What is the controversy surrounding medication-assisted treatment (MAT) for opioid use disorder, and what does evidence suggest about its effectiveness compared to abstinence-based approaches?

The controversy centers on using opioid agonist medications such as buprenorphine and methadone for long-term maintenance rather than requiring complete abstinence. Evidence indicates that medication-assisted treatment is more effective than an abstinence-based approach in reducing relapse, overdose deaths, and other harms associated with opioid use disorder.

The text notes that placing people with an opioid use disorder on a similar-acting medication has been controversial, but evidence points to this approach as more effective in reducing relapse than an abstinence-based approach. Supporting evidence shows that MAT with FDA-approved medications such as buprenorphine and methadone reduces overdose deaths, improves social functioning, lowers the risk of transmitting communicable disease, reduces criminal behavior, and improves neonatal outcomes for pregnant women. These long-acting opioid agonists also decrease cravings and the likelihood of relapse. The controversy may be heightened by social stigma, which can hinder the availability of methadone clinics and the willingness of practitioners to complete training to prescribe buprenorphine.