Medication-Assisted Treatment (MAT)

MAT is the opposite of “cold turkey”: Just as nicotine gum helps smokers quit tobacco, medication helps SUD patients maintain sobriety by suppressing withdrawal symptoms and cravings. MAT is highly effective for patients with opioid use disorder (OUD) and is commonly provided in specialized outpatient clinics. Some OUD patients wean off the medication after a few years. Others remain on a low dose indefinitely, just as many patients with depression take antidepressants long-term. The two government-approved medications for opioid addiction are buprenorphine (Suboxone®) and methadone. Most outpatient clinics specialize in one or the other. 

OFFICE-BASED OPIOID TREATMENT (OBOT)

 An outpatient clinic that prescribes buprenorphine (such as Suboxone®). Over the past decade, OBOTs like Ideal Option have become more widespread as the popularity of Suboxone has increased. Suboxone combines two drugs: the dominant ingredient buprenorphine, which suppresses withdrawal and cravings, and naloxone, which stops patients from experiencing a “high” from the medication. Patients receive a prescription that must be filled at the pharmacy.

PROS: Frequency of visits is dependent on the phase of treatment and will lessen as the patient stabilizes. In addition, because Suboxone is prescribed, patients can take the medication in the comfort of their own home. Almost instantly, the buprenorphine stops the nausea, vomiting, and other symptoms that make opioid withdrawal unbearable. Patients often feel more comfortable in a specialized addiction medicine clinic compared to a primary care office. Patients often say after their first dose of Suboxone: “Oh my god, I feel normal again.”

CONS: Not suitable for patients who need medically managed detox, intensive behavioral health counseling, and/or environmental control. Buprenorphine may not be suitable for heavy opioid users.

OPIOID TREATMENT PROGRAM (OTP)

 An outpatient clinic that dispenses methadone. For decades, methadone was the only medication approved for the treatment of opioid addiction. Taking methadone once a day keeps the brain’s opioid receptors satisfied while staving off the nausea, anxiety, and other withdrawal symptoms that drive users to seek more dangerous opioids. By law, methadone patients must come to the clinic daily and be observed taking the medication.

PROS: Methadone has served countless OUD patients well—far better than residential treatment programs that offer counseling but no medication. The tight supervision required by law is helpful for patients who lack family support and those who can’t get to both a clinic and a pharmacy.

CONS: The daily visits required by methadone clinics can be cumbersome for patients, especially those with jobs and/or children to care for. In addition, methadone, unlike buprenorphine, does have potential for abuse. Methadone doesn’t bind to opioid receptors as tightly as buprenorphine does, so patients who, for example, use heroin on top of methadone can get high. Taking too much methadone can also cause respiratory depression and heart problems. Buprenorphine does not carry those risks.