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Pros and Cons of Medication-Assisted Treatment for Opioid Addiction

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Your teen is addicted to heroin or other opioids. You’ve been getting lots of advice. Mental health professionals have told you about Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), 12-Step programs (e.g. Nar-Anon), and adolescent drug rehab centers. You’ve also heard about detoxification (often referred to as detox), and Medication-Assisted Treatment (MAT).

For teens addicted to heroin or other opioids, traditional detox—cutting off all the substances from their system at once—feels terrible. Medication-assisted treatment, or medication-assisted detox, employs a more gradual, tapering approach. Addicts take daily doses of specific, physician-prescribed medication to reduce their cravings to opioids and lessen the pain of withdrawal.

How Does MAT Work?

Several different types of medications are effective in treating teens’ heroin or opioid addiction during detox. Some of the most common are Methadone, Buprenorphine (what Suboxone tablets/filmstrips contain), and Naltrexone. These are all approved by the FDA. While each drug works in different ways, most work by occupying the same opiod receptors illegal opioids occupy.

However, medication-assisted treatment for substance addiction is an ongoing controversy. Doctors, mental health professionals, and researchers disagree as to whether an addict should be using one drug to overcome addiction to another drug.

Negatives of MAT

On one hand, the anti-MAT team feels that using drugs to treat addiction is like jumping from the fire into the frying pan. Many teens become addicted to the drugs meant to help them recover. The anti-MAT team points to the hundreds of teen deaths related to medications prescribed during detox, particularly Suboxone. Teens may abuse, sell, and/or trade Suboxone. Adolescents may combine Suboxone with other drugs, take it in ways not recommended by prescribing physicians, or use it to handle withdrawal symptoms in between episodes of excess heroin use (Velander, 2018).

This is why the anti-MAT proponents emphasize a cold-turkey approach to detox. These abstinence advocates encourage teens to immerse themselves in serious behavioral therapy and participate in 12-Step programs. They believe that teens need to address their core mental health issues at an adolescent drug rehab treatment center—to learn how and why they fell into addiction and glean coping skills to prevent relapse.

Benefits of MAT: Harm Reduction

The pro-MAT team also encourages therapy, 12-step programs, and treatment at inpatient drug rehab centers…in conjunction with medication-assisted detox. They argue that the brain of a teen addict—or any addict—is physically unable to tolerate cold-turkey detox using an abstinence approach (i.e. Simply cutting off opioids without anything to help with the side-effects of withdrawal.) Professionals, parents, and doctors feel that these medications are necessary to gradually and safely wean an addict off their drugs, without doing it all at once. Otherwise, teens may not be able to withstand the pain of withdrawal and the subsequent cravings for opioids, and may just end up relapsing since traditional detox feels so terrible.

Medication, they argue, helps them complete the detox process so they can then go on to actively participate in treatment at a substance abuse and mental health treatment center. This is based on the harm-reduction philosophy of substance abuse treatment. Harm reduction individuals advocate for settling for smaller, more realistic goals instead of reaching for a huge goal that may just end up backfiring.

Is MAT Good or Bad?

As in most cases, there’s no black and white answer. The choice to use medication-assisted treatment for overcoming one’s drug addiction is individual. Medication-assisted treatment should only be prescribed by a doctor/mental health professional familiar with your teen’s clinical history and behavioral patterns.

In any case, there’s one thing both sides agree on: That detox needs to be accompanied by serious therapy. MAT does not replaces the internal hard work involved in overcoming addiction. While Suboxone or Methadone may help a teen recover from the physical addiction, they don’t address the emotional and behavioral processes altered or damaged by addiction.

That’s why most adolescents addicted to heroin or other opioids need treatment at a teen drug rehab center, so they can learn the coping skills necessary to identify their weaknesses, prevent relapse, and regulate their emotions and behavior. The underlying roots of the substance abuse issue must be dealt with—or else relapse may occur sooner or later. If they’re in crisis, teen with an opioid use disorder may benefit from residential/inpatient treatment. Adolescents with lower levels of clinical acuity may benefit from intensive outpatient (IOP) or partial hospitalization (PHP) programs. At the very least, teens undergoing MAT should see a mental health professional on a weekly basis to discuss their progress. That’s in addition, of course, to their regular appointments with the doctor managing their medication-assisted treatment.

Our Behavioral Health Content Team

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