There has been a significant focus on increasing access to MAT for opioid addiction. The development of new effective treatments has risen and is of great importance given the devasting effects of opioid use disorder. This year, the Food and Drug Administration (FDA) announced its plan to expand MAT for opioid dependence by providing new guidance to the industry. Acceptance of new treatments, and the value of new options for MAT for opioid use disorder, is on the rise and necessary for better management of the opioid epidemic. MAT is becoming more recognized as the gold standard of care for the treatment of substance use disorder. The intended purpose of MAT for opioid use disorder includes a decrease in illicit opioid use, decreased mortality, and improved long-term sobriety.
Opioid dependence has reached a critical level in the United States, driving by overprescribing and diversion of opioid painkillers. The social impact of this is a growing tide of dependence in substantial terms related to treatment, lost work productivity, criminal activity, and social welfare expenditure (Hall, 2006).
The leading cause of accidental death in the US is drug overdose. More than 2 million Americans have opioid use disorder ( OUD). Around 66 percent of the more than 63,600 drug overdose deaths in 2016 involved an opioid. The opioid epidemic was calculated to cost the US economy over $504 billion in 2015, according to a report by the White House Council of Economic Advisors (CEA). With the current treatments available, as many as 91 percent of those in recovery experience relapse, and 80 percent of those individuals do so within one month of discharge from a detox program. Long-term abstinence is a very challenging endpoint to achieve through current treatment options due to poor compliance. On average 115 people die everyday from opioid overdose in the USA. There are few families that have not been touched in some way by this crisis.
A growing interest in medication-assisted treatment exists. MAT is an evidence-based standard for treating opioid use disorder which is currently not being widely used despite literature proving its effectiveness. The perception of MAT has been changing recently however, and some of the biggest treatment providers such as Hazelden Betty Ford Foundation, who previously offered abstinence-only treatment, began offering MAT in 2012.
The three primary medications used for the treatment of opioid use disorder are methadone (agonist), buprenorphine (partial agonist), and naltrexone (antagonist). Buprenorphine is a relatively new drug approved for use in 2002 which causes limited stimulation of the opioid receptors in the brain and can suppress withdrawals and cravings. Methadone is a pure opioid receptor agonist which means it is a perfect plug into the receptors of the brain causing complete stimulation of those receptors, thereby also relieving cravings and withdrawals. These two medications trick the brain receptors to stabilize and reduce the withdrawal symptoms and cravings that make it difficult for individuals to stop using opioids.
"MAT is an evidence-based standard for treating opioid use disorder which is currently not being widely used despite literature proving its effectiveness"
Naltrexone works differently from methadone and buprenorphine. It is an opioid antagonist that blocks the effects of opioids. An opioid dependent person should not receive naltrexone before they have been detoxed. It is different from methadone and buprenorphine because it has no opioid agonist properties and it does not provide stimulation of the receptors in the brain. Evidence also suggests that naltrexone is effective for the treatment of alcohol use disorder.
In the last 15 years, new FDA-approved medications have been developed to treat opioid use disorder and there are more medications being developed that are seeking FDA approval,
• In May 2018, the FDA approved the medication, Lofexidine, to alleviate withdrawal symptoms and to facilitate the discontinuation of opioids. The fear of the physical symptoms that individuals endure during detox can be one of the biggest barriers for those seeking treatment;
• In 2016, the first buprenorphine implant (Probuphine) was approved by the FDA for the treatment of opioid use disorder. It was designed to provide a constant, low-level dose of buprenorphine for a period of six months;
• The extended-release injectable naltrexone (Vivitrol) was approved by the FDA in 2010 to treat opioid use disorder and was previously approved in 2006 for the treatment of alcoholism. This medication provides patients suffering from opioid use disorder the opportunity to take medication monthly as opposed to daily dosing, which improves compliance;
• CAM2038 (Supplied by Camrus and Braeburn Pharmaceuticals) is a product candidate currently seeking FDA approval. It is a long-acting monthly buprenorphine subcutaneous injection that targets improved treatment compliance and reduced diversion;
• BICX102 (Supplied by BioCorRx Pharmaceuticals) is a product candidate currently seeking FDA approval. It is a long-acting naltrexone implant that can last several months and is being developed for opioid and alcohol use disorders.
Real, substantive challenges continue to face us, but we know what works and have a roadmap for treating addiction. More accessible and affordable medication-assisted treatments are available with more to come soon. Public and private health care systems, collaborating with government, are needed to continue the progress being made with MAT. These medications, combined with proper therapy and support, can make a significant impact on this crisis if they become more widely adopted by treatment providers.