The opioid crisis is making its avalanching consequences known across the country; to governments, the medical community, pharmaceutical industry and our own friends and families who are suffering through addiction or loss.

Amid the scramble to find ways of breaking the oft-deadly reliance on powerful drugs such as fentanyl, one solution being used locally is Medicated-Assisted Treatment, a process using FDA-approved medicines with therapy, counseling and 12-step programs.

Sara Barr, program manager of Livengrin, a regional treatment and rehabilitation center with offices in Bethlehem, explained MAT, which has been around since the 40s, and how it’s being used in today dangerous drug climate.

“The main goals of MAT are to reduce, eliminate, or prevent the use of illicit drugs, potential criminal activity, and/or the spread of infectious disease, and to reduce the amount of fatal overdoses that are taking place.” Barr said studies outlining fiscal savings in communities are expected in the coming years, but she’s seen firsthand the benefits to clients.

“Many clients on Vivitrol have reported decreased physical cravings for both alcohol and opioids. I have also had clients be able to re-build the relationships with their family members in a healthier manner when they are involved in MAT because it provides an extra layer of accountability.”

Barr said clients come to Livengrin and similar programs through doctor’s referrals and simply calling when they’ve decided they want help. Individuals begins treatment with a comprehensive drug and alcohol assessment, and upon its completion a recommendation for a level of care will be made – anything from detox to outpatient.

The two most common medications currently used at Livengrin are Buprenorphine (Suboxone) and Naltrexone (Vivitrol.)

Buprenorphine, approved for use in 2002, was the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices. It has a similar but weaker effect – with a definite ceiling to its intensity – than the dangerous drugs it’s replacing, which lowers the risk of misuse, dependency and side effects. It’s most recent derivative, Subclocade, is an injection which reduces the possibility for mis-use of the medication and helps individuals come off of it with reduced withdrawal or side-effects.

Individuals must be fully detoxed from all opioids and alcohol before starting Vivitrol or Naltrexone, which are used for both disorders. They are non-addictive, and Vivitrol blocks opioid receptors in the brain for one month at a time, helping prevent relapse to dependence while clients focus on counseling.

No treatment is perfect, of course.

“As with any medication there are certainly challenges to MAT,” Barr said. “For example, there are side-effects associated with medications such as naltrexone and Vivitrol including stomach upset, nausea, and pain at the injection site. Some insurance companies do not cover the medications yet and clients may have to pay upwards of thousands of dollars for the medications. Additionally, there is a shortage of doctors in the area who are licensed to administer the drugs. Clients typically have to go to specific addiction doctors or facilities and simply cannot go to their primary care physicians.”

Barr said MAT was developed as a form of harm-reduction based treatment. Harm-reduction in the substance use disorder field tends to spark a great deal of controversy because it deviates from traditional methods which center around complete abstinence from all mind-altering substances. The harm-reduction approach has a great deal of contemporary research behind it and addresses the current public health crises showing that if harm can be reduced, it may prevent fatal overdoses.

“In fact,” she said, “in 2015 the director of national drug control policy, Michael Botticelli, pointed out that the evidence is clear that those with opioid use disorders can greatly benefit from both behavioral and support services in conjunction with medication assisted treatment.”

Monitoring is, of course, an important part of the process, Barr said, and that stigmas exist when dealing with government employees, but procedures continue to be refines and support networks continue to grow to give clients the most effective help.

“It has always been my experience that probation officers would like to see the individuals that they monitor succeed and get out of the system.”