Medication Assisted Treatment (MAT)

Six medications are FDA-approved for opioid use disorder and alcohol use disorder. This page compares them, explains how long treatment can run and what insurance pays, and lays out the federal rules that changed since 2023. It closes with the questions worth asking a program before a first appointment.

What Is Medication-Assisted Treatment (MAT)?

Medication-assisted treatment (MAT) is medical treatment for a substance use disorder that pairs an FDA-approved medication with counseling and other support. Federal agencies now split the term in two: MOUD, for medications for opioid use disorder, and MAUD, for medications for alcohol use disorder. The older acronym MAT still covers both.

The opioid medications work in one of three ways. Methadone is a full opioid agonist, so it activates the same receptors that opioids do, which reduces withdrawal and cravings. Buprenorphine is a partial agonist, so it activates those receptors only in part. Naltrexone is an antagonist, which means it blocks the receptors instead of switching them on.

Counseling and recovery support are recommended and commonly offered alongside medication. Under the 2024 federal rule for opioid treatment programs (OTPs), though, a person’s medication does not depend on attending counseling.

Two medications are often mistaken for MAT itself. Naloxone (Narcan) reverses an opioid overdose, and in March 2023 the Food and Drug Administration (FDA) made it available without a prescription. Lofexidine (Lucemyra) eases withdrawal and is not a treatment for opioid use disorder.

Patients taking medication for OUD are considered to be in recovery.

Medications Used in MAT

The U.S. Food and Drug Administration (FDA) has approved six medications: three for alcohol use disorder and three for opioid use disorder. They work in different ways, are taken on different schedules, and are available from different places.

Methadone and buprenorphine are both agonists, acting on the same receptors other opioids do, but methadone is a full agonist and buprenorphine a partial agonist. Naltrexone is an antagonist and blocks those receptors instead. Acamprosate eases the brain changes alcohol use disorder causes, and disulfiram causes an unpleasant reaction if a person drinks.

Manufacturers’ labels differ on when a first dose can start. Sublocade’s label allows an injection after a single buprenorphine dose, and Vivitrol’s label puts the usual opioid-free stretch before that first injection at 7 to 10 days.

MAT for Opioid Use Disorder

Methadone and buprenorphine are linked to a lower risk of dying from an opioid overdose, and naltrexone is available to people who have stopped opioids completely. Most people with opioid use disorder get none of the three.

In a Massachusetts study of over 17,000 adults after a nonfatal overdose, methadone was linked to a 59% lower risk of opioid overdose death and buprenorphine to a 38% lower risk, Larochelle et al. reported in Annals of Internal Medicine in 2018. Naltrexone showed no association, possibly because few people took it. The three FDA-approved medications are safe and effective.

In 2025, 623,000 people aged 12 or older with past-year opioid use disorder, or 15.7%, received medication for it, according to SAMHSA’s National Survey on Drug Use and Health. SAMHSA asked those questions only of people who reported ever using heroin or a prescription pain reliever.

Provisional figures from the Centers for Disease Control and Prevention (CDC) put opioid-involved overdose deaths at 41,311 over the 12 months to May 2026. Naloxone can reverse an opioid overdose.

Choosing among the three belongs with a clinician, who weighs how long someone has been off opioids and how buprenorphine and methadone differ.

MAT for Alcohol Use Disorder

Three medications have FDA approval for alcohol use disorder, and none of the three is addictive. Naltrexone blocks the opioid receptors that make drinking feel rewarding. Acamprosate eases the brain changes that alcohol use disorder causes. Disulfiram causes an unpleasant reaction when a person drinks. Any of the three can be prescribed in primary care or by another health care provider, alone or with counseling.

Few people who could benefit from one ever get it. Of the 25.7 million people aged 12 and older with alcohol use disorder in 2025, 679,000, or 2.6%, received a medication for it, according to the National Survey on Drug Use and Health from SAMHSA.

Starting one does not require a specialty program: it can begin in a routine visit, or sit inside a longer course of alcohol addiction treatment.

Is MAT Just Replacing One Drug With Another?

No. A medication prescribed for a substance use disorder treats a chronic condition, the way a daily pill manages blood pressure or insulin manages diabetes. Taking one steadily does create physical dependence, and dependence is not addiction: it is a body adjusted to a drug it receives on schedule, without the compulsive use that defines a substance use disorder.

What Changed: X-Waiver, Telehealth and Methadone Rules

Since 2023, buprenorphine has been easier to prescribe, and since 2024 opioid treatment programs (OTPs) have had more room on take-home methadone and telehealth.

The X-waiver, the extra approval a clinician once needed for buprenorphine, is gone. The Consolidated Appropriations Act, 2023, signed on December 29, 2022, ended the DATA-Waiver, and the DEA’s January 12, 2023 letter confirmed that a DATA-Waiver registration was no longer required. Any practitioner registered with the DEA who holds Schedule III authority can now prescribe buprenorphine for opioid use disorder, subject to state law.

Prescribers carry one new duty under the Medication Access and Training Expansion (MATE) Act: a one-time 8-hour course at the first registration renewal after June 27, 2023, which falls on clinicians rather than on patients, the DEA’s March 27, 2023 letter says.

Methadone follows a separate rule, and it applies only inside an OTP. Under 42 CFR Part 8, effective April 2, 2024, with compliance required by October 2, 2024, a program may let someone take doses home, and the limits widen over time: up to 7 days of doses across the first 14 days, 14 days from day 15, and 28 days from day 31. The one-year history requirement is gone. Telehealth evaluations are allowed, with buprenorphine and naltrexone by video or voice alone, and methadone by video, or by voice alone only when a registered practitioner is present. Interim treatment can run up to 180 days, and medication no longer depends on counseling.

The DEA’s buprenorphine telemedicine rule is newer. In effect since December 31, 2025, it lets a practitioner prescribe for up to six months by video or voice alone after checking the prescription drug monitoring program (PDMP), then continue through another telemedicine route or a visit in person. Broader DEA telemedicine flexibilities run through December 31, 2026.

State law, and a program’s own policy, can still be stricter than the federal rule.

How Long Does MAT Last?

MAT has no fixed end date. Many people with opioid use disorder benefit from months or years of it, and some stay on medication long-term.

Stopping is a decision made with the prescriber who manages it. Tapering faster than that prescriber advises can bring back withdrawal and cravings.

Tolerance drops while someone is off opioids. The Vivitrol label warns a person is vulnerable “to potentially fatal overdose” when a dosing interval runs out, when a dose is skipped, or once the medication stops. Tolerance falls the same way after detox and after ending any medication for opioid use disorder. Naloxone reverses an opioid overdose and is sold without a prescription.

Settle these with the prescriber:

How Much Does MAT Cost, and Does Insurance Cover It?

What a person pays turns on the medication, the setting and their coverage. Medicaid has to cover each FDA-approved opioid use disorder medication, and most private plans cover MAT.

That benefit, counseling included, is permanent under the Consolidated Appropriations Act, 2024. States run their own Medicaid rehab coverage within those rules.

Medicare Part B pays for methadone, buprenorphine and naltrexone in a physician’s office or an enrolled opioid treatment program (OTP), along with intake, counseling, drug testing and peer recovery support. Copayments do not apply at an enrolled OTP, though the Part B deductible does. Part D may cover prescriptions for buprenorphine and naltrexone, depending on the plan, and Medicare rehab coverage has the details.

Marketplace plans must include substance use treatment as an essential health benefit, and the Mental Health Parity and Addiction Equity Act of 2008 requires parity with medical and surgical care.

Where coverage runs thin, FindTreatment.gov filters by payment type, surfacing state-funded programs and sliding-scale fees. Understanding how insurance and payment options fit together makes the first call easier.

How to Find MAT Near You

The starting point depends on the medication. A primary care provider can prescribe buprenorphine or naltrexone, and a telehealth prescriber can start it remotely. Methadone comes through a certified opioid treatment program (OTP).

FindTreatment.gov lists state-licensed programs and payment filters. SAMHSA’s old buprenorphine practitioner locator now redirects there. SAMHSA’s Opioid Treatment Program Directory lists OTPs by state, and the NIAAA Alcohol Treatment Navigator covers alcohol use disorder.

In 2024, 61.7% of treatment facilities offered medications for opioid use disorder, according to SAMHSA’s National Substance Use and Mental Health Services Survey (N-SUMHSS).

Intensive outpatient programs can run alongside medication. The SAMHSA National Helpline can be reached at 1-800-662-HELP (4357) for guidance, and 988 reaches the Suicide & Crisis Lifeline. The same searches work for someone helping a loved one.

Questions to ask:

Frequently Asked Questions About MAT