Over the last few months, I’ve received a number of calls, texts and emails asking me about Medication Assisted Treatments (MAT’s). Putting someone on MAT’s should not be part of an initial treatment plan during a patient’s first time in treatment. MAT’s should be considered after previous attempts at treatment have failed. I often refer people to an article I wrote about MAT’s last summer:
Vivitrol is injectable naltrexone. Because there isn’t any opiate or synthetic opiate in it, it is not a controlled substance. Any doctor can prescribe it. Patients get a shot 1x a month. Vivitrol helps reduce cravings and it mostly blocks the euphoric effects of opiates.
It is effective for both opiates (heroin, oxycotin, hydrocodone, etc…) and alcohol. Vivitrol is not a controlled substance, so it doesn’t take a special prescriber’s license or training to issue it. It is neither addictive nor abusable in any way. All that said, there is an American line of thought that says “take a pill, get better.” That tactic angers me for almost any illness. When it comes to getting clean and staying off of opiates or alcohol, Vivitrol (or other MAT’s such as suboxone) is not particularly effective without regular therapy and urine drug testing. The law does not require therapy or drug testing, but clearly the best practice is to do so. I tend to recommend Vivitrol for a period of 6 to 12 months. This allows the client enough time to stabilize, reduce cravings, get proper therapy, develop a support network and plan for the next phase of their life (education, work, service).
One of the key concerns about Vivitrol is that it is very expensive. Even with insurance, it can cost a few hundred to upwards of a thousand dollars a month. This means that it is really only accessible to the upper middle class and above. I’m hoping that will change. This summer, Senator Joe Vitale, introduced legislation that was ultimately passed by the NJ legislature and signed into law by Governor Christie that would allow people on Drug Court* to graduate from that program while still on MAT’s. It seems a bit wild that we need to have a bill that allows for this, but then criminal justice reform and the improvement of treatment & aftercare are often tough, uphill slogs (but there is improvement all the time…it is not a sisyphean task).
I have never taken money from any pharmaceutical company in any way, shape or form. I never intend to. I think that once one takes money from a pharmaceutical company, it compromises both your viewpoint and the appearance of your viewpoint. I prefer to remain a neutral, well-informed outsider that others can trust.
Finally, I’m a bit appalled by the comments on articles that I’ve read over the years about MAT’s and how they can help people get and stay clean. The comments usually follow one of three themes:
(1) I got sober through God and AA. That’s the only way. Everything else is BS.
(2) I hope this author dies a fiery, painful death.
(3) Another shill for Big Pharma. I hope you die.
All this really proves is that one probably shouldn’t read the comments at the end of articles, but for the fact that it shows us where a percentage of the interested population are currently at. Educate, educate, educate. The data is there (though usually people with ideas that entrenched will double down on their beliefs, even in the face of data).
* Drug Courts cost about 20% of jail, while offering a better return on the public dollar. Less of them relapse and return to crime compared with their brethren that are stuck in jail or prison without treatment, education or job training.