Medication Assisted Treatment and Young Adults (MAT)
The Efficacy of Medication Assisted Treatment and Young Adults (MAT)
There are many prominent studies supporting Medication Assisted Treatment (MAT). When combined with behavioral counseling it can be thought of as the “whole patient” approach. Long term success rates in relation to opioid dependence and the potential relief drugs like buprenorphine/ naloxone can bring to you or your loved one is exciting news. Some studies reveal 60-70% success rates and the immediate reading of those numbers are cause for optimism. However, a fine reading of these studies reveals different outcomes depending on the way opioids are consumed and the different socio-economic backgrounds of each individual.
The fine reading reveals that a history of heroin use is often associated with poor outcomes, including pain severity prior to treatment. In another study by the National Institute on Drug Abuse (NIDA) it was also revealed that participants who primarily used painkillers had a higher rate of treatment completion than those who used heroin. That same study further revealed that individuals who inject heroin either intramuscularly or intravenously had lower outcomes compared to heroin users who snort or smoke the drug. This exposes a significant correlation between the outcomes for individuals who originally used opioids to get high verse the individuals who originally used opioids for pain relief.
In an older, much smaller study, it suggested that extended treatment with buprenorphine-naloxone improved retention in therapy and reduced abuse of several drugs by the end of the trial. The average age in the study was 19 years and individuals were either detoxed off of opiods with ongoing counseling or given long term buprenorphine treatment along with ongoing counseling--counseling consisted of one group therapy session and one individual session per week. The results were clear: 79% of the individuals who received detoxification and counseling dropped out of therapy whereas only 30% of individuals dropped out of therapy who received buprenorphine-naloxone treatment. Yet all individuals were tapered off their medications by the end of the study.
The above study only tells us that young adults do well in treatment while on antagonist medication, but the study also fails on a few fronts: 1) it fails to reveal what the long term results were post treatment; and 2) what is an appropriate amount of time for the young adult to be on opioid antagonist medication? Taking seriously the fact that young adults are the largest users and abusers of both prescription pain medications and heroin it makes sense to empower their recovery journeys with some form of MAT. Or, due to the fact that they are the largest abusers of prescription and opioid pain medications they might be the most likely to abuse antagonist medications.
Remember that there is a difference between craving a drug to get high and craving a drug to reduce physical and emotional pain. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine is abused more than any other prescription opioid subtype. Alternative studies suggest that participants who injected opioids were more likely than non-injectors to drop out of treatment (44% versus 34%), meaning there is a high likelihood that these user’s poor outcomes can be attributed to using opioids to get high as an original genesis of the addiction. If you or your loved one initially consumed opioids to get high--given the propensity of buprenorphine abuse---then this form of MAT therapy might not be appropriate for you.
The argument here is not whether or not buprenorphine substitutes one addiction for another or that there is no efficacy of opioid antagonist drugs ability to restore balance to the brain circuits affected by addiction. In fact, when you compare outcomes between those who took opioids in the first place to get high verse those who had a history of major depressive disorder studies reveal that the depressed patients were twice as likely to have good outcomes. The concern is whether or not these medications have as much efficacy for the young adult due to the fact that in one study it revealed that 28% of the individuals who dropped out of the study were under the age of 25 years--consistent with previous research, young age and use of opioids… predicted early dropout. Other factors may include unemployment, underdosing patients, and criminal history as predictors of treatment dropout.
The above information reveals that the prescribing of opioid antagonist medications is not a silver bullet and that the responsible prescribing of these medications is dependent upon an individualized therapy approach, meaning these drugs are not appropriate for all patients.
Therefore, targeting emerging adults and those who do not respond to buprenorphine treatment for increased supervision and intervention is supported compared to buprenorphine treatment alone. Peaks Recovery Centers supports the use of MAT throughout treatment on a case-by-case basis and when treating the young adult families should be aware of the tension that exists for prescribing these powerful agonist medications. From our vantage point there is simply more to getting well than being medicated and young adults simply face different challenges when recovering from opioid use disorder than other age range demographics. We need to be thoughtful about MAT in relation to the young adult.