There are many different treatment options for addiction to opiates like Oxycontin. Once you realize you are addicted and want help, it is difficult to figure out what the best treatment option is for you. Two of these options are rehab and medication assisted treatment (MAT). MAT includes Suboxone, Subutex, Zubslov and methadone treatment.
What Is the Difference between Rehab and MAT?
Rehabilitation treatment or rehab is a residential treatment facility for drug and alcohol addiction. It is inpatient treatment and typically lasts 30 days or more. Inpatient treatment means that you stay at the facility 24 hours a day. If you are physically addicted to opiates like Oxycontin, you may need a medical detox prior to rehab. Oxycontin and other opiates are physically addictive. When you stop taking them, you can have withdrawal symptoms. Withdrawal can be severe or mild depending on how much opiates you are taking.
Some rehab facilities include detoxification (detox) from opiates. Detox is a medical treatment to rid the body of opiates or other drugs. Detox is only done by medical professionals. Medications can be given to the addicted person to help make the detox more comfortable for the addicted person. Some facilities use a Suboxone or Subutex taper to help ease withdrawal symptoms.
Medication Assisted Treatment (MAT)
MAT or medication assisted treatment is outpatient treatment. Unlike rehab, you do not stay at an outpatient facility 24 hours a day. If you are in MAT, you will go to the facility for counseling and medication on a regular basis but still remain living in your home.
There are several types of MAT:
Suboxone, Subutex and Zubslov
Suboxone, Subutex and Zubslov are medications for the treatment of Oxycontin and other opiates. They are prescribed by a doctor who is certified to prescribe these medications for the treatment of addiction. These medications can be prescribed in a doctor’s office or at a clinic. Clinics that prescribe these medications also provide counseling. If you are prescribed them in a doctor’s office, you may need to find your own counselor if you are paying for treatment through insurance. Most insurance require counseling or they will not pay for the medication. You may also be required to verify sobriety through urinalysis or mouth swabs. Medication is usually prescribed for two weeks to a month. This means you have to see the doctor once or twice a month in addition to whatever counseling is required.
Suboxone, Subutex and Zubslov contain a drug called buprenorphine. Buprenorphine is an opioid, a synthetic or man-made opiate. It is a partial agonist which means that at its maximum, it doesn’t have the same effect as an opiate agonist like Oxycontin. Buprenorphine has a ceiling effect which means that above a certain dose, it has no effect. This makes it less likely for someone to overdose while taking this medication. However, overdose is still possible when it is combined with other drugs.
The difference between Suboxone and Subutex is that Suboxone contains naloxone. Zubslov is another brand name medication which contains buprenorphine and naloxone. Naloxone was added to Suboxone and Zubslov to prevent addicts from abusing buprenorphine by injecting it. Subutex is generally prescribed to pregnant women and other people who cannot take naloxone. Suboxone, Subutex and Zubslov are taken orally by placing the medication under your tongue.
Methadone is an opioid, a synthetic or man-made opiate. It is a full agonist. Methadone is prescribed by a doctor at a clinic. A methadone clinic also provides counseling services to the addicted person. The laws for methadone clinics vary by state but most require that you receive counseling once or twice a month. Methadone is dispensed at the facility and must be taken in front of a nurse. It comes in either a liquid form or a wafer which is liquefied in hot water and juice. At most methadone facilities, you have to go to the facility daily in the beginning. Clients can get take-home doses depending on how long they have been at the facility and how they are progressing. Take-home privileges are often a reward for sobriety which is monitored through random urinalysis or mouth swabs.
Which Treatment Is Best for Me?
Counselors use this rule of thumb to determine the best treatment for a client: What is the least restrictive treatment that would be effective for this client? This means we look for a treatment that is effective and can help the client but without placing them in a restrictive environment unless it is necessary. For a person who has just experimented with drugs, this might mean counseling. For someone who is on the path to becoming addicted, this might mean intensive outpatient counseling.
However, the person who is physically addicted needs a more restrictive environment for treatment. This means rehab or MAT. Rehab is restrictive because you have to stay at the facility 24 hours a day, follow their rules and do everything according to the facility’s schedule. MAT is an outpatient treatment but it is restrictive because it is long term treatment. Some people take MAT medications for years or even the rest of their life.
Reasons to Choose Rehab
This is a list of reasons to consider rehab over MAT. If you meet any ONE of these criteria, consider rehab first before MAT.
- Never been to rehab
- Have gone to rehab before but never put in much effort
- Went to rehab before but only for other people and not for yourself
- Have not been to rehab for a long time
- Have been successful with rehab before but have relapsed
- Young people (under the age of 25 to 30)
- Using drugs for a short period (1 to 3 years)
- Unemployed and can devote time to their recovery
- Want to be completely abstinent
- Willing to go to 12 Step meetings
- Want to learn about addiction
- Want to learn to live without the use of drugs or alcohol
This is not to say that if you don’t fit all of these criteria, you should automatically go to MAT. Even if you meet ONE of these criteria, you may want to consider rehab. MAT is long term treatment. In my opinion, it is more restrictive than rehab because you have to make a commitment to this treatment which could last for years. I think MAT should be considered a last resort when all other treatment has not led to recovery.
Reasons to Choose MAT
This is a list of reasons you may want to choose MAT over rehab. If you meet any of these criteria, MAT might be the right choice for you.
- Unable to leave your life commitments for 30 days or more (This does not include primary caregivers for children since there are facilities that can accommodate children)
- Are fully employed and would lose your job if you left for 30 days or more
- Have been to numerous rehabs and 12 Step groups with no success
- Are prepared to participate in long-term treatment
- Are committed to using no other drugs while in treatment
- No insurance coverage for treatment , could not afford rehab or find a program to cover the cost
- Financial responsibilities that prevent you from leaving for 30 days or more
- Risk losing housing if you leave for 30 days or more
- Health issues which prevent you to leave for 30 days or more
- Are not willing to leave home for 30 days or more
- Legal issues which prevent you from leaving for 30 days or more
- Facilities have long waiting lists and you have an immediate need for treatment
Basically, I would recommend rehab over MAT unless you have no option to leave for 30 days, cannot find a facility to treat you or are unwilling to go to inpatient treatment. The other case is pregnancy. If you are addicted to Oxycontin or other opiates and are pregnant, you cannot be detoxed from opiates. Detox would put the fetus at risk for miscarriage. MAT is the only approved treatment for pregnant women addicted to opiates.
This is not to say MAT cannot be an appropriate treatment for Oxycontin addiction. Many people believe MAT has saved their life. However, you are still required to take medication every day. There is a freedom that comes from being completely abstinent. Knowing that you don’t have to wake up and take anything, gives an addict a sense of accomplishment and pride. Since this is achievable, I hope every addict will give rehab a chance before going to medication assisted treatment.
Medication assisted treatment involves continuing to take an opioid on a daily basis. It can be used as a tool to complete abstinence or it can be abused by using other drugs along with it. People who are already taking one drug are more likely to take another. You are also responsible for taking the medication properly. This is difficult for an addict to achieve. Addicts wouldn’t be addicts if they could control their use of medication. However, this is what is expected of people on MAT. Methadone is more controlled since you have to go to the treatment facility more frequently but there are still ways to abuse this medication.
Many addicts make the mistake of getting involved with other clients at their treatment facility. Remember that everyone might not be there for the same reasons as you are. Some addicts go to MAT to avoid withdrawal and not to get off drugs. They may be continuing to use other illicit drugs which could trigger cravings and drug use for you.
Before you make a choice on whether you want rehab or medication assisted treatment, ask yourself what your goals for treatment are. If you want to live a normal, drug free life, then rehab is the best choice for you. If you just want to stop withdrawal and increase your functioning, then MAT may be for you.
Whichever treatment you choose, the more effort you put into treatment, the more you will get out of it. Including counseling and 12 Step groups as a part of your treatment, will increase your chances of success. Working on co-occurring disorders with mental health treatment, resolving legal issues, reconnecting with family, developing social support, letting go of friends who still use drugs, going to school, getting a GED and becoming employed will help you to lead a normal, drug free life.
- About the author Anna Deeds:
- I am a recovering addict and a Licensed Professional Counselor. I have over 7 years clean from all substances and more than 10 years from illicit drugs. I work as an addiction counselor and have more than 5 years experience counseling addicts.
Page last updated Dec 11, 2013