public health emergency. Having seen that services could be delivered this way without compromising quality, the Substance Abuse and Mental Health Services Administration (SAMHSA) this month announced its intent to make many of these COVID-initiated changes permanent. This promises to expand access to life-saving medication for all.
Challenges to widespread implementation of MAT remain. These include a shortage of trained providers in some communities, and lagging participation from eligible professionals in others. But as MAT continues to gain broad-based acceptance, treatment providers increasingly will be expected to include medication treatments in their programming.
As retiring Missouri state substance abuse director Mark Stringer told the newsletter Alcoholism & Drug Abuse Weekly in an interview last January, he had offered a frank two-part response to one executive in the state who insisted his agency would continue to resist offering medication treatment: “One, you’re not going to have any patients, and two, we’re not going to pay you.”
Tools for improvement
As more SUD treatment organizations integrate MAT into their clinical care, the field will learn more about the conditions that lead to the best patient outcomes. At one time in the field’s history, abstinence from substance use was the only accepted measure of an intervention’s success. With today’s expanded vision of what it means to be in recovery, outcome evaluation has become much more complex, incorporating measures of patient engagement in care and quality of life.
This type of analysis requires a system that gives you all the necessary tools for smart decision support. Extensive data collection and reporting capabilities can allow you to understand how medication treatment’s benefits can be optimized for your patient population. Sigmund Software’s enterprise EHR solution can generate the metrics that will drive improvement in your program.
With medications often essential to stabilizing patients and allowing the rest of treatment to take hold, program leaders’ decision to use them is no longer a matter of “if,” but “how.” As we learn more about predicting who will respond best to which treatment, the importance of medications in the continuum of care will only grow. We can be there with you as you realize the vision for comprehensive SUD treatment that helps patients realize the full benefits of a life in recovery.
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