Treating Opioid Use Disorder

Focus On Recovery – Spokane Regional Opioid Task Force

What is MAT?

MAT is Medication Assisted Treatment. Methadone, buprenorphine, and naltrexone are Food and Drug Administration (FDA) approved medications often combined with behavioral therapies to treat Opioid Use Disorder. They are used to treat those who have an addiction to short-acting opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone. Medications used in this type of treatment normalizes brain chemistry and body functions without the negative effect. This stability allows MAT patients to achieve healthy social, psychological and lifestyle changes. It decreases overdoses, increases the likelihood that someone will stay in treatment even through relapse, is more effective in reducing illicit opioid drug use that non-pharmacological treatments, and improves health treatment in other areas as well. For example, a person using MAT is more likely to enroll in HIV treatment and keep up their HIV treatments. People may safely take medications used in MAT for months, years, several years, or even a lifetime. Plans to stop a medication must always be discussed with a doctor.

How MAT can help

Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. People struggling with OUD are in great part a struggling to overcome the effects of these changes. Medications such as methadone, LAAM, buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids, but with protective or normalizing effects.

A common misconception associated with MAT is that it substitutes one drug for another. Instead, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. MAT programs provide a safe and controlled level of medication to overcome the use of an abused opioid. And research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability.

Opioid Overdose Prevention Medication

Naloxone, also known as Narcan, is the life-saving drug that can reverse an overdose. It is not addictive, nor can it cause harm if administered. Some people have expressed concern that using Naloxone will only encourage more drug abuse. However, a recent study done at Harborview showed that there is no evidence that providing naloxone increases overdose or opioid use risk behaviors. One reason cited is that Naloxone puts the person experiencing an overdose in sudden, acute withdrawal, the symptoms which can include tremors and seizures.

Anyone who is currently using, has a loved one using opioids, or is working with people who are using prescription or illicit opioids should consider carrying Naloxone. Naloxone is available for purchase at most pharmacies. Some pharmacies require a prescription from a provider. There are a few pharmacy chains—Walmart, Walgreens and Yolks—in the Spokane area that can prescribe Naloxone directly. 

Naloxone Standing Order

The Statewide Standing Order to Dispense Naloxone can be used as a prescription for naloxone. People may take this standing order  to a pharmacy to get naloxone, instead of going to a health care provider to get a prescription.

These videos show how to administer Naloxone

Types of Treatment

According to the American Society of Addiction Medicine (ASAM), there are five main levels of treatment in the continuum of care for substance abuse treatment. For more information about how the ASAM criteria is used to make decisions about the level of care a patient needs, visit: 

Level 0: Early intervention services

Called Early Intervention for Adults and Adolescents, this level of care constitutes a service for individuals who, for a known reason, are at risk of developing substance-related problems, or a service for those for whom there is not yet sufficient information to document a diagnosable substance use disorder. The duration of early intervention services greatly depends on the patient’s understanding of the perils of substance use and whether he or she makes behavioral changes to avoid the path to drug addiction. Patients are closely monitored for symptoms that indicate they need a higher level of treatment.

Level 1: Outpatient Services

These typically consists of less than 9 hours of service/week for adults, or less than 6 hours a week for adolescents for recovery or motivational enhancement therapies and strategies. Outpatient treatment requires patients to attend regularly scheduled meetings. This level of treatment allows patients to carry on with their routine while receiving face-to-face services with addiction or mental health professionals. It is ideal for people who have jobs or a strong support system at home, and it typically costs less than other levels of treatment. Level I care includes evaluation, treatment and recovery follow-up services. It addresses the severity of the individual’s addiction, helps implement behavioral changes and improves mental functioning.

Level 2: Intensive outpatient services (IOPs)

These are used to address addiction detoxification or round-the-clock supervision is not required but do required intensive support for behavior changes in order to help with relapse management and provide coping strategies. It requires a minimum of nine hours per week. This program comprises counseling and education about mental health and substance use issues. Patients are referred to psychiatric and medical services if addiction specialists deem it necessary. However, intensive outpatient programs cannot treat unstable medical and psychological conditions.

The treatments included in intensive outpatient are:

  • Screening and intake assessment
  • Psychological and behavioral treatments
  • Psycho-education
  • Self-help groups
  • Supportive services

Level 3: Residential/inpatient services

Level 3 of the continuum of care provides residential substance abuse treatment. This level of treatment is typically appropriate for patients who require a stable living space to help with their recovery. Treatment and assistance are provided around the clock, and the facility is staffed 24 hours a day, seven days a week. The patients may live on site or in a living facility in close proximity to the drug and alcohol treatment center so nearby services are readily available.

Level 4: Medically managed intensive inpatient services

Out of the four levels of treatment, level 4 is the most comprehensive and intensive. It offers 24-hour medically directed evaluation, care and treatment, including daily meetings with a physician. The facilities are usually equipped with the resources of general acute care or psychiatric hospitals and offer substance abuse treatment that also addresses co-occurring disorders. The last level of treatment focuses on stabilizing patients and preparing them for transfer to a less robust level of care for continued monitoring as they progress toward recovery.

Detoxification

or detox, is the clearing of a substance from the body while managing withdrawal symptoms. When someone regularly consume alcohol or drugs over a period of time, their body becomes accustomed to the substance and their body chemistry changes. Once they stop using, their body responds with withdrawal symptoms. Some of these symptoms can be fatal, depending on the substance. The detox process manages these withdrawal symptoms and prepares the person to enter a rehabilitation program. A program with medical detox provides supervision and medications to make the process safer and more comfortable. Detox can be done on an inpatient or outpatient basis. It usually includes 3 stages: evaluation, stabilization and transitioning to treatment. Medically supervised detox is strongly recommended for alcohol, opiate or benzodiazepine withdrawal, which can be fatal.

Detox is not actually treatment, as it does not treat any underlying addiction.

Aftercare

Consists of any intervention after initial substance abuse treatment. It is an integral part of preventing relapse. Aftercare programs provide recovering addicts with the coping skills and self-help strategies necessary to maintain sobriety once released from treatment. Those in recovery must make significant lifestyle changes if they expect to achieve permanent abstinence, and aftercare programs provide them with support and empowerment while beginning their new journeys. Common types of aftercare include 12-step programs, rehab alumni programs, one-on-one or group counseling, and sober living homes. People can pick and choose which programs work best for them.

Behavioral Therapy

helps engage people in drug abuse treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviors related to drug abuse, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and prompt another cycle of compulsive abuse. 

Spokane Focused On…

Treatment

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