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10 TFAH • WBT • PaininTheNation.org 2. Boosting medication-assisted treatment Enhancing behavioral health services requires ensuring providers are employing up-to-date treatments that have been proven clinically effective, notably medication-assisted treatment (MAT)—the use of FDA-approved medications in combination with therapy to treat substance use disorders. The FDA has approved three medications to help treat opioid disorder: methadone, buprenorphine and naltrexone. The FDA has also approved naltrexone, acamprosate and disulfiram to treat alcohol use disorders. These drugs are clinically effective; reduce or prevent withdrawal symptoms; relieve cravings; block the reward sensations from substance use; and sustain recovery. 63,64 MAT is one of the National Principles of Care for Substance Abuse and endorsed by all major government health agencies and experts in the field. Nevertheless, SAMHSA has found that MAT is underused. 65 Indeed, a Blue Cross Blue Shield study of its member plans found that the number of patients diagnosed with an opioid use disorder between 2010 and 2016 exceeded the increase in those receiving MAT by eight-fold. 66 They attributed this discrepancy to the misperception that MAT simply replaces one illicit substance with another, discrimination against MAT patients, lack of physician training, and negative views about MAT in the healthcare field. 67 Another complicating factor is the fact that both methadone and buprenorphine are controlled substances that are subject to additional restrictions when used to treat an opioid use disorder, including limits on the number of patients that one practitioner can treat. 68 In addition to being clinically effective, MAT also makes fiscal sense. A 2015 study found that treatment of opioid dependence with methadone and buprenorphine was associated with $153 to $223 lower total healthcare expenditures per month than behavioral health treatment without MAT, and that patients were 50 percent less likely to relapse when treatment involved MAT. 69 A systematic review of the literature has found that pharmacotherapy treatment of alcohol dependence produced marked economic benefits. 70 Unfortunately, despite research to the contrary, many physicians do not believe that MAT is more effective than abstinence-based treatment, according to a 2016 GAO review. 71 Healthcare systems are working to educate their clinicians about the effectiveness of MAT. 72 These medications are clinically effective; reduce or prevent withdrawal symptoms; relieve cravings; block the reward sensations from substance use; and sustain recovery. $153 to $223 Monthly healthcare expenditure savings asscociated with treating opioid dependence using behavioral health treatment and MAT Patients whose treatment involved MAT are 50% less likely to relapse

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