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1 1) What are the benefits t clients f encuraging the use f MAT? Withut MAT, 90% f individuals with Opiid Use Disrder (OUD) will relapse within ne year. With MAT, the relapse rate fr thse with OUD decreases t 50% at ne year. Mre prmising statistics have been demnstrated fr thse whse treatment includes psychscial interventins. Outdated Substance Use Disrder (SUD) treatment mdels are ften ne-size-fits-all. Traditinal SUD services are ften slely based n an abstinence-nly philsphy and ften d nt fllw a medical mdel f treatment. Evidenced-based services that incrprate MAT address the bilgical prcesses f physical dependence and cravings a majr cause f relapse. As with mst medical cnditins, MAT takes a chrnic, bilgical-based cnditin apprach understanding that multiple streams f care are needed t gain cntrl and manage this fatal disrder. While all MAT regimens are effective in treating SUD, they may nt be equally effective fr all individuals. There are many frms MAT, fr bth OUD and Alchl Use Disrder (AUD), with multiple ways f administratin. As a result, treatment can be narrwly tailred t each individual s needs. 2) Isn t MAT just exchanging ne drug fr anther? All disrders f addictin are chrnic cnditins with very real bichemical cmpnents. Research is cnclusive that SUD is linked t specific receptrs invlved with the reward system in the brain. This is especially true fr OUD, which als invlves receptrs that are respnsible fr pain relief and feeling pleasure. Fr the treatment f OUD, MAT wrks n these same receptrs in varying ways. With the exceptin f methadne, MAT des nt treat pain. When taken as prescribed and under apprpriate supervisin, MAT used in the treatment f OUD is nt addictive. Unlike herin, MAT prescriptins d nt induce feelings f euphria r cause habitual, unhealthy r cmpulsive use. When taken as directed, MAT des nt cause either intxicatin r withdrawal as seen with prescriptin pain medicatins and herin. Mre imprtantly, cntinual use f MAT enhances lng-term recver by decreasing cravings. In fact, studies have shwn that after shrt-term use f MAT fr detx nly, relapse is mst likely t ccur, and can result in a fatal verdse. Misguided beliefs abut MAT and hw they wrk nly cntinue t stigmatize individuals suffering frm SUD. 3) Hw safe is M AT? The Wrld Health Organizatin has placed methadne and buprenrphine fr the treatment f OUD n their list f essential medicatins. The American Sciety f Addictin Medicine (ASAM), Natinal Institute f Drug Abuse (NIDA) and Substance Abuse and Mental Health Services Administratin (SAMHSA) recgnize MAT as the Standard f Care and Evidenced-Based Treatment fr individuals suffering frm SUD. When used as prescribed under apprpriate supervisin, MAT can safely be taken withut damaging side effects. But, as with any medicatin, there are ptential side effects. When experienced, these side effects are knwn t be minr, with n lng-term

2 health risks, and mst reduce ver time, nce a stable dse f medicatin is reached. The decisin abut MAT shuld be made nly after discussin with a medical prfessinal abut the ptential side effects, as well as btaining a clear understanding f the risks and benefits f incrprating---and nt incrprating---mat int a lng-term treatment plan. 4) What exactly is methadne and hw des it help clients in vercming their dependence? Accrding t the U.S. Office f Natinal Drug Cntrl Plicy, methadne is a rigrusly well-tested medicatin that is safe and efficacius fr the treatment f narctic withdrawal and dependence. Pharmaclgically, methadne is a man-made piid. It is knwn chemically as a full agnist. In ther wrds, it cmpletely binds t the piid receptrs in the brain like all ther prescriptin pain medicatins, including herin. Methadne is available in the frm f a pill r ral slutin, and has been available in the US fr mre than 65 years. Methadne is prescribed under strict state and federal guidelines nly by prviders with the apprpriate training, certificatin and credentials. When utilized t treat chrnic pain, methadne can be prescribed by a physician and filled in a pharmacy. When used t treat OUD, methadne can nly be prvided in a licensed, regulated methadne treatment prgram r Opiid Treatment Prgram (OTP). Methadne is lng-acting and des nt generate the euphric feeling like that f a shrtacting piate, such as herin. When prvided at the crrect dse, methadne des nt cause impairment t mental functin r daily activities. Instead, methadne eliminates acute symptms f piid withdrawal and relieves craving. 5) What is buprenrphine? Buprenrphine has been available since 2002 fr the treatment f OUD. It can be prescribed by a qualified medical prvider and filled in a pharmacy. Unlike prescriptin pain medicatins, medical prfessinals must have a special license thrugh the Fd and Drug Administratin (FDA) t prescribe buprenrphine. Like all ther piids, buprenrphine acts n the piid receptrs in the brain. Unlike methadne, prescriptin pain medicatins, and herin, buprenrphine des nt cmpletely bind t piid receptrs. As such, it is chemically knwn as a partial agnist and nly binds t parts f the piid receptr resulting in relief frm symptms f withdrawal and decreased cravings. Buprenrphine des nt require increasing dsage with lng-term use t achieve its effects, which is different frm full agnists. And, even in high dses, buprenrphine des nt cause the respiratry depressin. Since 2002 buprenrphine has been FDA-apprved in many different frms and rutes f administratin including a pill, disslvable tablet, buccal film, 6-mnth implantable rds, and mst recently a 30-day IM injectin. As a result, buprenrphine can be tailred t the needs f individuals within a cmprehensive, lng-term treatment plan.

3 6) What is naltrexne and what is the difference between agnist and antagnist M AT? FDA apprval f MAT, in all its frms, allws individuals t seek treatment withut the preccupatin f physical cravings r the anxiety f impending withdrawal. MAT can be tailred t individual needs, and can be prvided in multiple settings. A simple way t remember the different frms f MAT is t understand hw they wrk n the piid receptrs t achieve the same result f lng-term recvery and preventin f fatal verdses. Three different classes: Full agnist (methadne) An piid that binds cmpletely t the piid receptr in the brain May nly be dispensed in a federally regulated methadne clinic fr the treatment f OUD Must be taken n a daily basis Eliminates withdrawal symptms and relieves drug cravings Des nt require increased dsing t achieve the same therapeutic effect Partial agnist (buprenrphine) Binds partially t the piid receptr in the brain May nly be prescribed by a physician, nurse practitiner r physician assistant that has the apprpriate FDA license/data 2000 Waiver Certificatin Can be filled by a cmmunity pharmacy Must be taken as prescribed in a pill, disslvable tablet, buccal film, 6- mnth implantable rds r 30-day IM injectin Eliminates withdrawal symptms and relieves drug cravings Des nt require increased dsing t achieve the same therapeutic effect Des nt induce respiratin depressin resulting in fatal verdes Antagnist (naltrexne) Inhibits piids intrduced int the system frm binding t the piid receptrs in the brain that cause euphria, dependency, respiratry depressin and verdse Des nt require apprpriate FDA-licensure and may be prescribed by a physician, nurse practitiner r physician assistant acting under the scpe f their licensure Can be filled by a cmmunity pharmacy Des nt require increasing dsing t achieve the same therapeutic effect Must be taken as prescribed in a pill r 30-day IM injectin

4 As with any medicatin, there are ptential side effects. Deciding which frm f MAT best meets the needs f an individual shuld take int cnsideratin the fllwing: Substance use histry medical and mental health histry Past treatment histry Psychscial needs and recvery gals The decisin abut MAT shuld be made nly after discussin with a medical prfessinal abut the ptential side effects, as well as btaining a clear understanding f the risks and benefits f incrprating---and nt incrprating---mat int a lng-term treatment plan. 7) Hw lng des medicatin-assisted treatment last? Incrprating MAT int any treatment plan shuld be designed t address each individual s unique situatin. Duratin f treatment varies and shuld take int cnsideratin the individual s treatment respnse, needs and circumstances. There is n FDA limit n hw lng an individual may utilize any MAT in their treatment. The rule f thumb is that ne shuld remain n MAT t achieve and maintain their recvery gals. 8) What guidance des the FDA give regarding medicatin-assisted treatment during pregnancy? Methadne has been used fr pregnant wmen with OUD since the 1970 s and has been recgnized as the gld standard f care since In additin, The FDA issued safety labeling changes fr buprenrphine prducts when prescribed fr use during pregnancy. Research has demnstrated the fllwing benefits frm methadne and buprenrphine treatment during pregnancy: Stabilizes fetal levels f piids Reduces repeated prenatal withdrawal Imprves nenatal utcmes Increases maternal HIV treatment and reduces the fetal transmissin Prmtes better prenatal care

5 9) Is there MAT fr alchl-use disrder? There are several FDA-apprved medicatin-assisted treatments fr AUD, which include: Medicatins used t reduce reward frm alchl intake: Naltrexne, Revia and VIVITROL (naltrexne IM injectin) Medicatin used t reduce cravings Campral EC (acamprsate) Medicatin used t cause adverse effect f alchl ingestin Antabuse (disulfiram)