MAT has become a noun, synonymous with the treatment of addictive disorders, especially opioid use disorder (OUD). Why this term and how did it originate?
Medications are commonly used to treat or prevent any number of ailments. We have thousands of medications in so many different categories and more are discovered every day. Why do we need to specifically reiterate the use of medications in the treatment of addictive disorders? Addictions for the longest time were seen through a moral lens as the manifestation of moral failing, weak will power, refusal to take personal responsibility. Medical intervention to treat a self-inflicted condition makes no sense. Use your will power, turn back to spirituality, and rid yourself of the demon, the moral voices roar. A healthy dose of stigma and social isolation would be an added benefit!
The advances in the understanding of the neurobiology of addiction and behavioral therapies gave patients additional options for recovery. It was and still is a long fight to bring the treatment of addictive disorders into the mainstream of medicine. The first break in the treatment of opioid addiction came with the approval of methadone in 1974. This was at first seen as a controversial measure. Substituting an illegal opioid with a legal opioid! This treatment was not readily accepted by the medical community, social activists, many patients, and their families. However, strong data was accumulating on the benefits of keeping a segment of patients on this medication. Patients were able to stop using heroin, maintain jobs, take care of their families. Many patients needed to be on methadone for long periods of time, some life-long. Methadone had finally taken a step in the direction of treating a disorder as a medical condition. It made sense to reassure patients on the benefits of using a medication. It was time to describe this new approach as Methadone Assisted Treatment (MAT), the beginning of the term MAT.
How did Methadone Assisted Treatment become Medication Assisted Treatment? Methadone was needlessly viewed with concern as substituting one opioid for another. Methadone, an opioid has clear benefits as a medication, no different than an antihypertensive, or an antidiabetic drug. It made sense to shift the focus away from methadone to a broadly acceptable term ‘medication’. Medication emphasized therapeutic benefits of methadone to attain a level of normalcy by breaking the cycle of opioid addiction. Changing ‘methadone’ to ‘medication’ became the new standard of care.
The opioid epidemic of the 1990’s brought on by the irresponsible promotion of prescription opioids once again brought into sharp focus the need to treat the disorder medically. By the middle of the 2000’s we had additional medications approved for the treatment of opioid use disorders, i.e., buprenorphine and the monthly injection of naltrexone sold under the brand name Vivitrol. The term MAT was broad enough to include all medications approved by the FDA for the treatment of all addictive disorders, including alcoholism.
Presently we have just four FDA approved medications for the treatment of opioid use disorder: methadone, buprenorphine, naltrexone and lofexidine and just three for the treatment of alcohol use disorder, disulfiram, naltrexone and acamprosate. There are no FDA approved medications for the treatment of cocaine or methamphetamines. Several medications approved by the FDA for other indications are used off-label for the treatment of some addictive disorders and behaviors.
MAT has become the standard of care for the treatment of addictive disorders, but less than 20% of the 21 million people affected by drugs and alcohol receive MAT as part of treatment. We have a long way to go before the treatment of addictive disorders with medications becomes as routine as treating other chronic conditions and we don’t have to use the term MAT anymore.
Percy Menzies, M. Pharm. is the president of Assisted Recovery Centers of America (ARCA), an integrated treatment center for addictive disorders and mental health based in St Louis. He can be reached at: pmenzies@arcamidwest.com.