A Candid Review of MAT: Medication Assisted Treatment for Opioid Addiction

There is a common language being propagandized at the highest levels of government that are being trickled down through the mainstream media to the consumer “addicts and families of addicts” by lobbyists for the pharmaceutical manufacturers.

It’s all smoke and mirrors…

Today’s MAT model is nothing more than the SAMHSA “Harm Reduction” methadone medication modality from 20 years ago “repackaged” under a different name and utilizing evidence-based best practices while employing Suboxone as the primary medication instead of Methadone to promote the “Solution” to stop overdoses and deaths in the community. Hence, “addressing the epidemic.”

Medication Assisted Treatment for Tapering Vs. Long-Term Opioid Maintenance Therapy

There are two common forms of using medication to address opioid use disorders (OUD):

Let me say this in no uncertain terms… I do not follow the standard highly propagandized Suboxone 18-month maintenance modality in many cases becomes a lifelong maintenance MAT model. I do not agree with it, I do not believe “ANYONE” should be handed down a life sentence on medications to prevent relapse. There are alternative options to be considered as well as offered to give the individual the choice.

Does Long-Term Opioid Maintenance Work?

Some individuals may find help from long-term opioid maintenance program; however, long-term opioid maintenance should be reserved for high-risk cases and should be considered a last resort for a majority of individuals addicted opioids.

Not everyone is a candidate for long-term methadone or Suboxone use, and long-term opioid replacement SHOULD NOT be offered to everyone with a heroin or opioid addiction…

Opioid maintenance should be likened to invasive or radical therapies, reserved for only high-risk cases where the threats of chronic relapse, overdose and death are high. Patients with a history of chronic relapse may be candidates for long-term maintenance and should be referred to a Suboxone clinic, rather than a traditional detox setting using medication-assisted treatment.

The Hybrid MAT Modality of Medication Assisted Treatment for Opioid Addiction

With only two options being propagandized for medication-assisted treatment for opioids, I set out and established a 3rd option which is not only humane, its simply based around putting in the work as a provider by doing truly individualized assessments and not lumping everyone together with a one size fits all mentality. I call this the “Hybrid MAT” this modality offers INDIVIDUALIZED CLIENT-CENTERED CARE, not the typical one size fits all!

The Hybrid MAT modality of addiction treatment promotes both client retention and relapse prevention in a shameless fashion. This is also the type treatment for opioid addiction that a majority of consumers are calling for. They just haven’t found anyone to listen to them…..I don’t mean this to sound like a 12 steps cliché, but addicts want an easier, softer way to recover without being condemned to a life sentence of taking addiction relapse prevention medications– and the Hybrid MAT model of addiction treatment provides this with integrity “Stop The Stigma” being our primary ideology.

Hybrid MAT Treatment from an Insurance Providers Perspective

Not only does the Hybrid MAT form of opioid treatment offer those addicted to heroin and other opioids another option, but it takes evidence-based practices a step further. This process ensures the appropriate clinical treatment plans are individually designed while meeting the individual crucial physical needs of those who ultimately want to achieve a recovery of abstinence are met.

From the insurance provider’s perspective, it’s about “Client Retention” which equals “Relapse Prevention.” At the end of the day, this means “Revenue Generation” for the insurance provider – or to put it bluntly, “cost savings.”

Opioid Addiction Treatment Costs

Heuristic data shows that on a national level a client averages 6 to 8 detox/recidivism yearly. At $2,989 per day for a 10-day stay, that number is astronomical.

In order to be considered a true “Hybrid-MAT” addiction treatment provider, the services offered/rendered must include “medication management” in conjunction with “mental health management,” the program cannot only rely on substance use disorder (SUD) clinical staff. Bottom line, your staff licensure qualifications must support the medical necessity and clinical necessity. It’s imperative the EMR clinical documentation implementations correlate in order to generate reimbursements from insurance providers.

Authorization for Reimbursement from Insurance Providers

Important note: Insurance providers want to see an end game in your treatment planning. My Hybrid MAT modality of MAT/SOP is 120 days from inception.

When I first started this in 2016, I was only getting 22 days of authorizations and now we’re averaging 88 days.

Suboxone Dosage and Titration under Hybrid MAT Protocol

The Hybrid MAT protocol doctors I have worked with to develop the process started by prescribing what is considered a conservative 8mg dose from the point of entry at detox level of care. We found that the 8 mg Suboxone doses are sufficient in most cases to relieve withdrawal symptoms and offer a comfortable detox. On the rare occasion the dose was increased to 12mg – MAXIMUM – with the continued microtitration process.

This dosage and taper schedule has also allowed us to obtain authorizations up to 10 days at a time of “medication stabilization” until we hit the 2mg mark – after-which point we began the very micro-micro process by monitoring and documenting vitals clients weren’t crawling out of their skin. Titration protocol varies by Individual case and adheres to the recommendation of the overseeing medical professional.

In some cases, the use of Vivitrol and extended-release naltrexone may be utilized in the 120 SOP. All medications and dosages vary by each candidate. This, of course, is all based upon individualized Treatment plans, ONE SIZE DOES NOT FIT ALL.

How the Hybrid MAT Opioid Treatment Differs from Other MAT Treatments

Historically, subacute detox providers have often conducted a “Rapid Detox,” using faster and riskier taper schedules. Statistically, this does not work – from the insurance provider’s standpoint. The Hybrid MAT process, and its utilization of microtitration, further promote client retention and relapse prevention. This establishes that the provider is capable of eliminating the onset of Post-Acute Withdrawal Syndrome (PAWS). PAWS is a leading cause of early recovery relapse and recidivism, and a prime concern for insurance providers reviewing a medical treatment.

Symptoms of Post-Acute Withdrawal Syndrome

• Depression
• Obsession-compulsive behavior
• Inability to concentrate
• Cravings for drugs or alcohol
• Anhedonia
• Emotional overreactions
• Emotional Numbness
• Intense feelings of guilt
• Generalized anxiety
• Sleep disturbances
• Panic Disorders

In the Hybrid MAT process, we put a heavy focus on helping the patient to understand the symptoms of withdrawal and cope with them. This is a component of care that is vital to a successful recovery but is missing from many of the current modalities.

All aspects of our Hybrid MAT treatment protocol for opioid use disorders provides safety, and comfort to the client. It will also reduce AMA’s and detour recidivism.

Our Hybrid MAT treatment modality is a win for opioid-dependent patients who are seeking an “easier” way to begin recovery from their addiction and is a win for insurance companies – whose main concerns are keeping the client engaged in their sobriety, keeping them from using illicit forms of opioids, and reducing the financial hemorrhaging caused by treatments costs.

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