Saturday, May 14, 2011

MAT- medicated assisted treatment


image credit onur dogu

the clinic where i work has been working with medication assisted therapy for quite some time. the most well known mat is antabuse for alcohol abuse/dependence. with the onset of meth and cocaine in the last 30 years and the advancement of pharmatech, the use of mat to address stimulant dependence is being looked at much more seriously.
i have several clients that are currently using naltrexone to combat the cravings and the obsession for the next buzz. there are some mixed results certainly, but i believe that these studies are studies are still in their infancy. it is interesting to work with folk who are very protective of their systems when medications are involved, but behave as such raconteurs where smoking or injecting homemade speed is concerned.
we have clients that are using starting to work with injections of vivitrol as well. this is a monthly shot that works on the same principles of naltrexone, but without having to take a pill every day. below is an article describing some of the science behind the meth-focused mat.


One of the most vexing drug dependencies is that of methamphetamine Known as “speed,” “crank”, “ice,” “gak” and “crystal”; methamphetamine has emerged as the street drug with the greatest potential for harm and the most stubborn resistance to treatment. Methamphetamine works on sensitive neurotransmitters that regulate the synthesis and release of dopamine and nor-epinehprine. The most powerful of human emotions and feelings are directed and controlled by the activity of these two monoamines. Methamphetamine use, especially when abused chronically, turns the regulatory systems for dopamine and nor-epinephrine upside down. The very powerful direct effects of the drugs use means that withdrawal from it will be equally ferocious and difficult; relapses and reoccurrences in use are common if not predestined. Developing the therapies and pharmaceutical agents that can combat methamphetamine addiction has been difficult and has resulted in only marginally effective results. The search for medications that can soften the withdrawal and mute intense cravings is never ending. Recently a drug that’s widely used to treat opiate and alcohol dependencies has been experimented with in treating methamphetamine-addicted patients, the results have been promising.
Because opioids receptors in the brain are co-localized, microscopic neighbors so to speak on dopamine neurons, scientific suspicion brewed that inhibition of opioid receptors next door to those of dopamine, might help reduce the action of methamphetamine as that drug seeks to activate and release stored up dopamine. In a Swedish study, naltrexone was studied for its role in reducing the cravings and direct effects of methamphetamine[1]. Methamphetamine using patients using naltrexone reported substantial reductions in the impact of methamphetamine’s central effects; they also reported that in abstinence, their cravings for methamphetamine were markedly reduced.
Naltrexone is a drug that has been in use since the late 60’s. The drug is a powerful antagonist at all three major opiate receptor sites. By locking up the opiate receptor sites in the brain, naltrexone prevents powerful agonists like heroin, morphine and oxycodone from getting to them. The drug is approved for use in the treatment of opiate and alcohol dependency. The sustained release form of naltrexone (Revia) has garnered high marks for its ability to reduce cravings in the treatment of alcoholics. In the case of Revia, a dose of the drug is injected intramuscularly and is slowly absorbed into the circulatory system over a period of 4 weeks. With structural chemistry similar to the powerful opiate oxymorphone and that of a like-acting cousin called naloxone (Narcan), naltrexone is a well-tolerated drug with few side effects. Naltrexone users must understand however that when taking the drug, their opiate receptors are blockaded and that should an opiate need to be administered to them for severe pain, opiate receptors would be locked up and unusable for analgesia. Physicians have several medications as options to use in situations like that, but it is important that natlrexone patients understand the change in brain chemistry that’s occurred with the use of the drug.
The study undertaken by the Swedish government clearly points out naltrexone’s abilities in reducing and muting the effects of methamphetamine on dopamine nerve cells in the brain. By diluting the intensity of craving for the drug, methamphetamine addicts find it easier to maintain their sobriety and to participate in activities and therapies that support a sober lifestyle. What remains to be seen, what wasn’t evaluated in this study is the direct effects that naltrexone has on rates of relapse in methamphetamine addiction. Perhaps this will be the next area of study in the use of this drug. In any case, the Swedish study points out the value that naltrexone has in aiding the methamphetamine addict through recovery.....reprinted from youthbridge.com