Author: Charles Frank

Medication Treatment for Opioid Use Disorder in the Primary Care Setting National Institute on Drug Abuse NIDA

At every visit, ask your patients about their overall physical, mental, and emotional well-being. If relapse occurs, work with patients to determine next steps, which may include more intensive therapy. Consider the logistics of induction visits, including performing inductions during a time of the day you know you will be at the office for several hours and ensuring you will have an empty exam room for the patient to be comfortable in. “There aren’t many illnesses where you can see actual change so quickly. It is so wonderful to help somebody in this manner, and you really get to see a profound change in your patients’ lives.”

Systemwide clinician and clinical care team education and training are crucial to support practice changes that provide safer and more effective pain treatment. CDC provides free online training and resources to support clinician education on the following topics, many of which include continuing education credits. If you are a physician’s assistant (PA) and are interested in offering patients office-based medication treatment for OUD, Mr. Stuetz suggests these recommendations to get started. Dr. Kushner has 15 years of experience implementing OBOT using medication treatment for OUD. These protocols and tips have facilitated implementation in her primary care practice over the years. It also shifted administrative responsibility and oversight of the program from FDA to SAMHSA.

How to become an Accredited and Certified Opioid Treatment Program (OTP)

Learn more about the accreditation and certification of OTPs and SAMHSA’s oversight of OTP accreditation bodies. Pew compared the findings with previously conducted reviews of OTP regulations.38 In most cases, disagreement between Pew’s findings and these publications were due to differences in definition or because regulations had  been updated since those reviews were conducted. Pew reviewed both statutes and administrative codes for the District of Columbia and all states, except for  Wyoming, using Lexis. Wyoming was excluded because the state does not have any OTPs or related regulations. Although other regulations can worsen patient experience, states can also improve it through regulations.

OTP Certification

A .gov website belongs to an official government organization in the United States. During the initial consultation—provide patients with more information, determine their level of commitment to treatment, and sign a detailed treatment agreement that delineates provider and patient responsibilities. Most patients will not be ready for induction on the first day, so the initial visit is a good time to cover the bases. Letter to OTP Directors, SOTAs and State Directors on Mobile Component (PDF | 216 KB)Information regarding the authorization for Opioid Treatment Programs (OTPs) to add a “mobile component” to their existing registration.

Certification of Opioid Treatment Programs, 42 Code of Federal Regulations, Part 2 protects patient confidentiality through restrictions concerning the disclosure and use of patient records pertaining to substance use treatment. During the first 12 months of the COVID-19 pandemic, more than 70,000 people died in the U.S. from an opioid overdose. Like many parts of the country, Kentucky has experienced a devastating opioid crisis, with the second highest overdose death rate in the U.S. according to the Centers for Disease Control and Prevention. After sending multiple reminders to each official, Pew received responses from all but 12 states (Delaware, Kansas, Mississippi, Missouri, New Hampshire, New York, Rhode Island, Tennessee, Utah, Vermont, Washington, and Wisconsin).

Government ID

  1. DPT oversees the certification of OTPs and provides guidance to nonprofit organizations and state governmental entities that want to become a SAMHSA-approved accrediting body.
  2. If relapse occurs, work with patients to determine next steps, which may include more intensive therapy.
  3. A program may apply for a provisional (initial) certification as it is working towards becoming accredited by a SAMHSA-approved OTP accrediting body.
  4. With input from SAMHSA, the Federation of State Medical Boards in 2013 adopted a revised version of the federation’s office-based opioid treatment policies.
  5. The regulation created a system to certify and accredit OTPs, allowing them to administer and dispense FDA-approved medications.

If the SOTA disagreed with the research team’s findings, Pew either updated the research or explained the decision not to. In those cases where we did not update our findings, those discrepancies were either due to differences in definitions or because updated regulatory language was not in effect until after June 1, 2021,  our cutoff date. Seventeen states have rules that explicitly allow this practice, though it may still be permitted in states without these regulations. A program may apply for a provisional (initial) certification as it is working towards becoming accredited by a SAMHSA-approved OTP accrediting body. The provisional certification is a temporary certification granted to a new OTP for up to one year, during which time it must become accredited.

This is an opportunity to expand access to medications for treatment of Opioid Use Disorders (OUD), especially in remote or underserved areas. Data shows that many states make it harder for OTP patients to access and remain in treatment in a variety of ways. For more information about OTP certification and opening a treatment program, contact your states OTP Compliance Officer. After a provisionally certified program becomes accredited, it must apply to SAMHSA for full certification via the renewal application.

Medication Treatment for Opioid Use Disorder in the Primary Care Setting

In addition, opioid use disorder (OUD) patients receiving these medications also receive counseling and other behavioral therapies to provide a whole-person approach. The regulation created a system to certify and accredit OTPs, allowing them to administer and dispense FDA-approved medications. OTPs are required to provide clinically appropriate substance use disorder counseling tailored to each patient’s clinical needs, values and preferences. Counseling must be delivered by qualified program clinicians engage with patients to develop suitable care plans and continuously monitor and update patient progress.

The final rule also removes all language and rules pertaining to the Drug Addiction and Treatment Act (DATA) Waiver from the regulations pursuant to the “Consolidated Appropriations Act, 2023”. Programs have shown that treatment in an OBOT program is effective for a substantial proportion of patients (50–80%) and that patients are typically highly satisfied with the OBOT services they receive (Gunderson & Fiellin, 2008). SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. In the United States, the use medication for opioid use disorder (MOUD) in opioid treatment programs (OTPs) is governed by the Certification of Opioid Treatment Programs, 42 Code of Federal Regulations (CFR) 8.

Urine drug screenings

The guidelines also provide OTPs with information on how programs can achieve and maintain compliance with federal regulations. The 2015 guidelines are an update to the 2007 Guidelines for the Accreditation of Opioid Treatment Programs. The new document reflects the obligation of OTPs to deliver care consistent with the patient-centered, integrated, and recovery-oriented standards of substance use treatment. We also need a broader public health awareness program to reduce stigma against people with addiction and against the different pathways for treatment, such as medication treatment like methadone. For example, such a campaign could clarify that medication treatments do not create new addictions, but rather help people manage addiction so they can recover.

Official websites use .govA .gov website belongs to an official government organization in the United States. I’d also like to see a multi-agency task force on opioid addiction that includes the Drug Enforcement Administration, the Department of Justice, and national coordination with the White House because a coordinated effort could likely make a great deal more progress. The largest source of overdoses is from illicitly manufactured fentanyl—these overdoses happen because of uncertainty in the supply. The drug users do not know what they are injecting or misunderstand what they’re injecting.

Importantly, if a patient refuses to participate in counseling, this refusal does not preclude them from receiving medications for opioid use disorder (MOUD). A medication unit is a component of an OTP that is geographically separated from the OTP. Medication units can be mobile or non-mobile, and they can provide the same services as an OTP, where space allows for quality patient care. Required services not provided in medication units must be conducted at the OTP, including medical, counseling, vocational, educational, and other assessment and treatment services.