Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. A Treatment Improvement Protocol TIP 43

摘要

Research supports the perspective that opioid addiction is a medical disorder that can be treated effectively with medications when they are administered under conditions consistent with their pharmacological efficacy and when treatment includes necessary supportive services such as psychosocial counseling, treatment for co-occurring disorders, medical services, and vocational rehabilitation. Medication-assisted treatment for opioid addiction (MAT) has been effective in facilitating recovery from opioid addiction for many patients. This TIP provides a detailed description of MAT, especially in opioid treatment programs (OTPs). MAT includes optional approaches such as comprehensive maintenance treatment, medical maintenance treatment, detoxification, and medically supervised withdrawal. Some or all of these approaches can be provided in OTPs or other settings. With the approval of buprenorphine for physicians office-based opioid treatment, MAT availability is expected to increase. Growing understanding and acceptance of opioid addiction as a treatable medical disorder have facilitated advances in MAT. The effectiveness of MAT advanced significantly with the development of methadone maintenance treatment in the 1960s and the creation and expansion of publicly funded treatment programs in the 1970s. The first official Federal use of the term maintenance treatment (referring to opioid addiction treatment) occurred in the Narcotic Addict Treatment Act of 1974. Perhaps the most important development in MAT during the 1990s was publication of recommendations by a National Institutes of Health consensus panel on Effective Medical Treatment of Opiate Addiction. The panel concluded that opioid addiction is a treatable medical disorder and explicitly rejected notions that addiction is self-induced or a failure of willpower. The panel called for a commitment to providing effective treatment for opioid addiction and for Federal and State efforts to reduce the stigma attached to MAT and to expand MAT through increased funding and less restrictive regulation. The implementation of an accreditation system for OTPs further serves to standardize and improve MAT.