Understanding the Full Scope of Addiction Treatment and Recovery
A guest blog provided by Mark Pirner, M.D., Ph.D.
I am concerned that the term medication-assisted treatment (MAT) – using methadone, buprenorphine, naltrexone – might be perceived outside of the addiction community as a stand-alone treatment for opioid use disorder. The implications are important because behavioral therapy, psychosocial change, and earnest personal work are all critical cornerstones of addiction treatment and recovery. It is a disservice to the community of stakeholders (including policymakers, government officials, criminal justice workers, insurance providers, healthcare providers, patients, and their loved ones) to allow the perception that medications alone are enough for recovery to happen.
Historically, the term MAT was coined at a time when limited or no FDA-approved medications were available for the treatment of opioid use disorder. MAT as a descriptor was intended to distinguish opioid use disorder treatment programs that incorporated medical therapy (e.g., methadone) in addition to behavioral modification and psychosocial intervention. The intent was not to replace behavioral and psychosocial treatments with pharmacological treatment(s), but rather to use both as complementary to each other. Pharmacology by itself was never intended to be a stand-alone treatment for substance use disorder (SUD). Guidelines today remain clear that treatment including behavioral/psychosocial intervention is essential for SUD treatment.
Should We Be Using TAM?
Perhaps a more appropriate descriptor for using adjunctive medication(s) in the treatment of SUD would be something like treatment-assisting medication or treatment-assisting modalities (TAM). This more accurately keeps the focus on the fact that treatments of all shapes and sizes can be tailored to patients and their providers with behavioral and psychosocial change at the core, whether with or without prescription medications or other modalities (such as treatment apps) that continue to be developed. This could also avoid the potentially unintended consequence of limiting access to newer or different treatment choices. For example, naloxone is a life-saving treatment that may not neatly fit into MAT since it is not a SUD maintenance therapy, yet it is a critical tool that reduces the morbidity and mortality of opioid overdose. Another example is if patients/providers are ‘forced’ through treatment algorithms or unwanted steps based on prior authorization criteria, not central (or potentially necessary) to their recovery plan.
Recovery is a holistic process that is worked through in stages. It is hard, it is lifelong, and it is not accomplished through medication alone. Further, hopefully and undoubtedly, new treatments will be developed, whether medication-based, app-based, behavioral-based or beyond our current imagination. It doesn’t really matter what we call them, and they still must meet the rigorous requirements of FDA-approval. But, when this is the case, they should be made available, and our terminology should be adjusted accordingly to avoid unintentional consequences.
About the author: Mark Pirner, M.D., Ph.D. is a senior medical director at US WorldMeds (www.usworldmeds.com), where he leads their medical affairs opioid withdrawal treatment portfolio. Dr. Pirner attended medical school at the University of Minnesota and, completed internal medicine residency at Duke University Medical Center and endocrinology fellowship at the National Institutes of Health. US WorldMeds is a wholly owned specialty pharmaceutical company based in Louisville, Kentucky, committed to raising awareness of opioid withdrawal syndrome and its treatment.
See other guest blog posts by Dr. Pirner: