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Medication Assistance
mat
Written by Alison Webb

Providing a foundation for solid steps into a recovery journey

Sarah Siegel grew up on Cliff Island, and today she has a great life. She has a family, and she is a recovery coach and a spiritual leader. She loves to meditate, read about different religious paths, play with her dogs, and grow her own food. But her life hasn’t always been like this.

About 15 years ago, when Sarah was addicted to heroin, a doctor told her that if she kept using it, she would die. “I always felt like death was just there, every second, looking over my shoulder,” Sarah says about that time. She decided to go on methadone. “I feel like choosing methadone really was that decision to pick life, from a place that I really didn’t have much to hold on to. And so, for me, deciding to go to the methadone clinic was really about picking life, deciding that I really wanted to live.”

Sarah’s recovery journey shares some similarities with Danielle Rideout’s, who is the Recovery Liaison for Westbrook, Windham, Gorham and Buxton Police Departments. She serves as a case manager for people with substance use disorder and helps them get connected to services. She listens to their stories, cheers them on, and shares their joys and sorrows. Getting to this point in her life wasn’t easy.

Danielle has been in recovery for almost 14 years.

Her recovery path included taking buprenorphine (commonly referred to by its trade name Suboxone), participating in a support group for mothers, volunteering in her community, and attending 12-step meetings. She also had lots of support from her family and community.

Danielle and Sarah’s stories aren’t unusual. Their recovery journeys included medication assisted treatment (MAT) that formed the foundation for them to rebuild their lives.. “I worked hard, really hard,” Sarah says. “And I couldn’t have done that without methadone…. but ultimately it was through all of that hard work that I found lasting recovery.” Danielle credits Suboxone as the foundation for her recovery. “That’s why I’m here, where I am in my recovery and my life. I wouldn’t be where I am today without it”

What is MAT?

MAT stands for “medication assisted treatment” and refers to FDA-approved medications for the medical management of addictions.

Below are some common medications used today:

  • For Opioid Use Disorder: methadone, buprenorphine (suboxone), or naltrexone
  • For Alcohol Use Disorder: disulfiram, acamprosate, and naltrexone, and varenicline, bupropion
  • For Nicotine Dependence: patches, lozenges, or gum

MAT for opioid use disorder is a little different than for other substance use disorders. Methadone and buprenorphine are controlled substances and not without risks; they can be diverted and used to get high. But risks are minimized when they are properly prescribed by a healthcare provider and taken as directed.

“Because of the way opioids work in the brain, stopping the use of opioids without medications is dangerous and can lead to relapse, overdose, and possibly death, explains Dr. Merideth Norris of CAP Quality Care, an addiction treatment center in Westbrook “For people with opioid use disorder who are not on MAT, the relapse rate is over 90 percent, and every relapse can kill you.”

Why do people with opioid use disorder need MAT?

Jeremy Spiegel, MD, a psychiatrist and buprenorphine prescriber at Casco Bay Medical, says that “when you have used substances over time, you are changing your brain, its neurochemistry. By continuing to use you create more changes in your brain, and your brain is clamoring for that substance.” People who use opioids experience withdrawal when they stop.

As Spiegel explains, “withdrawal is so difficult and compelling, and they want it to stop.” The only way to stop withdrawal is by taking more opioids. “They can’t stop being sick in withdrawal,” Spiegel says, “so they keep using. MAT is an evidence-based treatment that soothes those withdrawal symptoms and allows them to not crave substances so they can function in their lives.”

Norris likens opioid use disorder to having a traumatic brain injury or a stroke and says that the idea that it can be fixed with willpower and structure just isn’t realistic. “MAT is medication that helps the brain function. It helps people go to work, be good parents, be good citizens. It’s not replacing one drug for another, it’s treating a medical condition.”

How does MAT help people?

MAT helps people stay alive.

The most common times for opioid overdose are after a person hasn’t been using for a while, maybe for a day, a week, or a month. During that time, their tolerance for the drug goes down, and their body needs less. If they start using again, they might use too much and overdose.

Buprenorphine is used by some detox facilities to help patients manage the symptoms of opioid withdrawal, and when patients are stable, they are transferred to appropriate treatment.
ERs also use buprenorphine to manage withdrawal and then connect patients with treatment. Research shows that if treatment after the emergency room visit or detox includes buprenorphine, the risks of relapse and overdose are reduced.

Beyond detox, buprenorphine can form the foundation for a solid recovery in the community. Spiegel explains that MAT is intended to be used along with other recovery supports like individual and group counseling, recovery residences, and peer support. “When the medication works well, patients will have no withdrawal and no cravings. They feel well enough to engage in their recovery … buprenorphine helps you get better.”

Who is on MAT?

The simple answer is, “people from all walks of life are on MAT.”

Spiegel says that in his practice, most of his patients are employed, have families and are involved in their community. They are able to come to Casco Bay Medical, just like they would go to any other doctor’s appointment. Norris says that opioid addiction is widespread and can happen to anybody, says Norris. The people who come to CAP Quality Care for methadone and counseling are business owners, teachers, nurses, and lawyers.

Dr. Alane O’Connor, DNP, is a primary care provider and buprenorphine prescriber who provides “total patient care.” Her philosophy is, “you have to solve the problems that are in front of you,” including pregnant women with opioid use disorder.

These women are first in line for MAT because opioid addiction creates a significant risk to the health of the baby.

O’Connor is the medical lead of the Maine Maternal Opioid Misuse Initiative (MaineMOM), a 5-year, $5 million grant awarded to Maine to expand access to treatment for pregnant women with substance use disorders.
She explains that in these situations, “the safety of the baby is paramount, and MAT protects the pregnancy. If a pregnant woman is physically dependent on opioids, she needs to be on a medication that prevents withdrawal, which is the most dangerous thing for Moms during pregnancy.”

Withdrawal in a pregnant woman can bring on a miscarriage or early delivery of the baby, and MAT can prevent that. O’Connor’s treatment of pregnant women goes further than the pregnant mom. “The goal is to stabilize the family, so if there are other people in the family who are using, everyone gets offered treatment, usually MAT.”

“When MAT goes well, women can be motivated and it becomes a transformative experience,” O’Connor says.

In one research study she conducted, more than 90 percent of Moms on MAT went home from the hospital with their babies in their custody. O’Connor’s research has also shown that women who are able to access MAT early in pregnancy are more likely to remain in treatment a year after giving birth.

How long do people stay on MAT?

The only answer to this question is, “as long as they need it to be healthy.” Spiegel, Norris, and O’Connor agree—a person should be on MAT for as long as it takes for them to feel secure in their recovery and ready to stop. That could be six months, or six years, or more.

Danielle was on MAT for six and a half years, and she credits buprenorphine for the things she’s been able to do in her recovery. “I have my LADC (Licensed Alcohol & Drug Counselor), I’m going to grad school, I own a house, I have two children, I’m married to the man I’ve been with for 15 years,” she says “We have all of these things, and they’re all a direct result of my recovery. I truly believe Suboxone did that for me,”

What about stigma?

It comes as no surprise that people on MAT face judgment just about everywhere in the community. Spiegel says many of his patients have experienced prejudice and discrimination at other treatment providers and pharmacies, and among providers and staff at medical practices.

“Stigma makes it hard to take that first step to getting help,” he says. Norris agrees. “This is a population that encounters tremendous stigma, even in the recovery community. It is impressive and heroic that people come here for treatment despite stigma, in order to stay healthy.”

Pregnant women on MAT face especially strong stigma and may feel shame. Both Danielle and Sarah were on MAT during their pregnancies. Deciding to go on methadone was hard for Sarah. “For me, it was a forced acceptance that I was actually sick enough in my addiction that I couldn’t just pull myself out of it.” It didn’t help that she felt judgment all around her. “When I walked into the doctor’s office, there was just this assumption that I didn’t care about my child, and that wasn’t true.”

But, as O’Connor says, pregnancy can be highly motivating, and that’s how Sarah experienced it.

“I think for the first time in my life, I felt a sense of purpose that I had never experienced before. I felt just in awe that there was a being growing inside of me, and I had this drive to really care for myself in a different way. Everything that I did was so centered on the fact that I was pregnant, and I couldn’t wait to meet my child.”

For Danielle, buprenorphine was only part of her recovery. “It wasn’t like I was just using Suboxone for my recovery. There were other things, too,” she says. Being part of the Mom’s support group, going to meetings, volunteering, reconnecting with her community, and going back to school were important, too. “That’s what worked for me.”

MAT and recovery

MAT keeps people with opioid use disorder alive, so they can engage in their own recovery.

Sarah thinks of medication as a tool to help discover your recovery pathway.

It’s one step on the journey.

“Recovery is a process,” says Danielle. “We have to go through everything we’ve gone through to get to where we are today.”

Alison Webb

Alison Webb

Alison Webb, MPH, PS-C, a columnist for Journey, is a public health professional with over 20 years’ experience in community outreach and organizing, substance use and overdose prevention, community based substance use recovery supports, and linking community members with healthcare services. Alison is a strong recovery ally in her own community, where she has been a member of the Portland Overdose Task Force, Young People in Recovery, and as a past member of the Board of the Portland Recovery Community Center. She is active in legislative advocacy to increase recovery support services.