Review of medication-assisted treatment for opioid use disorder

Abstract

Context The American opioid epidemic has necessitated the search for safe and effective means of treatment for opioid use disorder (OUD). Medication-assisted treatment (MAT) encompasses select medications that are proven effective treatments for OUD. Understanding the mechanisms of action, indications, and implementation of MAT is paramount to increasing its availability to all individuals struggling with opioid addiction. Objectives This review is based on an educational series that aims to educate healthcare providers and ancillary healthcare members on the use of MAT for the treatment of OUD. Methods The database PubMed was utilized to retrieve articles discussing the implementation of MAT. Boolean operators and Medical Subject Headings (MeSHs) were applied including: MAT and primary care, MAT and telehealth, methadone, buprenorphine, naltrexone, MAT and osteopathic, MAT and group therapy, and MAT and COVID-19. Results Three medications have been approved for the treatment of OUD: methadone, naltrexone, and buprenorphine. Identifying ways to better treat and manage OUD and to combat stigmatization are paramount to dismantling barriers that have made treatment less accessible. Studies suggest that primary care providers are well positioned to provide MAT to their patients, particularly in rural settings. However, no study has compared outcomes of different MAT models of care, and more research is required to guide future efforts in expanding the role of MAT in primary care settings. Conclusions The coronavirus disease 2019 (COVID-19) pandemic has led to changes in the way MAT care is managed. Patients require a novel point-of-care approach to obtain care. This review will define the components of MAT, consider the impact of MAT in the primary care setting, and identify barriers to effective MAT. Increasing the availability of MAT treatment will allow for greater access to comprehensive treatment and will set the standard for accessibility of novel OUD treatment in the future.

Kratom as a potential substance use disorder harm reduction agent

“…For individuals with OUD, use of additional substances to offset their ‘highs’ or minimize withdrawal symptoms suggests need for harm reduction agents that can mitigate SUD symptoms without inducing opioid withdrawal or considerably increasing overdose risk. While there are highly effective OUD treatment options available, ( 58 ) they may not be viable for individuals looking to minimize withdrawal symptoms but unready to quit their preferred substance(s). Since methadone is a full opioid receptor agonist, use in conjunction with other opioids greatly increases overdose risk.…”

At a Crossroads: Opioid Use Disorder, the X-Waiver, and the Road Ahead

“…Because methadone is an opioid agonist, discontinuation is associated with withdrawal symptoms. 48 Methadone increases the risk of arrythmias such as QT interval prolongation and torsades de pointes 49 and is also associated with detrimental oral health effects. 50 Many patients with OUD have comorbid conditions such as hepatitis, HIV, acquired immunodeficiency syndrome, and depression, and polydrug use is common; methadone may have drug-drug interactions with agents such as protease inhibitors, antimicrobials, anticonvulsants, calcium channel blockers, and selective serotonin reuptake inhibitors.…”

Methadone Treatment Gap in Tennessee and How Medication Units Could Bridge the Gap: A Review

“…OUD is a treatable chronic disorder [9]. One treatment modality for OUD is medicationassisted treatment (MAT), a multitherapeutic approach that combines behavioral health interventions with pharmacotherapy [10]. MAT has been associated with a 2.56 risk reduction in all-cause mortality compared to abstinence-only treatment [11].…”