What is MAT facilitation?
As far as I know, MAT facilitation does not exist. If it did exist, it might be based on 12-step facilitation, an evidence-based form of therapy provided currently at many rehabs.
Why does 12-step facilitation exist?
12-step program involvement is believed to be an effective way to help people addicted to drugs or alcohol to remain substance-free long-term. Unfortunately, 12-step program effectiveness has been difficult to quantify. There are few studies to demonstrate that programs such as AA and NA help to keep their members away from drugs and alcohol.
Because of the elusive nature of proving that peer support meetings are successful, 12-step facilitation was created to interface between rehab clients and 12-step programs. Studies have determined conclusively that 12-step facilitation (TSF) is effective in getting clients to engage in 12-step programs.
Why do we need MAT facilitation?
MAT is medication-assisted treatment. For opioid addiction, this means using one of the following medications to treat the addiction: methadone, buprenorphine, or naltrexone. For the purpose of this article, I am going to focus on buprenorphine, the most common brand being Suboxone.
Suboxone is a safe and effective medication that has been helping people to stay opioid-free for years at a time. In addition to taking Suboxone, patients are instructed to also engage in psychotherapy.
Many doctors and treatment programs also insist on additional elements of treatment. They may require 12-step program involvement. Or, they may also require specific forms of therapy. For example, there is a new technology known as prescription digital therapeutics in which cognitive behavioral therapy is administered by a mobile application.
In my experience, there is one thing that leads to opioid relapse more than anything else. The greatest risk factor for relapse is stopping medical treatment too early.
Why would a patient taking Suboxone decides to stop taking their Suboxone?
There are several reasons that this might happen. The patient may have personal feelings against being dependent on medication.
They may have heard from family, friends, or the media, that medications such as Suboxone are not safe for long-term use. There is a belief held by many people that Suboxone treatment is “trading one drug for another.”
There may also be strong direct influences where a patient is told by family members, or even healthcare professionals, that they must not take Suboxone long-term. Parents persistently tells their adult children that they must stop medical treatment. Detox and rehab staff and doctors tell patients that Suboxone or Subutex are only good for short-term use.
I have even had patients tell me that they stopped their Suboxone because someone on the street advised them to stop! One patient told me that he proudly told a gas station attendant about his Suboxone success and the man told him that he would do better with kratom, a street herbal opioid replacement sold in gas stations!
Suboxone works best as a long-term treatment.
Currently, addiction treatment experts recommend that Suboxone therapy continue for at least 1-2 years. For some patients, longer therapy will be beneficial. Suboxone is safe for long-term use. Patients who continue taking their medication tend to remain opioid-free.
Additionally, patients who continue taking Suboxone enjoy productive, successful, and fulfilling lives. They move up in their careers, grow their families, start new businesses, and more. In short, they tend to thrive and excel in their lives.
We know that stopping Suboxone too soon often leads to relapse. What happens if therapy is stopped?
Surprisingly, patients can still do well without psychotherapy. Of course, addressing environmental triggers, and resolving past issues is helpful, but it seems not to be essential for ongoing success when it comes to opioid addiction.
Imagine that Suboxone treatment is a Christmas tree and all the additional therapies are lights and ornaments. While it is nice to have a well-decorated tree, even if the trimmings are removed, the tree will still stand.
Medication adherence is the foundation of a successful MAT program.
Since we know that Suboxone, or an equivalent buprenorphine medication, is the foundation for successful opioid addiction treatment, it follows that the best way to ensure long-term success is to support the patient in reaffirming their commitment to continuing medical treatment.
Additionally, we can greatly help opioid-addicted patients to transition to MAT with Suboxone by encouraging and educating them on the benefits of Suboxone treatment. In fact, healthcare providers may also benefit from further education on the benefits and safety of MAT as well as the importance of ongoing, sustained treatment.
As healthcare providers, our doubts and hesitation in strongly recommending MAT can have a detrimental effect on our patients. We need to approach treatment of the life-threatening condition of opioid addiction with confidence. Our patients depend on our guidance in providing them the best care possible.
Currently, there is an additional difficulty presented by the nature of street opioids, particularly adulterated heroin. Some patients undergoing the induction process to get started with Suboxone find that the transition can be more difficult than it would be with quitting short-acting prescription opioids, or even pure heroin. Unfortunately, some synthetic designer opioid analogs finding their way into street heroin are unusually long-lasting.
As a result of the difficult transition from opioids to Suboxone, some patients are starting on methadone, where Suboxone would have been preferable. With additional support and encouragement, healthcare providers can help patients to have success with Suboxone, avoiding the methadone clinic altogether.
Now is the time for MAT facilitation.
I believe that now is the time for us to get together and formalize a program of MAT facilitation. We can start by studying TSF and how it is applied effectively to increase engagement with 12-step programs.
How can we educate and support patients in our clinics and rehabs to make the right decisions and stick with effective medical treatment long-term? Also, how can we provide support to the rehabs and clinics themselves to encourage more widespread use of MAT and support for continuity of care and ongoing care for patients?
Currently, Suboxone treatment is considered to have a 50% success rate. While this is far better than the success rate of abstinence-based treatments, I believe that it could be far more successful.
With a solid program of MAT facilitation at all levels of contact with the opioid-addicted individual, the success rate of MAT with Suboxone will likely skyrocket into at least the 70-80% range, if not higher. The most common reason for Suboxone failing is when patients stop taking Suboxone too early.
Let us design a program of MAT facilitation and implement it in MAT-friendly rehab facilities. Then, we can begin the task of studying this new form of therapy to see how it increases MAT involvement and adherence and how it influences the long-term success rates of MAT.