Medical Assisted Treatment
Communities Bulletin

Contents

“Methadone has saved my life. Five years after beginning treatment, I graduated cum laude from college with a B.S. in Human Services Counseling. Thanks to this wonderful medication, I am now able to give something back to the community.”

An estimated 1.7 million individuals abused or were dependent upon opioids in 20021. Though Jay fortunately is in recovery, many more people are still in need of treatment. The estimated expense to society of opioid addiction nears $20 billion annually, yet the cost of treating an individual addicted to opioids is only $4,000 per year. If every opioid-dependent person in the United States received treatment, $16 billion would be saved every year2.

However, the stigma experienced by individuals with drug dependence and addiction discourages thousands of opioid-dependent individuals from obtaining treatment. The Americans With Disabilities Act (ADA) and the Rehabilitation Act of 1973 have effectively protected many recovering individuals with alcohol and drug use disorders from discrimination. In addition, through the establishment of effective community partnerships, everyone can help opioid-dependent individuals recover. Through recovery, the number of people in the criminal justice system decreases, high school graduation rates increase, the Nation’s social and health costs are lowered, and per capita output is increased.

Opioid dependence has been treated with methadone for more than 30 years, and the medical consensus is that it is among the most effective treatments available 3. Now, in addition to methadone, buprenorphine can be used to treat opioid addiction. The information in this brochure will inform you about medication assisted opioid treatment (MAT), give you some facts about opioid use and misuse in the United States, and offer resources for more information about building support for MAT in your community.

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Medication Assisted Treatment

On May 18, 2001, new regulations for the use of narcotic drugs in the maintenance and detoxification treatment of opioid addiction were issued. Old narcotic treatment regulations enforced by the Food and Drug Administration (FDA) were repealed. The new rule shifts administrative responsibility and oversight from the FDA to the Substance Abuse and Mental Health Services Administration (SAMHSA), both of which are part of the United States Department of Health and Human Services. This new system is designed to increase medical decision-making as well as overall involvement of the medical community in the treatment of opioid addiction. It is supported by the accreditation model currently in place in most medical institutions. MAT is clinically driven with a focus on individualized patient care.

Methadone Treatment

Methadone treatment combines medical therapy with psychosocial services to improve the health and physical well-being of persons addicted to short-acting opioid drugs such as prescribed pain medications. Methadone helps stabilize the patient by relieving physical withdrawal symptoms and reducing physiological cravings –without the negative effects and consequences of the short-acting drugs of abuse. Rehabilitation services enable individuals to achieve recovery.

Methadone, when taken as ordered by a physician, is safe and effective, and does not create a pleasurable or euphoric feeling, although some patients may experience side-effects such as constipation, water retention, drowsiness, skin rash, excessive sweating, and change in sex drive. The effectiveness of methadone has been shown in many studies over the past 30 years.

Buprenorphine Treatment

Buprenorphine (Suboxone™ and Subutex™) is a recently approved opioid addiction medication that, like methadone, suppresses withdrawal symptoms and blocks the effects of short-acting opioid drugs. Buprenorphine has been demonstrated to be effective when combined with psychosocial services, which often are needed to help people with substance use disorders. Buprenorphine treatment is an alternative to and not a replacement for methadone treatment, which is often not available in some communities. Because the two treatments are different, patients and their families need to become familiar with the distinctions in the medications and the psychosocial services provided.

For additional information on buprenorphine, please visit http://www.buprenorphine.samhsa.gov.

Medical and Mental Health Needs of Medication Assisted Patients

Patients with a history of misusing short-acting opioids frequently enter methadone or buprenorphine treatment with high rates of medical complications, mental health issues, other substance use problems, and infectious diseases, such as HIV/AIDS and hepatitis. Often, treatment for these other conditions involves medications that may have interactions and, therefore, need to be monitored carefully by the treating physician. For example, patients receiving methadone or buprenorphine who have an acute or chronic pain may require special attention because of interactions between methadone and buprenorphine, and commonly prescribed pain medications.

Other Opioid Addiction Medication Assisted Treatments

Opioid-dependent individuals also can be treated with naltrexone (ReVia®) as an additional phase of detoxification or medically monitored withdrawal. Once an opioid-free state is reached, naltrexone is taken to block the effects of opioid drugs, should use occur. It is more prophylactic than therapeutic, and does not address issues of craving. Naltrexone also has been used as an adjunctive treatment for alcoholism. Although it does not block the effects of alcohol, some patients report a reduction in the number of drinking episodes when taking naltrexone.

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Medication Assisted Treatment Proves to Be the Solution

The history of MAT speaks for itself. However, sometimes actual stories of opioid-dependent individuals in recovery can ‘bring home’ the importance of community involvement in the recovery process. Following are the stories of two opioid-dependent individuals in recovery who received help through community programs and who are now living productive and drug-free lives.

“After barely surviving a 25-year-long battle with opiate addiction, during which I was a patient in at least 30 treatment centers and tried to follow every suggestion ever made to me about how to get my addiction under control, a physician made a strong statement that I seek treatment at a methadone clinic. I was completely taken by surprise. After all, I had been spoon fed methadone myths for years and thought methadone was simply a substitute for my opiate of choice and that any future including methadone would be very grim, at best.

I began methadone maintenance therapy on August 11, 2001. [After] receiving my first dose, I have not used a single opiate—or any other legal or illegal drug—since. Rather than living the grim life I predicted for myself as a methadone maintenance therapy patient, I now lead a reasonably happy, very full, and—more than anything—typical life with my 4-year-old son. Prior to being a methadone maintenance therapy patient, I went from owning my own business to being completely incapable of working for years due to my addiction.

Thanks to methadone maintenance therapy and a clinic that encourages proper dosing, I am now in a management position for a nationwide chain of retail stores and feel that my future is getting brighter every day. When not busy with my vocation, I involve myself in methadone maintenance therapy education and outreach and provide factual information about methadone and MAT to families and friends of other MAT patients so they do not remain so misinformed or under-informed about this miraculous, life-altering, and extremely effective treatment.

I realize now that if I had been given accurate information about how methadone maintenance therapy works and why it is so effective a long time ago, I could have avoided many of those long years of physical pain and mental and emotional turmoil that resulted from trying to live in a world that views people with the disease of addiction as weak, criminal, and morally destitute."

~ Renee Willis, New York

“Prior to becoming educated about my disease and its medical treatment, I was one of the ‘lower is best, shorter is best’ mentality because that is the treatment philosophy my provider still uses. Because of this philosophy, I cycled in and out of short-term, low-dose treatment episodes while my disease was progressing all the while. I was considered a ‘treatment failure’ and, unfortunately, I internalized this labeling.

Once I got on the Internet and started learning, I immediately could see that most of my problems were related to sub-therapeutic dosing. I was a poly-substance user while in treatment because I was self-medicating to try to normalize a methadone dose that was too low. Once I had the doctor raise my dose into the recommended therapeutic range, all other substance use stopped. Other teachings that went out the door included the ‘abstinence is the only way,’ ‘you can do it if you really want it,’ and similar sayings that only continued to make me feel bad. I came to understand I had a brain disease, not a moral failing. I was not a bad person; I was a person with an easily treated neurobiological disorder. As long as I continue to take my medication at an appropriate dose, I will continue to keep my disease in remission.

There are thousands of patients just like me, and many thousands more who—due to the ignorance of both providers and patients—continue to suffer with this disease, despite being involved in treatment. There is no question that an educated patient is a stable patient.”

~ Chris Kelly, Washington, DC

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Information Resources

For more information about MAT for opioid addiction, call SAMHSA’s National Clearinghouse for Alcohol and Drug Information (NCADI) at (800) 729-6686 or visit SAMHSA's Division of Pharmacologic Therapies at www.dpt.samhsa.gov.

For details on buprenorphine, MAT, or related SAMHSA activities, visit www.buprenorphine.samhsa.gov.

SAMHSA publishes Treatment Improvement Protocols (TIPS) that discuss buprenorphine (TIP 40), methadone (TIP in draft), and their pain related treatment issues (TIP 20) in more detail. There are also Technical Assistance Publications (TAPS) available to provide guidance and information to professionals in the field involved with MAT delivery. You can obtain these and other TIPS and TAPS through NCADI or you can visit www.samhsa.gov.

For more information about SAMHSA’s substance abuse treatment programs, grants, contracts, and services, visit SAMHSA’s web site or call (800) 729–6686; TDD (800) 487–4889.

For more information about the Rehabilitation Act and other Federally sponsored initiatives related to addiction and recovery, visit www.disabilityinfo.gov.

For more information about the Americans with Disabilities Act (ADA) and its provisions, please visit http://www.ada.gov.

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(Footnotes)

1. Substance Abuse and Mental Health Services Administration, (2003) Results from the 2002 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NHSDA Series H-22, DHHS Publication No SMA 03-3836). Rockville, MD.
2. National Drug Court Institute. Drug Court Practitioner Fact Sheet. “Methadone Maintenance and Other Pharmacotherapeutic Interventions in the Treatment of Opioid Addiction.” April 2002, Vol. III, No. 1.
3. National Institutes of Health. Consensus Statement. “Effective Medical Treatment of Opiate Addiction.” November 17–19, 1997. Vol. 15, No. 6. MD, 2003.
4. Tractenberg, A. Methadone-Associated Mortality. Epidemiologic Trends in Drug Abuse Volume II: Proceedings of the Community Epidemiology Work Group, Bethesda, MD: National Institute on Drug Abuse, in press.
5. Substance Abuse and Mental Health Services Administration, Office of Applied Studies Drug and Alcohol Services Information System (DASIS) Report: Treatment Admissions Involving Narcotic Painkillers: 2002 Update.
6. Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Emergency Department Trends From the Drug Abuse Warning Network, Final Estimates 1995–2002, DAWN Series D–24; DHHS Publication No. (SMA) 03–3780, Rockville, MD, 2003.

Facts About Opiate Use, Dependency, and Treatment

• Commonly used to treat heroin addiction, methadone also is used to treat addiction to other opiates, such as codeine, hydrocodone, oxycodone, and morphine. Methadone also is an effective painkiller, and is increasingly being used for this purpose. According to the Automation of Reports and Consolidated Orders System (ARCOS-2) administered by the Drug Enforcement Administration, the amount of methadone dispensed by retail pharmacies from 1997 to 2000 increased from 397 to 1,600 kilograms per year4.



• Treatment admission rates for misuse of narcotic pain relievers more than doubled between 1992 and 2002, according to SAMHSA. These admissions increased for all ages, but especially among people aged 20 to 30. Between 1997 and 2002, the proportion of new users – those entering treatment within three years of beginning use – increased from 26 percent in 1997 to 39 percent in 20025.



• An estimated 6.2 million people, 2.6 percent of the population aged 12 or older, were current users of prescription drugs taken non-medically. Of these, an estimated 4.4 million used narcotic pain relievers, 1.8 million used anti-anxiety medications (also known as tranquilizers), 1.2 million used stimulants, and 0.4 million used sedatives. Approximately 1.9 million persons aged 12 or older used OxyContin non-medically at least once in their lifetimes1.



• Use of pain relievers non-medically among those aged 12–17 increased from 9.6 percent in 2001 to 11.2 percent in 2002, continuing an increasing trend from 1989 when only 1.2 percent had ever used pain relievers non-medically in their lifetimes. Among young adults aged 18–25, the rate of ever having used pain relievers non-medically increased from 19.4 percent in 2001 to 22.1 percent in 2002. This rate was 6.8 percent in 20021.



• Emergency department mentions of narcotic pain medications rose from 99,317 in 2001 to 119,185 in 2002. The increase from 2000 to 2002 was 45 percent6.



• Narcotic pain medications accounted for 10 percent of total drug mentions in hospital emergency department visits related to drug abuse in 2002. Over the 8-year period from 1995 to 2002 mentions of narcotic pain medications rose 163 percent6.