Medication Assisted Treatment vs. 12 Step – Is it only One or the Other?

Are you a proponent for Medication Assisted Treatment (MAT) for opioid use disorder?  Do you believe that a 12 Step Program should not incorporate MAT?  Is  addiction is a voluntary disorder in your opinion?

There was a very interesting article posted today on MedScape for Nurses, titled “Opioid Crisis in America: Experts Call for Action”  The article noted Addiction experts, including the head of the National Institute on Drug Abuse (NIDA), are lobbying for greater support for addiction treatment, particularly medication-assisted treatment (MAT), to address America’s opioid addiction crisis.

At a press briefing on Capitol Hill organized by the American Psychiatric Association (APA) and featuring NIDA director Nora Volkow, MD, leading psychiatrists and other experts noted that in addition to a lack of education and training, stigma still prevents many clinicians from helping those with opioid dependence and other substance use disorders.

“We happen to be very lucky that we have medications that work to treat opioid use disorder,” said Dr Volkow. The drugs — methadone, naltrexone, and buprenorphine ― “prevent overdoses, they prevent relapse. But they are not being implemented,” in part because of stigma, she said.

“We’re treating [addiction] as if it were a voluntary behavior,” said Dr Volkow, who added that infrastructure remains inadequate to treat the vast numbers of those in the United States who have opioid use disorder.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recently reported that in the past year, more than 10,000 physicians have become certified to provide in-office buprenorphine treatment. Slightly more than 3000 have become certified to provide MAT for an upper limit of 275 patients. A total of 37,647 clinicians have certification to offer MAT to 30 patients or more, according to SAMHSA.

The article voiced concerns regarding Emergency Departments releasing patients with an opioid use disorder without aftercare or discharge instructions.  Education in diagnosing and treating substance abuse in medical school and specialties such as psychiatry remains neglected.

Another area of concern discussed was related to insurers’ reluctance to cover MAT for opioid use disorder along with the perception in many recovery programs that drug therapy amounts to simply swapping one addiction for another.

In our current society  we take hard stances on all subjects, and tend to dismiss the opinions of people with a different approach. In this case, there are definitely a variety of opinions on the best method for treatment for opioid use disorder. Learning and listening to experts on all sides and incorporating their experiences and results will yield the best results.  In addition, we must find ways to offer the appropriate level of supervised treatment to address this epidemic.