Medication Assisted Treatment in Drug Court, 0717 COBJ, Vol. 46 No. 7 Pg. 20
| Author | JAMI VIGIL, J. |
PROBLEM SOLVING COURTS
JAMI VIGIL, J.
This is the second in a series of articles dedicated to exploring current best practices and common issues facing problem solving courts locally and nationally. As described in the first article, problem solving courts are developing throughout the United States to promote rehabilitation and reduce recidivism through collaborative and therapeutically guided court programs that address complex problems such as substance abuse, domestic and family violence, mental health issues, and truancy.
Medication assisted treatment (MAT) is a hot topic for drug courts these days as prescription opioid misuse and heroin use continue to rise at alarming rates with no end in sight. This article explains MAT and discusses certain approved medications and their uses. Specifically, it outlines three medications approved to treat opioid use disorders and occasionally significant alcohol use, as well as the primary medication administered during acute opioid overdose.
Although the National Drug Court Institute (NDCI) reports significant scientific evidence supporting the effectiveness of MAT, it has been estimated that as many as half of all drug court programs nationally and many outpatient treatment providers choose instead a full abstinence model in which MAT is prohibited.1 This article does not advocate for or against MAT but rather seeks to provide information about MAT and proposed best practices.
The goal of drug court programs is recovery, and recovery is different for each person. A common principle of drug court programs is the understanding that recovery is a journey—a process that will very likely include ongoing craving and relapse or resumed use at some point.2 The discussion below incorporates this principle. It is not an exhaustive examination of MAT but rather a discussion of details relevant to drug court best practices.
Opioid Use Disorder and MAT
MAT is the use of medication to assist in treating drug addiction, aiding a person to engage in a treatment program. It is not drug treatment itself, nor is it meant to stand apart from a treatment program. MAT involves the administration of an approved medication, under medical and therapeutic supervision, to block or reduce the effects of opioids and sometimes alcohol, so that the individual can move beyond craving and continued use into treatment and ultimately recovery.3 Most frequently, MAT is used by individuals struggling with an opioid use disorder.
When discussing MAT, heroin is the drug that likely comes to mind; however, there are many different opioids that can lead to an opioid use disorder, and most are readily available by prescription. Opioids have been, and often still are, considered fundamental to pain management and post-operative care in the United States.4 For instance, most adults at some point have been offered a prescription for Vicodin (hy-drocodone), Percocet (oxycodone), morphine, or codeine following a routine dental or medical procedure. Regardless of whether the individual is misusing a prescribed medication or abusing illicitly obtained substances such as heroin and fentanyl, these chemicals have a high risk for dependence and addiction. Repeated exposure to these chemicals dramatically disrupts normal brain function, resulting in an opioid use disorder.5 (Further discussion of prescription misuse and drug court best practices will appear in the third article in this series.)
Generally, for those not using opioids, positive experiences produce good feelings and reduced pain through the release of endorphins within the brain. To feel that way again, individuals will repeat the positive experiences.6 Opioids stimulate the same receptors in the brain; however, the stimulation produces a much more intense experience within a faster time period than the brain’s natural system.7 Repeated exposure to the opioids unfortunately results in decreased natural endorphins, making it difficult to have positive experiences and feelings without opioids. Furthermore, should the individual try to decrease his opioid use, the lack of endorphins and opioids in the brain will produce unpleasant and painful withdrawal symptoms so severe that he feels compelled to resume opioid use to end the suffering.8 The more the individual uses opioids, the more desensitized his brain becomes to the drug. To produce the positive experience or maintain status quo and avoid withdrawal, he must use greater quantities of the drug.9 This opioid use disorder creates a cycle in which individuals are robbed of the ability to make good decisions that would benefit themselves and their children. 10
Three medications have been approved to disrupt this cycle: naltrexone, buprenorphine, and...
To continue reading
Request your trial