Medication for Addiction Treatment (MAT) for opioid addiction is the use of medications — including buprenorphine/naloxone (Suboxone), methadone, or naltrexone (Vivitrol) — to treat opioid use disorder, thereby reducing opioid cravings, withdrawal symptoms, and overdose risk.[1,2,3]

Buprenorphine, methadone, and naltrexone are approved by the United States Food & Drug Administration (FDA) for this purpose. MAT is most effective when used in conjunction with counseling and psychosocial support.[4]

MAT is critical for preventing overdose and death. A study on the effectiveness of long-term MAT found that one year after initiating treatment, 75% of patients were still in recovery.[5]

Stopping MAT is also directly correlated with relapse to opioid use. In a review of multiple studies, more than half of patients return to opioid use within one month of stopping MAT with buprenorphine.[6]

Benefits of Suboxone include helping patients to feel normal and healthy. When taken as prescribed by a medical provider, MAT treats addiction and can prevent the negative impacts of uncontrolled opioid use on daily functioning and long-term life goals.

How MAT Works

MAT is widely regarded as the most effective treatment for opioid use disorder (OUD).[7] A comprehensive MAT regime involves both medication and therapy, treating the whole person in a holistic treatment style.

In a Medication for Addiction Treatment program, you’ll start with an assessment from a clinician. You’ll discuss your opioid use, including the specific opioid used, average doses, and duration of use. The clinician will assess you for any co-occurring conditions, including both medical and mental health issues.

If appropriate, you’ll be prescribed medication to address OUD. Depending on the specifics of the program, you’ll have a treatment plan created for you that includes behavioral therapy, alternative therapies, health coaching, and supportive activities.

MAT is a long-term treatment for OUD. Generally, patients remain on MAT for months or years. Some remain on MAT indefinitely.

Studies show that short-term MAT does not support sustained recovery in the same way.[6] As a result, longer treatment durations are recommended.

Medications Used in MAT

Buprenorphine, methadone, and naltrexone are the primary medications used in MAT. These are often given in brand-name medications such as Suboxone (buprenorphine/naloxone) and Vivitrol (naltrexone).

Methadone

The original medication used in Medication-Assisted Treatment, methadone effectively relieves opioid withdrawal symptoms and cravings for those with opioid use disorder.

Due to its high potential for abuse, methadone can only be dispensed at specialized clinics. It cannot be prescribed to be taken at home.

When taken as directed, methadone is safe and effective. A study from the Norwegian Institute of Public Health showed that long-term methadone use can cause changes in the brain, affecting memory and learning abilities.[8] Overall, methadone is considered an effective MAT, particularly for heroin addiction.[9]

Buprenorphine

This medication is a partial opioid agonist. It binds to the opioid receptors in the brain, but it does so less strongly than full opioids like heroin and methadone. As a result, it reduces withdrawal symptoms and cravings when users stop using opioids.

Because buprenorphine has a lower abuse potential than methadone, it is often the chosen medication for MAT.[10] It is ultimately viewed as a safer medication than methadone.[7]

Suboxone is a combination of buprenorphine and naloxone that is often the preferred form of buprenorphine for MAT. Naloxone serves as an abuse-deterrent.

Naltrexone

This medication is approved by the FDA to treat both alcohol use disorder and opioid use disorder. It is an opioid agonist so it blocks the effects of opioids in the brain. This means people will not experience euphoria or other positive effects from opioids if they take them while on naltrexone.[11]

Patients have had issues with sticking with naltrexone therapy, so its use is limited compared to buprenorphine and methadone for opioid use disorder.[11]

MAT Outcomes

Medication-Assisted Treatment is considered the gold standard in treating patients with opioid use disorder. Studies repeatedly show that MAT reduces cravings for opioids and eliminates or lessens opioid withdrawal symptoms.[12,13]

Participation in MAT is associated with substantial reductions in overdose death rates.[14] A large meta-analysis showed a doubling in overdose death rates when patients discontinued buprenorphine treatment and a tripling in overdose death rates when patients stopped methadone maintenance treatment.[15]

Ongoing maintenance treatment with buprenorphine has been shown to reduce death rates by 50%.[14,16] As much as 90% of patients on MAT maintain sobriety after two years in treatment.[17]

When opioid use disorder is managed, virtually every aspect of life improves — daily living, overall health, mood, career prospects, family relationships, financial situations, and quality of life. MAT makes relapse to opioid use much less likely, enabling a path to a brighter future.

Is MAT Right for You?

Whether MAT is right for you will depend on your history of opioid use and attempts at recovery. For most people dealing with opioid use disorder, Medication for Addiction Treatment will be the right choice.

MAT will enable you to fully focus on recovery and building a life in sobriety since withdrawal symptoms and cravings will be controlled.

You don’t have to live with uncontrolled opioid use disorder any longer. MAT can help you move toward a healthier, more balanced life.

SOURCES

1. Buprenorphine. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine. March 2022. Accessed April 2022.
2. Methadone. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone. April 2022. Accessed April 2022.
3. Naltrexone. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naltrexone. April 2022. Accessed April 2022.
4. The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. American Society of Addictive Medicine. https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-pocketguide.pdf?sfvrsn=35ee6fc2_0. 2015. Accessed April 2022.
5. 1-Year Retention and Social Function After Buprenorphine-Assisted Relapse Prevention Treatment for Heroin Dependence in Sweden: A Randomised, Placebo-Controlled Trial. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)12600-1/fulltext?refissn=0006-3223&refuid=S0006-3223%2806%2900102-8. February 2003. Accessed April 2022.
6. Discontinuation of Buprenorphine Maintenance Therapy: Perspectives and Outcomes. Journal of Substance Abuse Treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382404/. May 2016. Accessed April 2022.
7. Buprenorphine vs. Methadone Treatment: A Review of Evidence in Both Developed and Developing Worlds. Journal of Neurosciences in Rural Practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271614/. January–April 2012. Accessed April 2022.
8. Long-Term Methadone Treatment Can Affect Nerve Cells in Brain. Norwegian Institute of Public Health. https://www.sciencedaily.com/releases/2012/08/120815082707.htm. August 2012. Accessed April 2022.
9. Methadone Maintenance Therapy Versus No Opioid Replacement Therapy for Opioid Dependence. Cochrane Database of Systemic Reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7097731/. July 2009. Accessed April 2022.
10. Medication-Assisted Treatment Improves Outcomes for Patients With Opioid Use Disorder. The Pew Charitable Trusts. https://pubmed.ncbi.nlm.nih.gov/12954743/. November 2016. Accessed April 2022.
11. Medications to Treat Opioid Use Disorder Research Report. National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work. December 2021. Accessed April 2022.
12. Buprenorphine Treatment for Opioid Use Disorder: An Overview. CNS Drugs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585403/. June 2020. Accessed April 2022.
13. Office-Based Treatment of Opiate Addiction With a Sublingual Tablet Formulation of Buprenorphine and Naloxone. New England Journal of Medicine. https://pubmed.ncbi.nlm.nih.gov/12954743/. September 2003. Accessed April 2022.
14. Buprenorphine: An Overview for Clinicians. California Health Care Foundation. https://www.chcf.org/wp-content/uploads/2019/08/BuprenorphineOverviewClinicians.pdf. August 2019. Accessed April 2022.
15. Mortality Risk During and After Opioid Substitution Treatment: Review and Meta-Analysis of Cohort Studies. The BMJ. https://www.bmj.com/content/357/bmj.j1550. April 2017. Accessed April 2022.
16. A Guideline for the Clinical Management of Opioid Use Disorder. British Colombia Centre on Substance Use. https://www.bccsu.ca/wp-content/uploads/2017/06/BC-OUD-Guidelines_June2017.pdf. June 2017. Accessed April 2022.
17. Facts About Medication-Assisted Treatment. South Dakota Departments of Health and Social Services, Division of Behavioral Health Prevention Programs. https://dss.sd.gov/formsandpubs/docs/BH/BHAO10_MAT_Brochure.pdf. Accessed April 2022.

The prescription medications Suboxone (buprenorphine/naloxone) and Prozac (fluoxetine) can interact and cause health issues. Never take these two medications together without checking with your doctor first.

While Suboxone and Prozac can cause interactions, the U.S. Food and Drug Administration says doctors should approach the issue with care.[7] In the past, some doctors withheld medications like Suboxone in people taking drugs like Prozac. The FDA says the damages associated with untreated opioid use disorder (OUD) are so high that the benefits of combined medications may outweigh the risks. This is especially true because depression is very common among people with OUD, and it is important to treat both conditions in that case.

What Are Prozac & Suboxone?

Before taking any prescription medication, ensure that you understand why it’s prescribed and how it works. Ask your doctor or pharmacist if you’re unsure.

Here’s what you should know about both Prozac and Suboxone:

Prozac

Fluoxetine (or Prozac) is an antidepressant used to treat a variety of conditions, such as these:[2]

• Depression
• Obsessive-compulsive disorder (OCD)
• Bulimia
• Premenstrual dysphoric disorder (PMDD)
• Panic disorder

Prozac belongs to a group of medications known as selective serotonin reuptake inhibitors (SSRIs). Fluoxetine works by increasing the time that serotonin (a special communicating chemical called a neurotransmitter) stays active in the nerves within your central nervous system.

Suboxone

Suboxone contains two ingredients: buprenorphine and naloxone.[3] When combined, they treat opioid use disorder (OUD).

What Is Serotonin Syndrome?

Serotonin is a neurotransmitter involved with regulating behavior, mood, memory and core body functions. Medications like Prozac work directly on the serotonin system, and sometimes, they cause problems.[8]

High levels of serotonin can cause serotonin syndrome, which can be life-threatening. Experts say the true incidence of serotonin syndrome is unknown, as most cases are mild and easily overlooked. Even serious cases might be attributed to some other cause.[9]

However, it’s important to know what serotonin syndrome looks like, as combining Suboxone and Prozac can lead to increased risks.

Researchers say some opioids can increase serotonin levels.[8] Combining these drugs can lead to a buildup of the hormone, and it can cause difficult clinical signs.

Serotonin syndrome can be mild. Out of 46,000 calls to poison control centers due to SSRIs in 2011, only 11 of those cases resulted in death.[5]

However, just in case, you should understand the side effects of serotonin syndrome so you can call your doctor if symptoms appear.[6]

Signs & Symptoms of Serotonin Syndrome

If you believe you are experiencing serotonin syndrome, you must call your doctor. Seek emergency services immediately if your symptoms are severe.

Signs and symptoms of serotonin syndrome may include the following:

• Agitation
• Anxiety
• Restlessness
• Disorientation
• Sweating
• High body temperature
• Fast heart rate
• Nausea
• Vomiting
• Tremors
• Rigid, jerking or overactive muscles
• Dilated pupils
• Dry mucous membranes
• Flushed skin
• Increased bowel sounds

Doctors treat serotonin syndrome by discontinuing your medications and monitoring you until they improve.[4] With prompt care, your problems should fade. This syndrome is temporary and resolved once you discontinue the medications.

If you have any concerns about your medication interactions, talk with your doctor.

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