Program, not a pill

FAQs

There are many misconceptions surrounding medication-assisted treatment. Program, not a pill leads with evidence, and we’ve answered common questions surrounding medication-assisted treatment and OTPs—where MAT is most commonly administered—to help keep the record straight.

Below are answers to commonly asked questions regarding Medication-Assisted Treatment and Opioid Treatment Programs.

About Medication-Assisted Treatment 

SAMHSA (Substance Abuse Mental Health Services Administration) defines MAT as the use of medications, in combination with counseling and behavioral therapies, to provide a comprehensive, “whole-patient” approach to treat people living with opioid use disorder. MAT programs are clinically driven and tailored to the individual.1

MAT has proven to be clinically effective in helping patients recover from opioid addiction. Additional benefits include:

  • Decreased opioid-related overdose deaths and illicit opioid use
  • Improved social functioning
  • Lowered risk of contracting infectious diseases such as HIV and hepatitis C
  • Reduction in criminal activities that often occur in result of one’s need to support addiction2

According to the National Institute on Drug Abuse, psychosocial and behavioral approaches to opioid use disorder provide incentives for individuals to remain abstinent, modify attitudes and behaviors related to drug abuse, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intense craving.

As stated on the National Institute on Drug Abuse’s website, research has shown that methadone maintenance is more effective when it includes individual and/or group counseling, with even better outcomes when patients are provided with, or referred to, other needed medical/psychiatric, psychological and social services (e.g., employment or family services).

There are three FDA-approved medications to treat opioid dependency: 

  1. Buprenorphine is an opioid partial agonist. It produces effects such as euphoria or respiratory depression at low to moderate doses. With buprenorphine, however, these effects are weaker than full opioid agonists such as methadone.  As with all medications used in MAT, buprenorphine should be prescribed as part of a comprehensive treatment plan that includes counseling and other behavioral therapies to provide patients with a whole-person approach. 
  2. Naltrexone is not an opioid, is not addictive, and does not cause withdrawal symptoms. Naltrexone blocks the euphoric and sedative effects of opioids such as heroin, morphine, and codeine.
  3. Methadone is a long-acting opioid agonist medication approved by the Food and Drug Administration (FDA) to treat Opioid Use Disorder (OUD) as a medication-assisted treatment (MAT). Methadone reduces opioid craving and withdrawal and blunts or blocks the effects of opioids.  When taken as prescribed, methadone is safe and effective. Methadone helps individuals achieve and sustain recovery and to reclaim active and meaningful lives. Methadone is one component of a comprehensive treatment plan, which includes counseling and other behavioral health therapies to provide patients with a whole-person approach.

While methadone is proven to help people get into and stay in recovery from an opioid addiction, methadone also has a high potential for misuse and can even lead to severe addiction. Methadone is different than buprenorphine and naltrexone because it is a synthetic opioid agonist, meaning it fully activates opioid receptors in the brain to produce pain relieving effects. When prescribed and administered appropriately (under the supervision of a practitioner), methadone is a safe and effective treatment for opioid-use disorder that reduces opioid cravings and withdrawal and blocks the effects of opioids.3

No, the dosage of medication does not produce the same euphoric effect associated with other opioids. When taken as prescribed, buprenorphine and methadone can help restore balance to brain circuits that are damaged by addiction, allowing the brain to heal while working toward recovery.4 Read more about the method of action and the differences in these medications and opioids. 

Opioid dependency medications are safe to use for months, years, or even a lifetime. As with any prescription, individuals must consult with their provider(s) prior to discontinuation.5

About Opioid Treatment Programs

OTPs are highly regulated, comprehensive treatment programs that provide medication-assisted treatment through multidisciplinary teams consisting of physicians, nurses, and counselors who are specialized to treat opioid addiction. 

Because of rigorous oversight and regulations, OTPs are the only entity legally authorized to treat OUD patients with methadone and have been the gold standard in treating OUD for over 50 years.

To provide MAT for individuals with OUD, OTPs must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by an independent, SAMHSA-approved accrediting body. Once certified, OTPs must renew certification annually or every three years depending on the accreditation timeframe awarded.Additionally, OTPs must be licensed by the state in which they operate and registered with the Drug Enforcement Administration (DEA), through their local DEA office.6

An OBOT allows primary care providers who have obtained their DATA 2000-waiver and completed necessary training to prescribe certain OUD medication within their regular clinical setting.7

Although both OTPs and OBOTs treat individuals with opioid use disorder (OUD), there are several key differences relating to the delivery of medication and care to patients with OUD: 

  • Unlike OTPs, OBOTs are not required to integrate behavioral health services or diversion control into their model of care.8
  • Medical Practitioners at OBOTs cannot prescribe or dispense methadone, but can prescribe schedule III, IV, and V medication such as buprenorphine and naltrexone. 
  • Medical practitioners at OTPs can dispense methadone, buprenorphine, naltrexone and other schedule III, IV, and V medications.9
  • OTP medications are dispensed or administered on site until individuals complete several weeks of compliant program attendance, toxicology screenings and overall adherence to their treatment plan in which case, medication can be taken at home and occasionally prescribed.
  • OBOTs do not require that individuals take their medication on site and medication is often prescribed.10

OTPS provide the following core services:

  • U.S. Food and Drug Administration (FDA)-approved opioid agonist and antagonist medication-assisted treatment (MAT) medications
  • Substance misuse counseling
  • Individual and group therapy
  • Drug/Toxicology testing
  • Periodic assessments11

Individuals progress through drug addiction treatment at various rates, so there is no predetermined length of treatment. For methadone maintenance, 12 months is considered the minimum, and some opioid-addicted individuals continue to benefit from methadone maintenance for many years.12

Effective treatment conducted in OTPs has been proven to help 80% of patients fully recover.

It is possible for individuals enrolled in OTPs to experience better physical health outcomes along with the following:

  • Improved social relationships with family, friends, and/or their community
  • Increased likelihood to get a job or start a career
  • A more positive outlook on the future
  • Discovery of new interests

1 https://www.samhsa.gov/medication-assisted-treatment (Medication Assisted Treatment, 2022)

2 https://www.samhsa.gov/medication-assisted-treatment (Medication Assisted Treatment, 2022)

3 https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone (Methadone, 2022)

4 https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/use-medications-methadone-buprenorphine-simply-replacing ((Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), 2018)

5 https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions (MAT Medications, Counseling, and Related Conditions, 2022)

6 https://www.samhsa.gov/medication-assisted-treatment/become-accredited-opioid-treatment-program (Certification of Opioid Treatment Programs, 2022)

7 https://www.ruralhealthinfo.org/toolkits/moud/2/systems-of-care/office-based-opioid-treatment (Office-BAesed Opioid Treatment, 2022)

8 https://www.ruralhealthinfo.org/toolkits/moud/2/systems-of-care/office-based-opioid-treatment (Office-BAesed Opioid Treatment, 2022)

9 https://www.ihs.gov/opioids/recovery/obot/ (Office Based Opioid Treatment, 2022)

10 https://www.ihs.gov/opioids/recovery/obot/ (Office Based Opioid Treatment, 2022)

11 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Opioid-Treatment-Program (Opioid Treatment Programs, 2022)

12 https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment-usually-last (Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), 2018)