Medication-Assisted Treatment (MAT) is an evidence-based approach for managing opioid dependence. It combines medications such as methadone, buprenorphine (Subutex, Espranor, Buvidal), and Naltrexone with psychosocial support to reduce withdrawal symptoms, cravings, and the risk of relapse.
💡 What is MAT?
MAT helps stabilize individuals with opioid dependence by providing medically supervised opioid agonists or antagonists. This reduces illicit drug use, improves quality of life, and enhances engagement with recovery services.
🟢 Risk Factors and Causes
- Genetic: Family history of substance use disorders.
- Environmental: Socioeconomic deprivation, trauma, or exposure to drug use.
- Lifestyle: Early exposure to opioids, chronic pain management, and co-existing mental health conditions.
- Polysubstance Use: Co-use of alcohol, benzodiazepines, or synthetic opioids increases risk.
🟡 MAT Treatment Options
There are three main categories of MAT medications: full agonists, partial agonists, and opioid antagonists.
| Medication | Type | Administration | Best for |
|---|---|---|---|
| Methadone | Full opioid agonist | Oral liquid (daily) | Patients requiring high-dose stabilization |
| Buprenorphine (Subutex, Espranor) | Partial opioid agonist | Sublingual tablet or lyophilisate (daily) | Lower risk of sedation & overdose |
| Buvidal | Long-acting buprenorphine | Subcutaneous injection (weekly or monthly) | Patients seeking reduced supervision |
| Naltrexone | Opioid antagonist | Oral tablet | Patients detoxed from opioids, motivated for abstinence |
🔍 Safe Prescribing in MAT
Safe prescribing is essential in MAT to ensure effective, ethical, and risk-managed medication use. It requires monitoring for safety concerns such as diversion, overdose risks, and interactions with other substances.
🛠 Prescription Requests: Traffic Light System
Prescribing decisions align with clinical urgency and potential patient safety risks. Most service’s follow a traffic light RAG system to prioritize prescription requests:
| Priority | Criteria |
|---|---|
| 🚨 Emergency (Immediate Change) | Pregnancy, acute physical/mental health deterioration, overdose risk, planned titration, prescription restart, correction of errors. |
| ⚠️ High Priority (After 14-Day Script Runs Out) | Dose reviews, long-term safety concerns, structured detox reduction plans. |
| 🔹 Routine (Next Batch Change) | Changes with no immediate safety impact or significant social/occupational concerns. |
🏥 Prescribing for Hospitalized Patients
- 📝 Verification: Confirm dose and last prescription date with the dispensing pharmacy and MAT service.
- 🚫 Controlled Storage: Patients’ own MAT supplies must not be self-administered in hospital.
- 🩺 Withdrawal Support: If MAT history is unknown, assess withdrawal using the Clinical Opiate Withdrawal Scale (COWS).
- 💊 Emergency Dosing: If withdrawal symptoms are evident, initiate:
- 🟢 Methadone: ≤ 20mg oral solution (with possible 10mg top-up after 12 hours).
- 🔵 Buprenorphine: Initial 4mg dose, with possible 4mg additional dose after 12 hours.
- ⚠️ Monitoring: Assess for sedation, respiratory depression, and overdose risks.
📢 Signs of Overdose & Emergency Response
Recognising an opioid overdose early can save lives. Signs include:
- Slow or stopped breathing.
- Pale, blue, or cold skin.
- Pinpoint pupils.
- Unconsciousness or non-responsiveness.
Emergency response: Call 999, administer Naloxone (if available), place the person in the recovery position, and monitor until help arrives.