Medication assisted treatment (MAT) in criminal justice settings as a double-edged sword: balancing novel addiction treatments and voluntary participation

Table 1 Medication-assisted treatment (MAT) for opioid addiction: primary options

Active ingredient (Brand name)	Available as injection?	Addictive potential	Dosing scheme	Reversible?	Available in the USA / EU?
Methadone	No	Yes (agonist^a)	Once daily	Yes, subject to 5–10 days of withdrawal	Yes / Yes
Buprenorphine (Subutex, Suboxone, Buvidal)	Yes	Yes (partial agonist / antagonist^a)	Daily or thrice weekly^b	Yes, subject to 3–8 days of withdrawal	Yes / Yes
Naltrexone (Vivitrol)	Yes^c	No (antagonist^a)	Every 4 weeks	No	Yes / No, but ongoing studies

Currently, maintenance treatment with Methadone or Buprenorphine is generally the first choice of treatment for opioid addiction. There is less supporting evidence for maintenance with injectable diacetylmorphine, long-acting morphine tablets or oral naltrexone. However, injectable naltrexone appears superior to tablets and is comparably effective to Buprenorphine-naloxone
^aMechanism of action at opioid receptors
^bInjectable buprenorphine is given once weekly or once monthly
^cLong-acting implants (Prodetoxone) are registered in the Russian Federation, whereas methadone and buprenorphine are prohibited

ISSN: 2194-7899