Medication-assisted treatment (MAT) 1: opioid substitution therapy

This chapter is the first of two parts describing the advantages, standards, and goals of medication-assisted treatment (MAT) for opioid use disorders. MAT is a complex biopsychosocial intervention with the provision of opioid substitution treatment (OST) at its core. These chapters aim to provide the clinician with charts, tables, and clinical guidance around the prescribing of OST within MAT. This first part (this chapter) covers the assessment of patients with opioid use disorders (OUDs), initiation, titration, and maintenance with OST, as well as physical monitoring and the treatment of those with OUDs requiring admission to hospital. Data presented here is based on clinical guidelines and the experience in treating persons with OUDs in Scotland, United Kingdom (UK), and reflects evolution in practice in response to the high levels of drug deaths and Scottish national MAT standards published in May 2021. Within the UK, the National Health Service (NHS) exists as a single-payer healthcare system, providing universal care to all residents. This of course is not the case worldwide, and there is substantial variation in availability of services between countries. Clinicians should always ensure that they are familiar with what services are available locally as well as local licensing and legal requirements around prescribing OST, as substitute medications are usually controlled drugs.