Medication-Assisted Treatment

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and other therapeutic techniques, to provide a “whole-patient” approach to the treatment of substance use disorders. Medications relieve the withdrawal systems and psychological cravings that cause chemical imbalances in the body. Research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, or physical functioning.

Effectively addressing the opioid epidemic requires a multi-systems collaborative approach by child welfare, law enforcement, court systems, substance use disorder treatment and mental health treatment, and healthcare providers. It is essential for these professionals to have an understanding of MAT as a viable option for parents/caregivers that have substance use disorders, especially opioid use disorders. The following resources assist communities, organizations, and agencies to better understand and implement evidence-based approaches to support safety, well-being, and recovery of children and families.

• Highlighted Resource

  • Opioid Use Disorder and Civil Rights Video and Webinar Series

    The National Center on Substance Abuse and Child Welfare (NCSACW), together with the Office for Civil Rights (OCR), created this training series to provide information to child welfare and court professionals about federal disability rights protections that apply to some parents with an opioid or other substance use disorder who are involved with child welfare.

    Opioid use disorder is a serious epidemic affecting families and communities across the nation. Discrimination, bias, and stereotypes could lead to barriers to accessing medication-assisted treatment (MAT) that may be illegal and may also seriously delay access to critical health and human service programs. It is important for everyone to know that federal disability rights laws protect some people with opioid and other substance use disorders.

    National Center on Substance Abuse and Child Welfare and Office for Civil Rights, 2021

    Exploring Civil Rights Protections for Individuals in Recovery from an Opioid Use Disorder

    
    

    Running Time: 00:24:53

    Part 1: Civil Rights Protections for Individuals with a Disability: The Basics

    This webinar provides information on protections for qualified individuals with a disability in the child welfare system and federal disability rights laws.

    
    

    Running Time: 00:19:20

    Part 2: Civil Rights Protections for Individuals with an Opioid Use Disorder

    This webinar discusses substance use disorders (SUDs), including Opioid Use Disorder, as a disability and federal disability rights protections for individuals receiving MAT.

    
    

    
    

    Running Time: 00:05:02

    Medication-Assisted Treatment and Common Misconceptions

    This video offers an in-depth look at MAT while addressing common misconceptions about treatment. It highlights strategies that inform effective child welfare and court practices and addresses common misconceptions.

    
    

    
    

    Running Time: 00:11:02

    Child Welfare Case Staffing: Social Worker and Supervisor

    This animated video simulates a child welfare worker and supervisor staffing a case involving a mother receiving MAT while pregnant. The staffing addresses misconceptions regarding MAT and how the mother may be protected under federal disability rights laws.

    
    

    
    

    Running Time: 00:10:35

    Child Welfare Case Staffing: Child Welfare Court Case

    This animated video simulates a hearing between a judge, a child welfare worker, and attorneys. The court and child welfare professionals discuss visitation for a mother receiving MAT.

    
    

    Note: This video and webinar series is supported by contract number HHSS270201700001C from the Substance Abuse and Mental Health Services Administration (SAMHSA), co-funded by Children’s Bureau (CB), Administration on Children, Youth and Families (ACYF). The views, opinions, and content of this video and webinar series are those of the presenters and do not necessarily reflect the views, opinions, or policies of SAMHSA, ACYF or the U.S. Department of Health and Human Services (HHS).

    This video and webinar series is intended to be a training opportunity. The simulated dialogues are hypothetical of a child welfare staffing and a court scenario. For training purposes, the content and conversations in the animated videos, highlight opportunities for improved practice and the need for person-first language. Child welfare systems are complex and vary widely by state. These training resources are not a final agency action and do not legally bind persons or entities outside the federal government. Each state incorporates the requirements of federal legislation into its state child welfare laws. These state laws specify when and how child welfare and dependency courts will be involved in the lives of families. When a child is under court supervision, the dependency court is responsible for monitoring that child’s safety and ensuring that he or she has permanency in the caregiving relationship following the timelines specified in the Adoption and Safe Families Act (ASFA).

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  Policy and Practice Resources

  • A Collaborative Approach to the Treatment of Pregnant Women With Opioid Use Disorders: Practice and Policy Considerations for Child Welfare, Collaborating Medical, and Service Providers
    (PDF 1.52 MB)

    Substance Abuse and Mental Health Services Administration, 2016

    The guide includes:

    • An overview of the extent of opioid use by pregnant women and the effects on the infant;
    • Evidence-based recommendations for treatment approaches from leading professional organizations;
    • An in-depth case study, including ideas that can be adopted and adapted by other jurisdictions; and
    • A guide for collaborative planning, including needs and gaps analysis tools for priority setting and action planning;

    View Document A Collaborative Approach to the Treatment of Pregnant Women With Opioid Use Disorders: Practice and Policy Considerations for Child Welfare, Collaborating Medical, and Service Providers

• Related Online Trainings, Videos, and Webinars

  • NCSACW Webinar Series on Opioid Use Disorders and Treatment

    National Center on Substance Abuse and Child Welfare (NCSACW), 2018

    NCSACW developed a webinar series on medication-assisted treatment for families affected by substance use disorders, opioid use in pregnancy, and treatment for neonatal abstinence syndrome. Please view the nine webinars’ services on opioid use disorders and treatment.

    Visit Website NCSACW Webinar Series on Opioid Use Disorders and Treatment
  • Webinar Series – Support for Hospital Opioid Use Treatment (Project SHOUT)

    California Health Care Foundation, 2018

    This program provides clinical leaders with the tools they need to start and maintain patients on buprenorphine or methadone during hospitalizations for any condition, be it medical, surgical, or obstetric. Specialists from the University of California, San Francisco provide a suite of supports: coaching, toolkits, monographs for pharmacy and therapeutics committees, webinars, and onsite presentations.

    Visit Website Webinar Series – Support for Hospital Opioid Use Treatment (Project SHOUT)
  • Substance Exposed Infants, Part 1: Supporting Pregnant and Post-Partum Women’s Use of Medication-Assisted Treatment and Psychotropic Medications

    Institute of the Advancement of Family Support Professionals, 2017

    This module introduces family support professionals and other service providers to basic information about the importance of medication compliance and provides information on how pregnant and parenting women being treated for behavioral health or medical conditions may be non-compliant or misuse medications.

    Visit Website Substance Exposed Infants, Part 1: Supporting Pregnant and Post-Partum Women’s Use of Medication-Assisted Treatment and Psychotropic Medications
  • Medication for the Treatment of Alcohol Use Disorder: A Brief Guide
    (PDF 508 KB)

    National Institute on Alcohol Abuse and Alcoholism, 2017

    Patients with alcohol use disorder (AUD) can turn to their primary care physicians when they need health care and often for complications related to AUDs. This webinar introduces the basics of when to provide medications for this disorder and what patient characteristics to keep in mind when choosing from the four Food and Drug Administration–approved medications available.

    View Document Medication for the Treatment of Alcohol Use Disorder: A Brief Guide

• State and Local Examples

  • Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders
    (PDF 1.86 MB)

    Substance Abuse and Mental Health Services Administration, 2014

    This report presents information about Medicaid coverage of medication-assisted treatment for opioid and alcohol dependence. It covers treatment effectiveness and cost effectiveness and gives examples of innovative approaches in Vermont, Massachusetts, and Maryland.

    View Document Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders
  • Medication-Assisted Treatment in Drug Courts: Recommended Strategies
    (PDF 1.17 MB)

    Legal Action Center, 2015

    This report contains three profiles of drug courts with effective medication-assisted therapies (MAT) programs, providing lessons and best practices on how to successfully incorporate MAT within urban, rural, and suburban drug court programs as well as nine recommendations related to services, collaboration, and assessment and monitoring.

    View Document Medication-Assisted Treatment in Drug Courts: Recommended Strategies

• Additional Resources

  • Clinical Use of Extended-Release Injectable Naltrexone in the Treatment of Opioid Use Disorder: A Brief Guide
    (PDF 446 KB)

    Substance Abuse and Mental Health Services Administration, 2015

    This publication offers guidance on the use of medication-assisted treatment (MAT) with extended-release injectable naltrexone for the treatment of an opioid use disorder. The guide covers patient assessment, initiating MAT, monitoring progress, and deciding when to end treatment.

    View Document Clinical Use of Extended-Release Injectable Naltrexone in the Treatment of Opioid Use Disorder: A Brief Guide
  • TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction
    (PDF 1.1 MB)

    Substance Abuse and Mental Health Services Administration, 2007

    These practice guidelines help physicians make decisions about using buprenorphine to treat opioid addiction. The document includes information on patient assessment, protocols for opioid withdrawal, and the treatment of pregnant women, teens, and polysubstance users.

    View Document TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction
  • TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders

    Substance Abuse and Mental Health Services Administration, 2012

    This Treatment Improvement Protocol equips clinicians with practical guidance and tools for treating chronic pain in adults with a history of substance misuse disorders. It discusses chronic pain management, including treatment with opioids, and offers information about substance abuse assessments and referrals.

    Visit Website TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders
  • Providers’ Clinical Support System for Medication Assisted Treatment (PCSS-MAT)

    Providers’ Clinical Support System, 2017

    This national training and mentoring project was developed in response to the prescription opioid misuse epidemic and the availability of newer pharmacotherapies to address opioid use disorders. The goal of PCSS-MAT is to make available the most effective medication-assisted treatments to serve patients in a variety of settings, including primary care, psychiatric care, and pain management.

    Visit Website Providers’ Clinical Support System for Medication Assisted Treatment (PCSS-MAT)
  • Providers’ Clinical Support System for Opioid Therapies (PCSS-O)

    Providers’ Clinical Support System, 2017

    This is a national training and mentoring project that was developed in response to the prescription opioid misuse epidemic and the availability of newer pharmacotherapies to address opioid use disorders. PCSS-O makes available programs on the safe and effective use of opioids for treatment of chronic pain and safe and effective treatment of opioid use disorder.

    Visit Website Providers’ Clinical Support System for Opioid Therapies (PCSS-O)
  • ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use
    (PDF 1 MB)

    The American Society of Addiction Medicine, 2015

    This guideline provides information on evidence-based treatment for opioid use disorders. It includes guidelines on assessment, diagnosis, and treatment as well as overview of the medications used to treat opioid dependence.

    View Document ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use
  • Federal Guidelines for Opioid Treatment Programs
    (PDF 682 KB)

    Substance Abuse and Mental Health Services Administration, 2015

    This publication provides updated guidelines for the operation of opioid treatment programs. It covers patient assessment, treatment planning, medication-assisted treatment (methadone and buprenorphine), overdose and relapse prevention, and recovery care.

    View Document Federal Guidelines for Opioid Treatment Programs
  • Advancing Access to Addiction Medications
    (PDF 4.84 MB)

    American Society of Addiction Medication (ASAM), 2013

    Medicaid coverage and use limitations differ from state to state, resulting in challenges in accessing Medicaid coverage in some areas. ASAM conducted a survey of state Medicaid agencies on accessing Medicaid for medication-assisted therapies (MAT). Challenges reported by states in accessing Medicaid for MAT include:

    • Complex authorization and re-authorization processes;
    • Lengthy approval processes;
    • Minimal coverage or reimbursement of counseling services to accompany MAT while also requiring counseling services as a preauthorization requirement; and
    • “Fail first” (or “step therapy)” criteria that require documentation that less costly therapies have proven ineffective.

    View Document Advancing Access to Addiction Medications