Medication for Addiction Treatment

Medication for Addiction Treatment (MAT) is the use of medications, with the use of psychosocial therapies and supports as needed, to provide a whole-person approach to the treatment of substance use disorders. While many people do well using just medication to treat their substance use disorder, other individuals benefit from additional psychosocial therapies and supports. Medication for opioid use disorder is the first line treatment for all persons, including pregnant and breastfeeding persons with opioid use disorder.

Safe and effective medications are currently available and approved by the United States Food and Drug Administration (FDA) for the treatment of alcohol use disorder, opioid use disorder, and tobacco use disorder. Medications for Opioid Use Disorder decrease the risk for overdose, overdose death, other deaths.

Guidance for Providers

The Office of Addiction Services and Supports (OASAS) regulations require the use of Food and Drug Administration (FDA)-approved medications for the treatment of substance use disorders.  

Parts 800, 816, 817, 818, 820, and 822 state that:

“All programs shall maintain a patient with substance use disorder on approved medication, including those federal Food and Drug Administration (FDA) approved medications to treat substance use disorder, if deemed clinically appropriate and in collaboration with the patient’s existing provider, and with the patient’s consent, in accordance with federal and state rules and guidance issued by the Office.”  

“All programs shall provide FDA approved medications to treat substance use disorders to an existing patient or prospective patient seeking admission to an Office certified program in accordance with all federal and state rules and guidance issued by the Office.”

OASAS treatment providers have requested clarification of this regulatory language. Specifically, providers have asked if OASAS regulations prohibit the treatment of substance use disorders with FDA-approved medications for non-FDA approved or “off-label” indications.  

Recommendations

While OASAS supports the use of FDA-approved medications for the treatment of substance use disorders, OASAS regulations neither prohibit nor encourage the use of FDA-approved medications for off-label indications when it is deemed medically appropriate by a New York State licensed physician, nurse practitioner, or physician assistant.

Medically appropriate situations may include the off-label use of a medication as an adjunct to an FDA-approved medication for substance use disorders or the off-label use of a medication as the primary treatment when no FDA-approved medication is currently available.

The prescribing professional’s medical rationale for prescribing or administering a medication for an off-label indication, and the patient’s informed consent that includes their understanding of the benefits and risks of using the medication for an off-label indication must be documented in the patient’s medical record.

Questions regarding the use of medications for addiction treatment in OASAS programs may be sent to the OASAS Division of Medicine, Psychiatry and Nursing. 

The following is a list of substance use disorders and the FDA-approved medications that treat them:

Alcohol Use Disorder

• Acamprosate
• Disulfiram
• Naltrexone

Opioid Use Disorder:

• Buprenorphine
• Methadone
• Long-acting Naltrexone Injection

Tobacco Use Disorder/Nicotine Dependence

• Bupropion
• Nicotine Replacement Therapy
• Varenicline

Medication for opioid use disorder (MOUD) is the preferred approach for treating pregnant persons with opioid use and/or opioid use disorder. MOUD is associated with better adherence to both prenatal care and substance use disorder treatment, and is associated with better outcomes, both for the pregnant person and the newborn.

Methadone and Buprenorphine are preferable to medically supervised withdrawal for pregnant persons, and are recommended by numerous professional medical organizations, including Substance Abuse and Mental Health Services Association (SAMHSA), the World Health Organization (WHO), the American Society of Addiction Medicine (ASAM), and the American College of Obstetricians and Gynecologists (ACOG).

Medically supervised withdrawal is not recommended during pregnancy as it is associated with higher rates of a return to opioid use and correlated with worse outcomes.

Adolescent Medication for Addiction Treatment Grand Rounds

Medical leadership at OASAS was joined by national experts for a unique three-part webinar series to discuss the use of medications to treat substance use disorders, including opioid use disorder, in adolescents and young adults. Please refer to the Adolescent Endorsement page for more information.

The three-part webinar series includes:

1. MAT and More: Using Medications for Youth with SUD - Alcohol, Tobacco, and Especially Opioids, hosted by Dr. Marc Fishman, Dr. Sharon Levy, and Dr. Marc Manseau
2. Meeting Youth Where They Are: SUD Treatment in Pediatric Primary Care, hosted by Dr. Sharon Levy and Dr. Kelly S. Ramsey
3. Involving Family in SUD Treatment for Youth, hosted by Dr. Marc Fishman and Dr. Grace Hennessy

Each of the three parts fulfills 1 clock hour credits toward:

• CPP/CPS initial
• CASAC/CPP/CPS renewal