MAT: Medication Assisted Treatment

By P. Casey Arrillaga, LCSW, LCDC

Medication Assisted Treatment, or MAT, is a form of addiction treatment that involves prescription drugs such as methadone and buprenorphine that are intended to help people get off opioid drugs including heroin and fentanyl. It has been a topic of hot debate for decades, because for some, MAT makes the life-saving difference that helps them achieve their recovery goals, while for others it is a placeholder until they start using their drug of choice again. Because of this, it is seen by some as enabling or even “fake sobriety.” In this post, we’ll explore the world of MAT, how it can be used most effectively, and what it means for you or someone you love.

What We Know So Far

Opiates are drugs that are either derivatives of the opium poppy or imitate its chemical structure. For thousands of years, these substances have been known to be highly effective at reducing pain and suffering, but they have also been known to be highly addictive. Various societies have tried countless things to deal with this dilemma. Opiates have been considered to be both wonder drugs and a scourge. Wars have been fought over them.

Humankind has learned to purify them more and more over time, making them both more effective, more addictive, and thus more deadly. We have moved from opium, to morphine, to heroin. More recently, science has developed synthetic versions that are many times more powerful, such as fentanyl. This medication has helped many people who were suffering, while simultaneously virtually wiping out entire communities.

Given how much these drugs reduce pain, they are not going away anytime soon. Many people use them safely, yet a certain percentage of the population finds them irresistibly euphoric beyond any other human experience. They will spend their lives chasing that high to the point that they ruin their lives, cause pain to those they love, overburden the health care system and other social services, and often die from overdose.

Many people realize they are getting caught in this trap and want to get out. Unfortunately, they quickly find that not only are they going to miss the high, which has often become less and less over time due to developing tolerance, but they quickly find the withdrawals from opiates are brutal. The brain has become dependent on the opiates and thus has stopped producing enough of the natural chemicals that reduce pain, produce motivation, and make life seem enjoyable. Thus, the user finds that they are miserable and in pain very quickly if they don’t keep a steady supply of opiates flowing into their system. These withdrawals can feel like hell on earth.

This is where MAT comes in. These medications get the brain sufficient levels of opiate effects but don’t hijack the user’s motivational system the way that opioid drugs do.  MAT works as a place holder of sorts and fills the area in the brain that produces craving.  But do not be mistaken, although MAT reduces craving significantly, some still find that the medications have milder euphoric properties. Thus, the temptation of addiction is reduced, but withdrawal effects are also avoided. This gives an addicted person the chance to live the type of engaged productive life that is often out of reach for people who are regularly using opiates.

The oldest and best-known of these medications is methadone. It was discovered in Germany near the end of World War II, but it wasn’t recognized as a potential part of treatment for opiate addiction until 1947. It came into more widespread use for MAT in the early 1960’s, at which time all addiction had much heavier stigma, and opiate addiction was considered one of the worst. As a result, there was a tug-of-war between those who favored stronger punishment as a deterrent against opiate use and those who saw the people with addiction as needing medical treatment. Federal and state policy around methadone was a compromise between the two.

Thus, by state law under federal guidelines, methadone could be prescribed, but the user had to check in daily at a methadone clinic to pick up that day’s dose as a way to have accountability. It is hard to think of any other medication that has such restrictions. This requirement has acted as a deterrent to using it both because of the inconvenience and the potential lingering stigma around having to be seen going in and out of such a clinic every day indefinitely.

Proponents of MAT saw an opportunity during COVID to ease some of these restrictions, but since lockdown ended, each state has made its own decisions about whether have to come to a clinic every day or not. As of 2024, the federal government has finally recommended that previous restrictions placed on methadone be lifted, allowing patients to take it home and take the pills on their own.

While these difficulties were being worked out, other options have been brought to market for MAT, chiefly buprenorphine in the early 1980’s. This medication works similarly to methadone without as much legal restriction. It was made popular under the brand names Subutex (which is no longer sold) and Suboxone (which combines buprenorphine with naloxone).  Beyond daily dosing, it is now available as a long-acting injection, implant, patch, or short-acting injection.

Like many aspects of addiction treatment, there is controversy around MAT. Studies show that MAT can be lifesaving, presenting a way to manage opiate addiction for people who cannot do it any other way. Both professionals and people who have the addiction look at MAT as a natural and obvious treatment. However, there are many for whom this treatment does not work.  In fact, some use this as a tool to withdraw off opioids when they are unable to find drugs either legally or illegally.  We have treated many that want to get off MAT and were unsuccessful on their own, because most report a worse withdrawal from MAT than from opioids. There are some people in recovery who see MAT as “not really sober,” and are thus highly critical of anyone who goes to recovery meetings while using it. Some professionals have become jaded by seeing too many people who seem to use MAT as a crutch until they can get back to using heroin or fentanyl. As with the opiates themselves, there are points to be made on both sides, and no easy answers.

One important fact that cannot be ignored is that there are many factors that contribute to an addictive pattern. This is why at Windmill we always ask, “Why did this person want to change the way they felt in the first place?”  There are many that build a biochemical dependence, but most also used it to escape. We know that MAT alone will not be able to “fix” that. That’s where treatment comes in. This is where we can address the feeling or potential trauma that needs to be processed, something that no medication can do.

How Do We Use This Information Effectively?

At Windmill, we recognize that there is not a one-size-fits-all answer to this debate. Instead, we evaluate every client who is addicted to opiates as an individual when it comes to whether MAT is appropriate. This means close collaboration between the medical and clinical teams to see if MAT is likely to be the factor that leads to success or if it will be abused. We cannot predict the future or read minds any more than anyone else can, but our experienced team has access to world-class information and experience. Objective and subjective reporting from Trac9, family/friends (patterns of use), our Brain Frequency program, along with genetic testing, allow us to make the best possible assessment of each client. This gives us the ability to match each client with the treatment that is most likely to work for them.

The Bottom Line

Opiate addiction is extremely difficult to beat and often deadly for those who don’t. MAT is not perfect for everyone who uses opiates, but it can make all the difference when matched with the right client. At Windmill, we use our depth of experience and ability to gather accurate information to make sure that each client who uses opiates gets the best possible chance of success.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.