Keli McLoyd is a policy analyst at Public Health Management Corporation, she focuses on substance use disorder policy development and implementation. Keli aims to increase access to substance use disorder treatment for vulnerable populations and utilizing evidence-based practices to help people move towards recovery. She explained how Medical Assisted Treatment are medications that have been FDA approved for the treatment of an opioid use disorder. There are three medications that are approved by the FDA and they are methadone, buprenorphine, and naltrexone. An interesting point that Keli mentioned was about how MAT has been stigmatized, people tend to believe that what MAT does is just replace one drug with another. Which I disagree with, I think that understanding how recovery may be uniquely different according to an individual is key to understanding why MAT is not just simply replacing a drug. Medical Assisted Treatment should also be linked to a therapeutic element and the purpose of it is to give people the opportunity to be stabilized so that they can function in their day to day lives, such as attaining housing or maintaining a job.
The first drug that Keli talked about was methadone, which is an opioid that works by partially blocking the receptors that would allow a person to feel the side effects of a drug. I though it was very interesting how Keli explained that prior to the 60’s, if a person was considered ¨hysterical¨, disabled or in need of support, they would get sent away to an institute or asylum. However, throughout the 60’s there was a push for community treatment. People began to recognize that people with mental illnesses are more likely to thrive and make progress if they are part of the community. During the 60’s and 70’s soldiers were also coming back from the Vietnam war addicted to opioids. Therefore, the United States created a methadone clinic. Due to the fact to how methadone is federally regulated, people are not allowed to take the medication in their homes and doctors cannot prescribe methadone. Thus, people can only be prescribed methadone through a methadone clinic. I agree with what Keli said in regards to it being an inconvenience for people when it comes to commuting and time. A persons life and schedule will have to revolve around having to visit the methadone clinic to get their doses. I also thought it was important how Keli mentioned that the duration of someone staying on methadone depends on the person. Again the point that recovery varies for each individual is brought up, some people may be able to stop taking methadone in two to three years and others may take it for the rest of their lives.
The second medication that is FDA approved is buprenorphine, which is a long acting opioid that suppresses feelings of withdrawal. A person can go from using their drug of choice to immediately taking suboxone. It is important to work with a provider that you trust, suboxone is supposed to keep you stabilized instead of high and or sick. It is also a portable medication, so people can take prescription in their homes. However, Doctors cannot prescribe it if they are not waived. They are required to take a course and there is also a limit on how many patients can get prescribe the medication. I thought that was an interesting point considering that doctors can prescribe a limitless amount of pain killers. Adding on, the third FDA approved medication is naltrexone. It is administered in the form of an injection and it lasts up to 30 days or there is also one that lasts up to 90 days, it is the extended release injection. This medication completely blocks your opioid receptors and a person must be fully detoxed 8-10 days before starting. If they take the medication without detoxing they will then be put in precipitated withdrawal. Keli also pointed out how people have a high risk of overdosing when they come out of a protected environment. Due to the fact that someone who relapses after being sober will go back to taking the same doses they previously took, a dose for which they no longer have a tolerance for. Therefore, naltrexone is good option for people who are leaving protected environments. I thought it was interesting that a questioned was asked about naltrexone being less stigmatized than the other two medications. The reasons being are that the medication doesn’t allow a person to feel high, there is no risk or diversion because it is in the form of an injection, and it also not a pill that a person has to take every therefore, no one will know if you are given the medication.