Medication-Assisted Treatment (MAT)

Medication-assisted treatment, increasingly called medications for opioid use disorder (MOUD) or medications for addiction treatment (MAT), pairs an FDA-approved medication with counseling and behavioral therapy. For opioid use disorder in particular, the evidence is not ambiguous: methadone and buprenorphine roughly halve the risk of death and dramatically improve treatment retention compared with abstinence-only approaches. The National Institute on Drug Abuse, SAMHSA and the American Society of Addiction Medicine all regard medication as the standard of care.

Despite that, the majority of Americans with opioid use disorder receive no medication at all. Some of the gap is access — methadone can only be dispensed through federally certified opioid treatment programs, and rural coverage is thin. Much of it is stigma, including from within the recovery community and, unforgivably, from some treatment facilities that still require people to taper off buprenorphine before admission. That practice contradicts the evidence and puts lives at risk.

It is worth being precise about what these medications do. Methadone and buprenorphine occupy opioid receptors, eliminating withdrawal and craving without producing a high at a stable therapeutic dose. That is not substituting one addiction for another: addiction is compulsive use despite harm, while a stable prescribed dose restores the ability to work, parent and think about something other than the next dose. Naltrexone works the opposite way, blocking opioid effects entirely and reducing alcohol craving. Acamprosate and disulfiram target alcohol use disorder specifically, and lofexidine eases opioid withdrawal without being a treatment for the disorder itself.

Compare the six medications below, then use the table to see how they differ in mechanism, dosing and practical requirements. Any decision belongs with a prescriber who knows your history, but going into that conversation informed will make it a far better one.