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RSAT Forum > Monthly Discussion > June 2021: Medication-Assisted Treatment (MAT) vs. Medications for Opioid Use Disorder (MOUD) View modes: 
skeller - 6/21/2021 9:41:07 AM
June 2021: Medication-Assisted Treatment (MAT) vs. Medications for Opioid Use Disorder (MOUD)

Question:  We used to refer to methadone, buprenorphine or naltrexone provided to persons suffering opioid use disorder as “Medication-Assisted Treatment” or “MAT.”  Now some are calling it “Medications for Opioid Use Disorder” or “MOUD.”  Are they the same thing?

Answer: Yes and no. They are often used interchangeably.  In fact, in some literature, treatment using these medications is referred to as “MAT/MOUD.” However, the two terms have different implications. SAMHSA recommended replacing the term MAT with MOUD in 2020.  The recommendation was made to indicate the primary role for medication in the effective treatment of OUD.  Some have argued that research has found that non-medical treatment does not improve upon treatment solely with medications for OUD. However, much of that research really only indicates that the specific non-medical treatments studied were ineffective.  Medication alone for OUD has also been found ineffective, not because it doesn’t work when people take it, but because the majority of people who are prescribed these medications don’t stick with them long enough to support long term recovery.  Most stop taking medication after six months. Retention rates are even lower for those involved in the criminal justice system, are unemployed, abuse other substances, having co-occurring mental health challenges and suffer housing insecurity.

For this reason, behavioral health treatment is crucial, if for no other reason than to encourage patients to continue their medication.  In addition, we also know that competent behavioral health treatment/support programs can help patients rebuild their lives, regain family and other support, and have the hope needed to sustain long term recovery.

Although SAMHSA recommended the name change, at the same time, it still doesn’t allow the agonist opioid medications to be prescribed like doctors prescribe most other medications. It still doesn’t allow doctors to prescribe methadone at all.  Patients must enroll in Opioid Treatment Programs (OTPs) to receive methadone for OUD.  It requires physicians and other medical personnel to complete training programs to prescribe buprenorphine if treating more than 30 patients.  It also limits their number of patients so that they can ensure their patients are engaged in concurrent treatment/support. Qualified practitioners, for example, must be in a setting that “provides access to case-management services for patients including referral and follow-up services for programs that provide, or financially support, the provision of services such as medical, behavioral, social, housing, employment, educational, or other related services.”

The agonist medications for MAT/MOUD themselves carry risks.  If misused, they too can be harmful, even lethal, no matter what name their use is given. The exception is naltrexone, also FDA approved for the treatment of both OUD and Alcohol Use Disorder. Because it is not a narcotic drug, naltrexone may be prescribed by any physician. However, studies too have found that patients are no more likely to continue this medication, generally provided as monthly injections, than they do agonist medications for OUD.  So here too complementary counseling and support is crucial.

For research on the above, this website includes a summary of the most recent research on these medications, particularly relevant to corrections: