By John Lavitt 03/11/16

The new advisory addresses whether medication-assisted treatment is “recovery,” and discusses duration and discontinuation.

SAMHSA Reviews Buprenorphine And Medication-Assisted Treatment for Opioid Use Disorder

Photo via Jr de Barbosa/Wiki Commons

The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued an updated advisory on the use of buprenorphine and medication-assisted treatment (MAT) for opioid use disorder.

Reviewing current information on the use of sublingual (beneath the tongue) and transmucosal (entering through a mucous membrane) buprenorphine, the intended audience for the update include prescribing physicians, other healthcare professionals, and healthcare policymakers. Given the proven effectiveness of MAT in terms of positive treatment outcomes, along with its lack of availability, the update attempts to address the importance of closing this gap.

A problem in the greater treatment community has been a traditional 12-step resistance to MAT. Many treatment professionals with 12-step backgrounds question whether MAT, like buprenorphine, for opioid use disorder can be considered legitimate recovery. Does using buprenorphine put a client’s recovery status in jeopardy?

In response to this question, SAMHSA highlights the opinion of noted recovery experts A. Thomas McLellan and William White. They clearly state: “Recovery status is best defined by factors other than medication status. Neither medication-assisted treatment of opioid addiction nor the cessation of such treatment by itself constitutes recovery. Recovery status instead hinges on broader achievements in health and social functioning—with or without medication support.”

The SAMHSA update reviews the new formulations of buprenorphine, and examines the effectiveness and safety of buprenorphine treatment. In addition, the drug’s contraindications (factors that justify withholding treatment from the harm it could cause the patient) and cautions, including medication interactions, are detailed as well as the importance of monitoring patients for indications of diversion and misuse. Finally, SAMHSA highlights the crucial role of informed consent and treatment agreements in any manifestation of medication-assisted treatment.

Opioid agonist medications like buprenorphine with naloxone have been found to reduce morbidity and mortality, decrease overdose deaths, reduce transmission of infectious disease, increase treatment retention, improve social functioning, and reduce criminal activity. Both the American Society of Addiction Medicine (ASAM) and the World Health Organization (WHO) endorse MAT as an evidence-based best practice for treating opioid use disorder.

Despite such widespread endorsement, side-by-side with a clear interest in MAT by potential patients, SAMHSA emphasizes the significant gap between the need for and the availability of this treatment.

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