This is the 4th post in a series taking a look at the evidence provided by advocates of medication-assisted treatment (MAT).
This post reviews some of the lessons from a closer look at the 19 studies in the meta-analysis provided by Newt Gingrich, Patrick Kennedy & Van Jones.
What have we learned?
We’ve learned a few things:
- The subjects in these studies often do not resemble the general population of treatment seekers. They are often pregnant, lower severity or misuse only prescription painkillers.
- The design of these studies often provide contact with research staff 3 to 5 times per week. Some even used monitored dosing.
- Even with these non-representative populations, retention ranged from around 30% to 65%, with most of those study periods being 16 weeks or less. There were a few with retention rates as high as 75% over a year. Those studies were in Sweden, with unusually intensive treatment or integrated into essential medical care.
- There was very little attention to abstinence. In the few studies where abstinence was mentioned, the outcomes were not good–relatively low percentages achieving abstinence for periods of 3 to 12 weeks.
- Ongoing drug misuse is the norm among the subjects in these studies.
- If you want to look at apparently effective models of MAT, go to Sweden. (Their studies included very high levels of monitoring, support, contingencies and services to address housing, employment and other needs.)
The pitch from Gingrich, Kennedy and Jones sounds very similar to many other advocacy pieces.
I don’t have any problem with advocacy for MAT. It can reduce harms associated with opioid addiction there are problems with access in rural areas. However, I do not understand how people like Gingrich, Kennedy and Jones can reconcile what the research actually find with this statement [emphasis mine]:
Medication assisted treatment, or MAT, is the use of FDA-approved medicine in concert with behavioral counseling for opioid addiction that has proven efficacy. Multiple studies have shown that MAT is essential to effective long-term recovery, by reducing cravings and the risk of fatal overdose and increasing abstinence and time in treatment. And we have known this for a long time.
These advocates oversell the benefits of MAT and will eventually undermine public confidence in treatment and the belief that opioid addiction is a treatable condition.
If I was a person seeking treatment for opioid addiction, I’d feel misled by the information they provide. For example, their statement “in concert with behavioral counseling” is diametrically opposed to the findings in the paper they share as evidence. Further, the paper does not provide any evidence for MAT as a path to abstinence. In fact, the paper suggests abstinence is rare among MAT research subjects.
Advocating for MAT is fine, but please give an accurate picture of the evidence and, given the limitations of MAT, inform readers about the kind of treatment doctors provide to their peers with opioid addiction.