MAT for opioid use disorder rests on the scientific principle that addiction is a brain disease. Dr. Alan Leshner, a former director of NIDA, first wrote about this concept in an influential 2001 article:
A core concept that has been evolving with scientific advances over the past decade is that drug addiction is a brain disease that develops over time as a result of the initially voluntary behavior of using drugs. The consequence is virtually uncontrollable compulsive drug craving, seeking, and use that interferes with, if not destroys, an individual’s functioning in the family and in society (Leshner, 2001).
NIDA (2009) has indicated that “addiction affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.”
This principle is also reflected in SAMHSA’s Treatment Improvement Protocol (TIP) Number 43, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs:
Discussions about whether addiction is a medical disorder or a moral problem have a long history. For decades, studies have supported the view that opioid addiction is a medical disorder that can be treated effectively with medications administered under conditions consistent with their pharmacological efficacy, when treatment includes comprehensive services, such as psychosocial counseling, treatment for co-occurring disorders, medical services, vocational rehabilitative services, and case management services (SAMHSA, 2005).
According to NIDA, staying in treatment longer improves patient outcomes (NIDA, 2012; NIDA, 2009). ONDCP has also documented the increased likelihood of relapse when individuals taper off their methadone and buprenorphine (ONDCP, 2014). The prevalence of co-occurring mental disorders in this patient population increases the likelihood of overdose and death.
As with any disease, it is important to provide care based on what the medical evidence indicates will work best for an individual. It is important to prudently apply the evidence gathered over the years to guide reasonable and impartial treatment for individuals in the justice system, who have opioid use disorder.