Module 3: What are Opioids? What is MAT?
HRSA HIV/AIDS Bureau (HAB)
The information in this module includes an overview of addiction and medication-assisted addiction treatment and, more specifically, of buprenorphine and methadone.
- A computer and compatible LCD projector to play the PowerPoint presentation.
Slide # 5: What are Opioids?
- Opioids are natural, fully semisynthetic/entirely manmade drugs that bind to receptors in different parts of the body, including the brain. These drugs are analgesics. They lower both the perception of and reaction to pain. Heroin, morphine, fentanyl, codeine, oxycodone, buprenorphine, and methadone are opioids.
Slide # 6: What do Opioids Do?
- Our bodies produce substances that are very similar to opioids; these are known as endogenous opioids or endorphines. Exogenous opioids, such as heroin and methadone, bind to the same receptors as endogenous opioids, which explains their powerful effect on human beings.
- Opioids release an excess of dopamine into the body. Dopamine is a neurotransmitter (brain chemical) involved with learning, motivation, pleasure, and reward. Opioids change the amount and sensitivity of dopamine receptors and can make people feel euphoric; in addition, opioids can suppress pain and reduce anxiety. Eventually, users require an opioid to continuously occupy the opioid receptor in the brain, or they develop withdrawal symptoms.
Slide #7: What is MAT, and Why Consider It?
A recent article by Dr. Laura Cheever and her colleagues defined MAT as “the use of medication such as methadone or buprenorphine in combination with counseling and behavioral therapies to provide a whole-patient approach to the treatment of opioid dependence."
- Methadone, buprenorphine, and naltrexone are the only medications approved by the U.S. Food and Drug Administration (FDA) for treating opioid addiction. Naltrexone is less commonly used to treat opioid addiction, in part because of poor adherence. An extended-release injectable form, however, was recently approved by the FDA which might overcome adherence barriers. Naltrexone prevents receptors from being activated by agonist compounds, such as heroin or prescribed opioids, and is reported to reduce opioid cravings and to prevent relapse. (See "advisory" in the online resources of Module 10.)
- Methadone can be dispensed at SAMHSA-certified OTPs.
- Buprenorphine can be dispensed at OTPs but is most readily dispensed by physicians with a waiver from the DEA.
- Naltrexone can be given by health care providers licensed to give prescription medications.
- Regardless of the setting in which MAT is administered, opioid-addicted patients must be medically supervised at the inception of treatment and receive continuous followup.
- With few exceptions, methadone is provided through accredited, certified OTPs, whereas qualifying physicians can prescribe buprenorphine as part of a patient’s medical care.
- Substance abuse has been associated with increased risk behaviors, including increased risk for acquiring and transmitting HIV. In contrast, MAT is associated with improved health outcomes and social functioning.
- Integrating MAT into Ryan White HIV/AIDS Program grantee sites adds a crucial component to the ever-growing, comprehensive scope of Program services. Integrating substance abuse treatment into HIV primary care sites provides the opportunity to address opioid addiction as part of medical care, thereby improving HIV medication adherence and treatment outcomes.
Slide #8: Patient Testimonials
- On the whole, patients who have participated in the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Buprenorphine Initiative had very positive feedback about their experiences with opioid addiction treatment.
- Patients have noted that they were more lucid, had improved social and cognitive functioning, and experienced a reduction in cravings.
- Positive patient responses to opioid addiction treatment have correlated with improved retention in care and antiretroviral therapy adherence.