The National Institutes of Health estimates that more than 2 million Americans are addicted to prescription opioids (e.g., fentanyl, oxycodone) and heroin.
Some experts and federal policy makers think medication assisted treatment (MAT) is the most effective way to treat opioid addiction and use. Others, such as Dr. Katherine Drabiak, a USF College of Public Health (COPH) assistant professor specializing in health law and medical ethics, aren’t so sure, noting that MAT is not a one-size-fits-all solution.
There’s also concern that while opioid users may beat one addiction (to the opioid), they can become dependent on the treatment drug.
MAT uses the drugs buprenorphine, methadone and naltrexone, along with counseling and behavioral therapies, to help an opioid user kick the habit and sustain recovery. In fact, in some states it’s now being ordered by the courts.
Drabiak highlights some of the concerns with MAT in an article she authored, “Expanding Medication Assisted Treatment Is Not the Answer: Flaws in the Substance Abuse Treatment Package,” published in the summer edition of the DePaul Journal of Health Care Law.
“In this research, I wanted to look at the evidence behind the claim that MAT constitutes an effective treatment. I also wanted to know by what metrics the claim is judged,” said Drabiak. “While MAT may reduce frequency of opioid abuse, the research shows the majority of patients still continue opioid abuse and engage in polysubstance abuse.”
According to Drabiak, this brings up a number of issues.
“There are discrepancies in the way medications used in MAT are described to patients and in the safety and risk profiles used in FDA product labeling,” she commented. “Does the patient understand the risks and benefits to MAT?”
What’s more, Drabiak’s research points to the fact that there’s a high rate of people for whom MAT doesn’t work. “Are people in MAT aware of that?” she asked.
Another issue, she added, is that some of the people in MAT may be getting their methadone but still be abusing other substances and committing crimes, like driving impaired. “MAT may not be as straightforward a solution as people like to think,” Drabiak commented.
Drabiak says her purpose in doing the research was twofold: to think more broadly when it comes to treatment for opioid addiction and to give health care providers better guidelines.
“When we think about the intersection of the criminal justice system and substance abuse, there’s a misconception that the justice system punishes people for having an addiction they cannot control, which isn’t the case. In most instances, people enter the justice system based on crimes they commit related to their drug abuse, like theft, child abuse or impaired driving.”
In Drabiak’s opinion, it’s not as simple as offering MAT treatment or punishing people for their drug-related crimes. It’s more complicated and nuanced than that, she notes.
“MAT can work, but it was designed for a small percentage of people with an intractable heroin addiction,” she said. “With this paper, I wanted to parse out what the benefits and hazards to MAT are. Many judge the success of MAT by seeing how many people stay in treatment. But with my research, I found there were still a lot of unanswered questions. A patient may be in treatment, but are they abusing another substance? Can they hold down a job? Take care of their families? Are they integrating back into society?”
While questions abound, the answer, says Drabiak, could lie with more personalized care.
“People need individual assessments. MAT may be a good option for some people, but there are others for whom it is risky, and I think in a lot of cases patients have no idea what they’re getting into. It isn’t one-size-fits-all and people need to be aware of what success the treatment has.”S
Story by Donna Campisano, USF College of Public Health