Understanding MAT: Medication-Assisted Treatment for Opioid Addiction

What Is Medication-Assisted Treatment (MAT)?

Medication-Assisted Treatment (MAT) is the use of FDA-approved medications — combined with counseling and behavioral therapies — to treat substance use disorders. MAT is most commonly used for opioid use disorder (OUD) and alcohol use disorder (AUD), and it is now recognized as the gold standard of care for opioid addiction.

Despite the overwhelming evidence that MAT saves lives, stigma has slowed its adoption. People in MAT are sometimes told they are "not really in recovery" or "just trading one drug for another." This is not supported by science. The medications used in MAT work on the brain's opioid system in a way that stabilizes function and eliminates the destructive cycle of cravings, use, and withdrawal.

The Three FDA-Approved Medications for Opioid Use Disorder

Buprenorphine (Suboxone, Subutex, Sublocade)

Buprenorphine is a partial opioid agonist — it activates opioid receptors but with a "ceiling effect" that limits sedation and respiratory depression. It dramatically reduces cravings and withdrawal symptoms, can be prescribed in a doctor's office (unlike methadone), and the most common formulation (Suboxone) contains naloxone to deter misuse.

Suboxone is taken as a sublingual film (dissolved under the tongue). Sublocade is a once-monthly injectable form of buprenorphine. Most people begin with daily Suboxone and may transition to a long-acting injectable for convenience and consistency.

Who can prescribe it: As of 2023, any DEA-registered practitioner with a Schedule III prescribing authority can prescribe buprenorphine for OUD — the previous X-waiver requirement was eliminated, significantly expanding access.

Methadone

Methadone is a full opioid agonist that eliminates opioid withdrawal and cravings when taken at the right dose. It has the longest track record in OUD treatment — research spanning 50+ years consistently shows it reduces illicit opioid use, decreases overdose death rates, reduces crime, and improves social functioning.

Methadone for OUD can only be dispensed through federally certified Opioid Treatment Programs (OTPs), commonly called methadone clinics. Initially, patients must visit the clinic daily to receive their dose; over time, good standing patients can earn take-home doses.

Best for: People with severe, long-term opioid dependence, those who haven't responded to buprenorphine, or those who prefer the structure of a clinic setting.

Naltrexone (Vivitrol)

Unlike buprenorphine and methadone, naltrexone is an opioid antagonist — it completely blocks opioid receptors rather than activating them. This means it has no abuse potential and is not controlled. It is available as daily oral tablets (ReVia) or as a once-monthly injection (Vivitrol).

The key limitation: you must be fully detoxified from opioids before starting naltrexone, or it will precipitate severe withdrawal. This makes it harder to initiate, and research shows lower retention rates compared to buprenorphine and methadone. However, for people who are highly motivated, have completed detox, or are in settings where controlled substances are a concern (e.g., criminal justice settings), Vivitrol is an effective option.

Naltrexone is also FDA-approved for alcohol use disorder (see below).

MAT for Alcohol Use Disorder

Three medications are FDA-approved for alcohol use disorder:

• Naltrexone (oral or Vivitrol injection) — reduces cravings and the pleasurable effects of alcohol. The most commonly prescribed.
• Acamprosate — reduces the anxiety and dysphoria of early sobriety, helping maintain abstinence
• Disulfiram (Antabuse) — causes an unpleasant reaction when alcohol is consumed; works through deterrence

These medications are dramatically underused — research shows that most people with alcohol use disorder who could benefit from medication are never offered it. If you're treating alcohol use disorder, ask your provider about these options.

How to Access MAT

1. Find a buprenorphine provider: Search the SAMHSA treatment locator (or use RecoveryFinders) and filter for "Opioid Treatment Programs" or "Medication-Assisted Treatment."
2. Contact your primary care doctor: Many PCPs now prescribe buprenorphine in their offices. The eliminations of the X-waiver means more access than ever.
3. For methadone: Search for licensed OTPs (methadone clinics) in your area using RecoveryFinders and select "Opioid Treatment Program" as a service type.
4. Cost and coverage: Medicaid, Medicare, and most private insurance plans cover MAT. Many OTPs offer sliding-scale fees.

MAT works best when combined with counseling and social support. RecoveryFinders can help you find programs offering integrated MAT with behavioral therapy — the combination that produces the best outcomes.