Use of MAT Terminology Leaves Many Wanting

A growing chorus of leaders in the addiction field would like to see a phaseout of the term “medication-assisted treatment,” which has become strongly linked to the nation's response to the opioid crisis but which many say does not reflect the chronic nature of addiction.

These individuals and groups, often with divergent perspectives on the precise role of medications in the treatment of opioid use disorder (OUD), add that MAT has become an emotionally charged term that serves only to deepen the field's divisions over treatment and recovery concepts.

Addiction Professional interviewed leaders of a nationally known specialty treatment facility and the president of the most prominent addiction medicine organization, both of which have sought to clarify medication's place in addiction treatment and recovery.

New trademarked language

Leaders at Maryland-based Ashley Addiction Treatment strongly believe that language matters in how professionals describe the key concepts of treatment and recovery. “We re-stigmatize in our field every day, with our patients,” says Ashley President and CEO Rebecca Flood, citing how value-laden terms such as “relapse” and “clean/dirty” manage to persist in daily conversation.

Discussions between Flood and Ashley chief medical officer Gregory Hobelmann, MD, led to a desire to identify a term that more accurately reflects the role of medication and the realities of the disease and its treatment. Over the past six months, Ashley has formalized its use of “Medication Supported Recovery,” a term that it has trademarked.

Flood explains that the trademarking process for MSR was designed to place Ashley in a leadership role in changing the conversation across the industry. She says the organization does not have designs on preserving use of the language for itself indefinitely.

“The term is not just a term to be different,” Hobelmann says. Rather, it more accurately reflects that medications (including but not limited to drugs to treat OUD, or even only to drugs to treat substance use disorders) are an integral part of supporting recovery. They do not, in Ashley's view, merely “assist” treatment.

“We want all the tools in the toolbox,” Flood says. Ashley's leaders hope MSR can be a concept around which the industry can coalesce. They believe there remains too much division between some medically focused professionals who barely consider any substance use treatment outside of lifetime medication as useful and some abstinence-focused professionals who don't even want to discuss medication as a potential option.

The industry's discussion around terminology was highlighted in March when the National Academies of Sciences, Engineering and Medicine issued a report that strongly backs the approved medications for OUD as first-line treatment. The report, “Medications for Opioid Use Disorder Save Lives,” replaced the commonly used “MAT” in its text with “medication-based treatment for OUD.” The authors stated that this more accurately reflects the chronic nature of the disease and the primary (not complementary, or temporary) role of medications in its treatment.

Ashley leaders say industry reaction to its effort to advance the “MSR” approach has been positive, with the organization credited for setting a different tone from use of a term that has become polarizing in the field.

Launching a conversation

The American Society of Addiction Medicine's (ASAM's) effort to clarify terminology related to addiction, treatment and recovery dates to 2013, when its board of directors approved a variety of definitions of terms as drafted by its Descriptive and Diagnostic Terminology Action Group.

At that time, ASAM included on its list of terms “medication assisted recovery,” referring to it as a transitional term to help the public and professionals understand pharmacotherapy's role in supporting recovery. It added at the time that the now-ubiquitous MAT is a variation on the medication assisted recovery concept. The ASAM document stated, “It is hoped that as the public and professionals recognize that recovery and treatment need to be holistic, appropriate pharmacotherapy would be well accepted as part of treatment and recovery, such that the terms MAR and MAT would be deemed unnecessary.”

ASAM's current president, Paul H. Earley, MD, believes the continuing struggle across the industry over terminology reflects to some degree a field that is still comparatively young in health care and an illness that has held stepchild status.

MAT, Earley says, encompasses a range of medication uses, from assistance in detox to a strategy to help maintain abstinence from alcohol use to a long-term maintenance approach for OUD. It has served as “the best available term for a confusing amalgam of issues,” he says. Earley, medical director of the Georgia Professionals Health Program, suggests that any terminology that could have caught on in the field probably would have ended up being just as contentious.

The research data clearly suggest that treatment with medications, especially for OUD, represents the standard of care, Earley says. When applicable research is available, it should be used to guide care, he says.

“Reactions to the 'MAT' term are an opportunity for discussion and dialogue,” Earley wrote to Addiction Professional in follow-up comments. “We all need more calm, thoughtful dialogue about the varying approaches to addiction care, as it is the most complex illness of humankind.”