Medication-Assisted Treatment in Illinois

Thousands of Illinois residents struggle with drug addiction every year. In 2021, more than 3,700 residents died from drug overdose. Of these fatalities, 81% were caused by an opioid. Because of this, the need for effective substance abuse treatment is more crucial now than ever.

Enter Medication-Assisted Treatment (MAT), an evidence-based treatment that combines medications and counseling to treat substance use disorders. It’s considered the gold standard for the treatment of substance addiction, and yet it remains underutilized in the state of Illinois.

In this article, we discuss everything you need to know about Medication-Assisted Treatment, including the medications used, the treatment’s effectiveness, and the concerns and misconceptions surrounding it.

Understanding Medication-Assisted Treatment

Medication-Assisted Treatment, or MAT treatment for some people, uses medication with counseling, behavioral therapies, and psychosocial support to effectively and safely treat Opioid Use Disorders (OUD).

The medications used are clinically driven to relieve psychological and physical cravings brought about by opioids without the negative effects.

“Failing to offer MAT is like trying to treat an infection without antibiotics,” said Alex Azar II, Secretary of the US Department of Health Services.

Indeed, MAT has seen countless evidence of its effectiveness. Yet, fewer than half of privately funded substance use disorder treatment programs offer MAT as a treatment solution, and not even one-third of patients receive it.

At Illinois Recovery Center, we ensure the accessibility and affordability of MAT services. While it’s true that every patient has a unique path to recovery, the facts don’t lie: MAT is by far the safest and most effective tool against substance abuse.

The ultimate goal of MAT is full recovery. Benefits of MAT include:

• Offer opioid treatment programs to help reduce opioid dependence-related overdoses and deaths
• Increased retention and social functioning in the treatment
• Improved maternal outcomes for breastfeeding and pregnant women with substance use disorder
• Decreased criminal activity and use of illicit opioids
• Increased chance of gaining and maintaining employment
• Decreased transmission of infectious diseases due to improper needle use, like Hepatitis C and HIV
• Addressing the physical and psychological aspects of addiction

Commonly Used Medications in MAT and Their Mechanisms of Action

As of 2023, MAT uses three medications to treat substance use disorder. All three medications—methadone, naltrexone, and buprenorphine—are approved by the U.S. Food and Drug Administration (FDA) and can only be obtained under a physician’s prescription.

These medications are particularly effective against short-acting opioids like morphine, heroin, and codeine, as well as semi-synthetic opioids like hydrocodone and oxycodone. They cannot be used in the treatment of hallucinogens, cannabis, and stimulant use disorders.

Methadone, naltrexone, and buprenorphine restore balance to the brain circuits affected by addiction, helping patients focus on working toward recovery.

Though considered opioids, they don’t produce the “high” associated with opioid misuse. They instead have a stabilizing effect that can help the seemingly never-ending cycle of craving and withdrawal.

Under the prescription of a physician, these medications are safe to use for months, years, or even a lifetime with little to no side effects.

Methadone

Methadone, sold under the brand names Methadose, DISKETS, and Dolophine, is a long-acting opioid agonist that’s taken as a replacement for heroin and other opioids.

It blocks the brain’s natural opioid receptors, thus reducing drug cravings and preventing opioid withdrawal symptoms. It’s been used in the treatment of opioid addiction since the 1960s.

The demand for methadone treatment often outpaces supply, resulting in extensive wait lists. The waiting list for methadone treatment has become so severe that some patients have to wait more than a year for a full-service treatment slot to become available.

Buprenorphine

Buprenorphine, sold under brand names Butrans, Buprenex, and Suboxone, among others, works much like methadone: it reduces cravings and controls withdrawal symptoms brought about by opium addiction.

It can be administered as a transdermal patch or implant, as well as sublingual tablets, injections, or in combination with naloxone. Implantable buprenorphine aids with treatment adherence and prevents medication misuse in tablet or film forms.

Unlike methadone, buprenorphine can be dispensed or prescribed by a physician in community hospitals, clinics, correction facilities, and health departments without administration training. This makes it a lot more accessible than the former. 

Naltrexone

Naltrexone, sold under the brand names Revia, Depade, and Vivitrol, is an opioid antagonist that prevents opioids from affecting the body.

Unlike methadone and buprenorphine, naltrexone can be given as a prescription by any licensed physician. It can be administered in tablet form or as an extended-release injection.

Oral tablets (Vivitrol) are taken regularly, whereas injections are taken once a month. 

Components of MAT: Medications, Counseling, and Support Services

MAT doesn’t have a single standard model, as treatment varies from patient to patient. However, most services have the following key components:

• Pharmacological therapy (a combination of methadone, buprenorphine, and/or naltrexone)
• Behavioral therapy (Cognitive Behavioral Therapy, 12-step Facilitation, Motivational Interviewing, Contingency Management, etc.)
• Psychosocial services or interventions

The duration of MAT depends on the medication used and the patient’s needs.

According to the National Institute on Drug Abuse, patients taking methadone may need therapy for at least 12 months.

After the first 90 days of the treatment, the dosage is gradually reduced until the patient is on a maintenance-level amount. The dosage goes down as the treatment progresses and until the medication is no longer needed.

As for buprenorphine, the minimum treatment duration is eight weeks. Like methadone, the dose may be lowered to maintenance once the patient has been sober. The amount is tapered off for four to six months until the therapy ends.

Naltrexone treatment should last for at least 12 weeks. If the patient becomes abstinent in the last several months of treatment, the medication is weaned off.

Patients on naltrexone must closely work with their healthcare providers because, as an antagonist, its side effects aren’t immediately noticeable. The risk of overdosing while on naltrexone is higher than both methadone and buprenorphine.

Throughout the treatment, patients undergo counseling, behavioral therapy, or a combination of both. Psychological treatment teaches patients about healthy coping and communication skills and how to build a supportive recovery network.

Addressing Concerns and Misconceptions About Medication-Assisted Treatment

Some critics view replacement medications like methadone, buprenorphine, and naltrexone as substituting one addiction for another.

Conveniently, these same critics forget that opioid medications are merely a part of the MAT approach. They’re used to assist other components of treatment to effectively treat the patient from substance use disorder.

Nevertheless, it’s undeniable that these medications are opiates, and all opiates have addictive properties. Thus, the biggest concern people have about MAT is the tendency for patients to rely on medication as their primary treatment.

This shouldn’t be the case, as patients on MAT should instead work on healing the psychological and emotional causes of addiction.

Without addressing the reasons for addictive behavior, the patient puts themselves at risk of becoming addicted to the new substance—even one prescribed as part of the MAT plan.

MAT Isn’t Reliant on Medication

MAT isn’t reliant on medication but rather on psychological treatment. An effective MAT plan touches on past trauma and other contributing factors, addresses conflicts, and teaches new ways of handling life without relying on drugs. 

MAT requires strict supervision at a certified facility. As with prescription medication, there is a potential risk for side effects. The use of other illicit drugs, medications, and alcohol can increase those risks.

Fatal overdoses like opioid overdose cases are a real and dangerous risk when taking these medications, so patients on MAT are obligated to follow their physicians’ strict orders and visit a licensed facility at the designated schedule.

Dispelling the Stigma Associated With MAT

Medication-Assisted Treatment plan is surrounded by a lot of harmful stigmas. Critics often say that if you’re still using, you’re not in recovery. But that isn’t the case.

According to a study published by the American Journal of Public Health, overdose deaths caused by heroin dropped by nearly 70% over 14 years when access to MAT increased.

MAT medications are tools that allow patients to focus on building healthy support systems and behaviors. Support, understanding, and encouragement are critical on the path to recovery and breaking the barriers of shame and judgment associated with MAT.

Remember:

Addiction thrives in secrecy. Stigma encourages isolation and prevents conversation.

MAT is an effective treatment lifesaving intervention with clinically-proven effectiveness. People who seek help through MAT are almost always doing so with the desire to get better. They’re not using MAT as a means to get free and legal access to opioids.

When someone living with OUD asks for help, they shouldn’t be scrutinized or judged; they should be celebrated for their efforts and given support. Only then will the stigma surrounding MAT be dispelled.

Barriers to Implementing MAT in Illinois and Potential Solutions

Despite the growing interest in evidence-based treatment practices, pharmaceutical therapies for the treatment of opioid use disorders remain an afterthought in many areas of the state. The biggest barriers to implementing MAT in Illinois are as follows:

• Lack of perceived effectiveness of MAT
• Lack of knowledge on how to implement MAT within the treatment setting
• Lack of access to medical personnel with MAT expertise
• Staff resistance and stigma to the use of MAT as a treatment option
• Financial inaccessibility of treatment options used in MAT

Of the 250 publicly-funded SUD programs analyzed by the National Council for Behavioral Health, 63% failed to offer Medication-Assisted Treatment.

The most commonly reported barrier was related to financial inaccessibility (i.e., organizational costs and patient costs). The reluctant attitudes of healthcare providers also led to the underutilization and lack of access to MAT.

To overcome the above-mentioned barriers, healthcare providers must be given organizational support before, during, and after they complete the MAT DATA waiver requirements.

It’s also wise to increase the availability of extended-release MAT formulations in rural areas, as well as enforce policies that require insurance companies to cover evidence-based OUD treatments.

Providers should be educated on the effectiveness of MAT to rule out the stigma surrounding evidence-based addiction treatment.

MAT biases in the medical setting have led to a lack of support for patients struggling with OUD and serve as a near-impenetrable barrier to its implementation.

Drug users seeking Medication-Assisted Treatment must be given appropriate community resources and high-quality, affordable MAT care.

MAT is still a relatively unfamiliar approach for many providers, which makes it all the more important for all parties involved to understand the value and possible outcomes of the cure.

Continued Research and Advancements in MAT

Medication-assisted treatment has been around since the 1930s. Advancements in neurobiology and behavioral therapies have significantly evolved since t. Still, researchers continue to look into the therapeutic benefits of MAT medication to bring the treatment into mainstream medicine.

MAT has seen countless modifications from its inception, with the recent being the introduction of office-based methadone maintenance, extended-release injectable naltrexone, and implantable and monthly injectable buprenorphine.

Researchers are currently looking at the effectiveness of heroin vaccines, biased agonism at the seven-transmembrane receptor (GPCR), Deep Brain Stimulation (DBS), and gene-targeted therapy.

Practical, clinical, and pharmacologic barriers prevent these treatment practices from coming to fruition. Larger studies need to be conducted to confirm the effectiveness of these treatments.

Wrapping Up

Medication-assisted Treatment is the golden standard for the treatment of substance use disorder as it combines clinically-approved medications with behavioral therapies. Despite that, the number of rehab facilities in Illinois practicing MAT remains stubbornly low, especially in rural areas.

The concern over the use of MAT comes from structural and organizational barriers, financial inaccessibility of treatment options, and stigma among providers. Dispelling these barriers is imperative for the introduction and continued use of MAT to combat the ever-growing substance epidemic in Illinois and the United States as a whole.If you or someone you know is struggling with substance use disorder, help is available at Illinois Recovery Center. Alongside MAT, we offer other evidence-based treatment options to ensure people get the service they need for detoxification away from addiction and improve their mental health.