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Medication Assisted Treatment (MAT)

Fortunately, when it comes to being addicted to some drugs, there are medicines that work to reduce the effects of withdrawal and/or reduce cravings. With respect to opioid use disorder these medications reduce mortality rates as they significantly reduce the chance of relapse and overdose. In fact, for persons who have been injecting opioids for years the recommended treatment would be suboxone or methadone maintenance.

Here is a list of medication assisted treatments for various drugs:

Drug Addicted to Approved MAT Potential MAT
Opioids
(OxyContin, Percocet, Fentanyl)
Buprenorphine and Naloxone (Suboxone)
Buprenorphine
Methadone
Hydromorphone
Naltrexone (Revia) (Apo-Naltrexone) (Vivitrol)
How it Works
Until recently, methadone was the primary drug prescribed for the treatment of opioid use disorder. However, the chance of an overdose is 6 times higher with methadone than with buprenorphine (Suboxone). BC and Ontario have now made Suboxone the primary drug prescribed for opioid use disorder and it is on the provincial formularies, meaning those who qualify will receive the drug free of charge. Other provinces will likely follow BC and Ontario.

Buprenorphine is a partial opiate agonist. It binds to the opioid receptors in the brain, relieving symptoms of withdrawal and cravings without producing a high. It is the safest of the opioid medications. It is now available as an implant in the US. Suboxone is a sublingual strip or pill (it goes under your tongue).
Methadone is used in the case of a severe addiction to opioids where Suboxone does not sufficiently releave the symptoms of withdrawal. Methadone is a full opioid agonist, like heroin. It binds to the opioid receptors in the brain, relieving symptoms of withdrawal and cravings.
In the most severe cases where persons on methadone continue to relapse, hydromorphone can be  prescribed to  prevent withdrawal and cravings.
In persons motivated to choose abstinence, naltrexone can be used to manage cravings. Revia and Apo-Naltrexone are the pill form of naltrexone and must be taken daily. Vivitrol is the injectable form of naltrexone which lasts one month. Vivitrol is currently not available in Canada and costs about $1,000 per shot in the US. However, physicians may apply to get Vivitrol for a specific patient under Health Canada’s Special Access Program. Due to a loss of tolerance there is a high risk of overdose if naltrexone is discontinued and there is a return to opioid use.

Drug Addicted to Approved MAT Potential MAT
Alcohol Disulfiram
Naltrexone (Revia) (Apo-Naltrexone) (Vivitrol)
Acamprosate (Campral)

Baclofen

Topiramate (Topamax)
New compounds, like ABT-436, are being tested all the time

How it Works

Disulfiram causes uncomfortable nausea and headache when combined with alcohol.
Naltrexone blunts the euphoric effects of alcohol. You do not have to be abstinent from alcohol to use naltrexone. Vivitrol is the injectable form of naltrexone which lasts one month. Vivitrol is currently not available in Canada and costs about $1,000 per shot in the US.However, physicians may apply to get Vivitrol for a specific patient under Health Canada’s Special Access Program.
Campral helps prevent alcohol relapse likely by reducing withdrawal symptoms like anxiety, insomnia and cravings.

Baclofen is currently used as a muscle relaxant and Topomax as an anti-seizure drug. They are being studied for their effects on reducing alcohol relapse rates.

Drug Addicted to Approved MAT Potential MAT
Nicotine Nicotine
Varenicline (Champix)
Bupropion (Wellbutrin)
Nortriptylline
Mecamylamine
How it Works

Nicotine replacement products including gum, patches, lozenges and inhalers (sprays or vapes) allow smokers to stop smoking without suffering withdrawal and cravings.
Champix is a partial agonist. It blocks the nicotine receptors in the brain, reducing withdrawal symptoms and craving.
Wellbutrin is an antagonist at the nicotine receptor, blocking any nicotine effect.
Mecamylamine (an antihypertensive) is being studied.

Drug Addicted to Approved MAT Potential MAT
Cannabis none

buspirone
dronabinol

nabilone
entacapone
lithium
URB-597
MLA endocannabinoid-metabolizing enzyme blockers

How it Works

Buspirone, dronabinol, nabilone, entacapone and lithium are all available drugs used to treat other conditions. They are being studied for treatment of cannabis use disorder.

URB-597 and MLA endocannabinoid-metabolizing enzyme blockers are experimental.

Drug Addicted to Approved MAT Potential MAT
Cocaine none Disulfiram
Topiramate
Tiagabine (Gabitril)
Modafenil (Provigil)
Lisdexamfetamine (Vyvanse)
Nacetylcystine (NAC)
Amantadine
Bromocriptine
Gabapentin (Neurontin)
Nocaine
How it Works

These are all drugs that are used for other conditions (except Nocaine) and are being studied for their use in cocaine use disorder. Currently there is a controversy about treating an addiction to stimulants (like cocaine or methamphetamine) with other stimulants.

Drug Addicted to Approved MAT Potential MAT
Amphetamine
Methamphetamine
none none
FAR would like to thank Dr. Meldon Kahan for reviewing the Medication Assisted Treatment (MAT) section of this website for accuracy.