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State updates guidance for medications for addiction treatment

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Just two years ago, the state released its first MAT Guide — a comprehensive set of recommendations for healthcare providers treating opioid use disorder.

But a lot has changed since then, down to the name of the treatment. Back then, MAT stood for “Medication Assisted Treatment.” Now, it’s “Medications for Addiction Treatment.”It’s one of many changes outlined in the 2021 MAT Guide. The Alaska Department of Health and Social Services released the new guide this week.

One of its authors is Dr. Sarah Spencer. She works at the Ninilchik Traditional Council’s Community Clinic and is board certified in family and addiction medicine.

“We’re learning new things all the time about how to improve care for patients," she said.

There are a lot of updates in this edition of the MAT Guide. For one, the name change. Spencer said it’s because researchers now understand medications like suboxone aren’t just supplements to other kinds of treatments when it comes to addressing opioid use. They work really well on their own.

“The medications alone, even without psycho-social supports, can give significant benefits. So that was a big change in the recommendations," Spencer said.

Another update — there’s no time limit on treatment. Spencer said research has found there isn’t a benefit to stopping medication early.

There are recommendations for addressing other substance use disorders in this guide, too. Spencer said 80 percent of the time, she’s treating opioid addiction. But she sees a lot of overlap with alcohol and stimulant use disorders, as well.

Heather Phelps, a mental health clinician with the state, was another co-author of the guide.

“We wanted to incorporate a section about working in a pandemic situation," she said. "We really wanted to make sure we had more Alaska resources and include some of the people that we knew were working with medications for addiction treatment in other areas. So MAT in rural Alaska, and working with the Department of Corrections and the therapeutic drug court.”

There are about 500 providers that can provide MAT treatment in Alaska. They’re certified through the Drug Addiction Treatment Act of 2000 Waiver, or DATA Waiver.

That number has grown by 100 from the time of the last MAT guide.

“But just because we have an increase doesn’t mean that all the DATA Waiver prescribers are actually practicing," Phelps said. "And so we’re really trying to reach out to them.”

She said there’s still stigma around MAT treatment.

“There’s a lot of myths around it. We know that there are many different pathways to achieve recovery," she said. "We have research upon research that shows that patients that take MAT treatment actually do better in long-term recovery.”

Spencer said it’s important to keep providers up to date on that research.

As a specialist, she keeps up with the changing guidelines and recommendations for treating opioid use disorder. But she realizes not every doctor can.

“The typical primary care provider isn’t able to follow all those changes in the guidelines on an ongoing basis, and they may miss some of the updates to that," Phelps said. "So by updating these general guidelines, it allows them to have a place to go where they can see where all the guidelines are."

The updated MAT Guide is available on the Department of Health and Social Services website. (As of Monday, the website is down due to a malware attack.)

Phelps said the Alaska Native Tribal Health Consortium is developing its own MAT guide for rural Alaska, which will come out later this year.

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