Starting Over After a Relapse: What You Should Know About Going Back on MAT

Medically reviewed by Paul Ballas, D.O.

Written by Emily Van Devender

Posted on October 28, 2026

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Key Takeaways

Medication-assisted treatment, or MAT, is a helpful option for people with opioid use disorder who want to work toward recovery, even after a relapse.
MAT can reduce opioid cravings and withdrawal symptoms, making it easier to stop using opioids again. Because MAT may combine medication with counseling, it can provide the structure and support needed to focus on recovery goals and make lasting changes.
If you have experienced a return to opioid use after previous MAT, talking to your doctor about restarting treatment is a great next step, as your care team can create a personalized plan that includes behavioral therapy, updated medication options, and overdose prevention measures like naloxone to help support your long-term recovery.

View all takeaways

Medication-assisted treatment (MAT) for opioid use disorder can help put you on the right track to recovery. However, no treatment for substance use can guarantee a future without relapse. If you’ve relapsed after going through MAT in the past, starting over is a reliable step you can take toward recovering again.

For people with opioid use disorder (OUD), MAT can lower the risk of returning to opioid use compared with behavioral treatment alone. However, a return to opioid use can still happen.

Starting over with MAT may give you the extra boost you need to return to recovery. Remember that recovery is a lifelong process and that relapsing doesn’t mean you’ll never reach your goals.

🗳️ Have you talked with a doctor about restarting MAT after a return to opioid use?

Yes, and it was helpful

Yes, but it wasn’t helpful

No, but I plan to

No, and I don’t plan to

How Restarting MAT Can Help

After relapse, MAT can be an appropriate next step regardless of the circumstances that led to the relapse. Because MAT may combine counseling with medications, it can give you the structure you need to focus on your recovery goals and make sustainable changes.

Medication-assisted treatment is also generally safer than trying to taper or discontinue opioids on your own. Different medications used for MAT modify your brain chemistry to shrink or remove two of the biggest roadblocks between you and your recovery: opioid cravings and withdrawal symptoms.

Opioid Cravings

Medications used in MAT significantly reduce opioid cravings, which are the strong urges you feel to use opioids. Opioid cravings can be extremely intense and are linked to a higher risk of relapse. Without support from an MAT program, it can be very easy to give in to those cravings, especially when life circumstances become unpredictable or challenging.

Withdrawal Symptoms

Some MAT medications also prevent withdrawal symptoms, which makes it easier to stop using opioids if you’ve started again. Opioid withdrawal can cause highly unpleasant symptoms like pain, fever, nausea, and sweating. Without MAT, these symptoms can be extremely difficult to push through, which may drive some to continue using opioids.

Why Your MAT Treatment Plan May Need To Change

If you compare your life now with your life when you started MAT the first time, you can probably see some significant differences. Just as your life has changed, your medication-assisted treatment plan may need to change too.

Your OUD specialist will evaluate your needs with ongoing monitoring while planning and adjusting your treatment plan accordingly. They take all areas of your life into consideration to ensure you receive a high level of individualized care, including treatment for mental and emotional concerns.

Concerns About Injectable MAT

Having gone through MAT before, some people might hesitate to restart treatment because of negative experiences with injectable medications. They may find injections to be triggering due to a history of intravenous drug use, or they might have irritation around an injection site.

Long-acting injectable medications may be convenient because they don’t need to be taken every day. Because these injections last for weeks or longer, some people may have fewer medication visits. Your care team can still schedule follow-up visits based on your needs.

If you had a negative experience with injectable MAT for any reason, let your OUD specialist know. Other options, like oral medications, might be a better fit for starting over with MAT.

Safety Considerations for Restarting MAT

When recommending medications for opioid use disorder (MOUDs), your care team will make decisions that prioritize your safety, which may lead to different treatment recommendations from previous experiences with MAT. If you’re restarting MAT, it’s important to recognize the following.

Changes in Opioid Tolerance

You probably already have some idea of how tolerance works — if you take opioids regularly, eventually your body will need higher doses to experience the same effect.

During an opioid relapse, your tolerance can increase rapidly. But it can also change quickly, and a break from opioids can bring your tolerance down again. Your doctor will consider your tolerance level when prescribing MOUDs like methadone, which is an opioid.

Increased Risk of Overdose

MAT lowers the overall risk of opioid overdose, but some risks depend on the medication and where you are in treatment. For example, overdose risk can be higher when starting or adjusting methadone. People taking naltrexone may also be at greater risk if they stop treatment, miss doses, or try to overcome the medication’s opioid-blocking effects.

Your overdose risk can increase at certain points during or after treatment, including when you:

Leave an inpatient treatment program without enough support outside of the facility
Discontinue MAT and return to old patterns of opioid use
Take opioids after stopping or missing naltrexone when your opioid tolerance may be lower or try to take enough opioids to overcome naltrexone’s blocking effects

Considerations for Different Types of MAT

While all MOUDs share similar goals, they don’t all work in the same way. There are important considerations for taking each type, and your care team will manage your medications to help you take them safely. They tailor your treatment to your needs and can adjust your dose or taper your medication based on side effects or treatment progress.

Buprenorphine

Buprenorphine is a partial opioid agonist, which means it interacts with opioid receptors but causes weaker effects than full opioid agonists like heroin or methadone. When taken within a comprehensive MAT program, it can help reduce your opioid dependence, curb cravings, and prevent withdrawal symptoms.

How you start buprenorphine depends on the type of opioids you have been using and the treatment plan your provider recommends. With the traditional approach, you usually wait until withdrawal has started before taking your first dose.

In some cases, providers may use a low-dose approach that starts buprenorphine while a person is still taking other opioids. Your provider will choose a method that lowers the risk of sudden, severe withdrawal.

Some medications combine buprenorphine with naloxone in the same product. In these medications, naloxone helps discourage misuse. Your care team may also recommend a separate naloxone nasal spray or injection to keep on hand in case of an opioid overdose.

Methadone

Methadone is a full opioid agonist that blocks the effects of other opioids by attaching to opioid receptors. In doing so, it reduces cravings and can prevent withdrawal symptoms.

It’s important to follow your doctor’s instructions closely while undergoing methadone treatment for OUD, as taking too much of it can cause an overdose. Never take an extra dose if you miss a dose or if you don’t feel like it’s working.

Naltrexone

Naltrexone is a MOUD that can also be prescribed for alcohol use disorder (AUD). Unlike buprenorphine and methadone, it isn’t an opioid agonist. It’s an opioid antagonist, which means it blocks opioid receptors to reduce cravings. Because it isn’t an opioid, it won’t lead to an addiction and won’t cause withdrawal symptoms of its own when you stop using it.

You’ll have to stop taking all other opioids for seven to 14 days before starting naltrexone. Starting naltrexone too soon after your last use of opioids can trigger sudden, severe withdrawal. It’s important to recognize that taking naltrexone can lead to a very low tolerance for opioids, so a relapse with even a low opioid dose can lead to overdose.

What To Expect When Reconnecting With a Treatment Provider

When you reconnect with a treatment provider to start over with MAT, you can expect to have a detailed conversation about your opioid use and overall health. The information you give your provider will help them create a safe treatment plan for you that addresses your needs. You can expect to:

Reassess medications — Some medications may cause dangerous interactions with certain types of MOUD, so it’s important to tell your provider about all medications you take.
Review co-occurring conditions — Liver health problems and other conditions may affect MAT, so tell your provider about your medical history to the best of your knowledge.
Talk about substance use — Tell your provider about other substance use patterns, including sedative and alcohol use, so they can plan your treatment safely.
Assess your current support system — Your provider may ask about the support network you already have in place, including family, counselors, or support groups you attend.

Talk to Your Doctor

If you’ve had a return to substance use after previous treatment with MAT, talk to your doctor about starting over with MAT. Relapses are very common, and nonjudgmental support is available. Your care provider can help you establish a comprehensive recovery plan that includes behavioral therapy and other support.

Your care team may also recommend overdose prevention measures as you restart MAT. They may recommend having access to naloxone. Naloxone can be taken by itself as a nasal spray or injection.

If there are signs of an overdose, naloxone can rapidly reverse the effects of an opioid to stop the overdose. Ask your doctor about naloxone and other overdose prevention measures that might be helpful as you start MAT to support long-term recovery.

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