Medication-Assisted Treatment Models
treatment (MAT) is the use of pharmacological medications, combined with counseling and
behavioral therapies, to treat SUD. Research shows that combining
medication, counseling, and/or behavioral therapies can be effective for substance use
disorder (SUD) treatment. Therefore, medications prescribed as part of MAT models are one component
of a comprehensive treatment plan that focuses on the "whole patient." This model describes
medications involved in MAT and the following model describes behavioral therapies that be
used in combination with medications as part of MAT.
As of 2020, there are three medications approved by the Food and Drug Administration (FDA) for the
treatment of opioid use disorder. There are no medications approved by the FDA for the treatment of
cannabis, hallucinogen, or stimulant use disorders.
Medications for Opioid Use Disorder
Three medications have been approved
by the U.S. Food and Drug Administration (FDA) for the treatment of opioid dependence: methadone,
buprenorphine, and naltrexone. These medications are effective for treating people with opioid use disorders, as
well as legally prescribed opioid pain relievers that are misused, such as oxycodone, hydrocodone, and morphine.
The medications work by easing withdrawal symptoms from opioids and blocking its euphoric effects.
– Methadone has been used since the 1960s for the treatment of opioid use disorders by reducing
cravings and preventing withdrawal symptoms. Patients who take methadone must receive the medication while
under physician supervision and the medication can only be dispensed through an opioid treatment program certified
by the Substance Abuse and Mental Health Services Administration (SAMHSA). Demand for methadone
treatment often exceeds availability, leading to extensive waitlists. One
methadone clinic in rural Vermont reported a waitlist of over 900 people, which meant an approximate
1.9-year delay in accessing methadone treatment. Learn more about the benefits and costs of methadone maintenance
– Buprenorphine allows for the reduction or elimination of withdrawal symptoms that can accompany
the discontinuation of opioids. The benefit of buprenorphine is that, unlike methadone treatment,
it can be prescribed or dispensed by certified healthcare providers in clinics, community
hospitals, health departments, or a correction facility, making it a more accessible treatment
option. Buprenorphine is closely regulated, and healthcare providers must qualify for a waiver in
order to prescribe the medication. In order to qualify for a waiver, the healthcare provider must
receive certification and training on the dispensing of this medication for the treatment of
opioid use dependency. The Comprehensive
Addiction and Recovery Act of 2016 included a provision that, for the first time, allows not only
physicians but also physician assistants and nurse practitioners to prescribe buprenorphine.
SAMHSA provides extensive information on certifications
and trainings, as well as buprenorphine waiver management. Additionally, SAMHSA's Clinical Guidelines for the Use of Buprenorphine in
the Treatment of Opioid Addiction provide information about screening, assessing, and
treating opioid use disorder with buprenorphine. Buprenorphine can be administered as sublingual
transdermal patch, or in a combination formulation with naloxone. In May 2016, the FDA approved
Probuphine, the first implantable buprenorphine for the treatment of opioid dependence.
Implantable buprenorphine may help with treatment adherence as well as prevent the stealing and
misuse of tablet or film forms of the medication. Learn more about the
benefits and costs of buprenorphine
– Unlike methadone and buprenorphine, naltrexone is an opioid antagonist, which means it works by
blocking opioid receptors and preventing their euphoric effects. While it can help reduce
cravings, naltrexone should only be used seven to ten days after medically managed withdrawal
(detoxification) from opioids has been completed. Naltrexone can be prescribed by any healthcare
provider licensed to prescribe medications. It does not require special training like
buprenorphine and methadone. Naltrexone can be delivered as a daily oral dose or as a long-acting
injection. The long-acting injection only needs to be administered once per month, which has
shown an increase in adherence
and retention rates.
Examples of Rural Medication-Assisted Treatment Models
Project Lazarus, which began in
Wilkes County, North Carolina, has created a series of toolkits designed for care managers, primary care
providers, and emergency department staff about opioid use disorders. The Project Lazarus training addresses
common misconceptions about opioid use disorders and addresses resistance of some providers to prescribing
medication-assisted treatments. The program encourages healthcare providers to obtain buprenorphine waivers
and provide this treatment option in their communities.
Considerations for Implementation
Buprenorphine and methadone are opioids; these treatment options are sometimes viewed as a method of
replacing one addictive substance for another. However, under the supervision of healthcare providers
certified to dispense the medications, these drugs can reduce and eliminate withdrawal symptoms and
reduce the high-risk behaviors often associated with drug use, particularly injection drug use. In
addition to reducing risk behaviors, these medications can increase retention rates for treatment.
One 2015 study in The American
Journal of Drug and Alcohol Abuse found that rural treatment centers were less likely to
prescribe buprenorphine, which could indicate opportunities for provider education on its benefits. A
2015 study from the Annals of Family
Medicine found that 82.1% of counties that reported no physicians who could prescribe
buprenorphine were rural counties. As a result, rural residents must travel long distances to receive
treatment. Buprenorphine may have especially beneficial outcomes in rural communities where there is
opposition to the establishment of methadone clinics or where transportation barriers prevent
patients from accessing the methadone clinic. Even among prescribers who have obtained the SAMHSA
waiver for prescribing buprenorphine, certified providers may only treat 30 patients at a time in the
first year, followed by up to 100 patients in subsequent years. Although a
final rule published in July 2016 increased access to buprenorphine by increasing treatment caps
for eligible providers to up to 275 patients annually, it still may not be adequate to meet the
growing demand for the medication.
Program Clearinghouse Example
Resources to Learn More
Treatment Physician Locator
A directory of practitioners authorized to dispense buprenorphine by state.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)
Comparison of Rural vs Urban
Direct-to-Physician Commercial Promotion of Medication for Treating Opioid Use Disorder
Describes outcomes from a study examining opioid use disorder medication promotion in urban versus
Author(s): Nguyen, T., Andraka-Christou, B., Simon, K., & Bradford, W.
Citation: JAMA Network Open. 2(12)
Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Environmental
Describes the challenges and barriers restricting access to MAT in rural primary care settings.
Identifies practices and innovative models of care effective in implementing MAT services and
includes a comprehensive collection of tools and resources to help providers, patients, and
communities for implementing MAT in rural practices.
Organization(s): Agency for Healthcare Research and Quality
Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address
Key Barriers Within the Treatment System
Discusses the key barriers to accessing evidence-based opioid use disorder care and offers strategies
to address these barriers.
Author(s): Madras, B., Ahmad, N., Wen, J., & Sharfstein, J.
Citation: NAM (National Academy of Medicine) Perspectives
Organization(s): Prevention, Treatment, and Recovery Working Group of the Action Collaborative on
Countering the U.S. Opioid Epidemic, National Academy of Medicine
for the Treatment of Alcohol Use Disorder: A Brief Guide
Provides guidance on the use of MAT for patients with an alcohol use disorder. Includes information
on screening and assessment, developing a treatment plan, medication selection and monitoring patient
Organization(s): Substance Abuse and Mental Health Services Administration, National Institute on
Alcohol Abuse and Alcoholism
National Institute on Alcohol Abuse and Alcoholism
Provides a variety of resources focused on alcohol use disorder including research articles, fact
sheets, training, presentations, and funding opportunities for research and conferences.
Organization(s): National Institute on Alcohol Abuse and Alcoholism
ASAM National Practice Guideline for the Treatment of Opioid Use Disorder
Provides guidance for primary care providers when evaluating and treating opioid use disorder, and
managing opioid overdose with a focus on using evidence-based pharmacotherapy treatment.
Organization(s): American Society of Addiction Medicine
Providers Clinical Support System
Compiles educational resources, training modules, online trainings,
information on MAT waivers, and clinical resources for healthcare providers involved with opioid use disorder
Organization(s): Providers Clinical Support System (PCSS)
Systematic Review of Rural-Specific Barriers to Medication Treatment for Opioid Use Disorder in the
Discusses implementation issues for medication assisted treatment for opioid use disorder in rural
areas. Identifies the need for additional rural-specific medication treatment studies.
Author(s): Lister, J., Weaver, A., Ellis, J., et al.
Citation: The American Journal of Drug Alcohol Abuse, 46(3), 273-288