This TIP, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, incorporates the many changes in medication-assisted treatment for opioid addiction (MAT) that have occurred over the most active decade of change since the inception of this treatment modality approximately 40 years ago. The TIP describes the nature and dimensions of opioid use disorders and their treatment in the United States, including basic principles of MAT and historical and regulatory developments. It presents consensus panel recommendations and evidence-based best practices for treatment of opioid addiction in opioid treatment programs (OTPs). It also examines related medical, psychiatric, sociological, and substance use disorders and their treatment as part of a comprehensive maintenance treatment program. The TIP includes a discussion of the ethical considerations that arise in most OTPs, and it provides a useful summary of areas for emphasis in successfully administering MAT in OTPs.

Contents

• Acknowledgments
• What Is a TIP?
• Consensus Panel
• Editorial Advisory Board
• Consensus Panelists
• KAP Expert Panel and Federal Government Participants
• Foreword
• Executive Summary
• Chapter 1. Introduction
  • Purpose of This TIP
  • Key Definitions
  • Audience for This TIP
  • A Decade of Change
  • Remaining Challenges
  • The Future of MAT
• Chapter 2. History of Medication-Assisted Treatment for Opioid Addiction
  • Emergence of Opioid Addiction as a Significant Problem and the Roots of Controversy
  • Origins of Opioid Maintenance Therapy
  • Regulatory History
• Chapter 3. Pharmacology of Medications Used To Treat Opioid Addiction
  • Pharmacology and Pharmacotherapy
  • Dosage Forms
  • Efficacy
  • Side Effects
  • Interactions With Other Therapeutic Medications
  • Safety
• Chapter 4. Initial Screening, Admission Procedures, and Assessment Techniques
  • Initial Screening
  • Admission Procedures and Initial Evaluation
  • Medical Assessment
  • Induction Assessment
  • Comprehensive Assessment
  • Appendix 4-A. Example of Standard Consent to Opioid Maintenance Treatment
• Chapter 5. Clinical Pharmacotherapy
  • Contraindications to Opioid Pharmacotherapy
  • Stages of Pharmacotherapy
  • Medically Supervised Withdrawal
  • Take-Home Medications
  • Office-Based Opioid Therapy
• Chapter 6. Patient-Treatment Matching: Types of Services and Levels of Care
  • Steps in Patient–Treatment Matching
  • Patients With Special Needs
  • Treatment Planning
• Chapter 7. Phases of Treatment
  • Rationale for a Phased-Treatment Approach and Duration
  • Phases of MAT
  • Transition Between Treatment Phases in MAT
  • Readmission to the OTP
• Chapter 8. Approaches to Providing Comprehensive Care and Maximizing Patient Retention
  • Core Services
  • Retaining Patients in MAT
  • Counseling and Case Management, Behavioral Treatments, and Psychotherapy
  • Benefits of Family Involvement
  • Integrative Approaches
  • Relapse Prevention
  • Referral to Social Services
  • Involuntary Discharge From MAT
  • Patient Advocacy
• Chapter 9. Drug Testing as a Tool
  • Purposes of Drug Testing in OTPs
  • Benefits and Limitations of Drug Tests
  • Drug-Testing Components and Methods
  • Development of Written Procedures
  • Other Considerations in Drug-Testing Procedures
  • Interpreting and Using Drug Test Results
  • Reliability, Validity, and Accuracy of Drug Test Results
• Chapter 10. Associated Medical Problems in Patients Who Are Opioid Addicted
  • Integrated Versus Referral Services
  • Routine Testing and Followup for Medical Problems
  • Acute, Life-Threatening Infections
  • Infectious Diseases
  • Patients With Disabilities
  • Pain Management
  • Hospitalization of Patients in MAT
  • General Medical Conditions and MAT
• Chapter 11. Treatment of Multiple Substance Use
  • Prevalence of Multiple Substance Use in MAT
  • Common Drug Combinations Used by Patients in MAT
  • Effects of Other Substance Use
  • Management of Multiple Substance Use in MAT
  • Inpatient Detoxification and Short-Term Stabilization
• Chapter 12. Treatment of Co-Occurring Disorders
  • Prevalence of Co-Occurring Disorders
  • Motivation for Treatment and Co-Occurring Disorders
  • Etiology of Co-Occurring Disorders
  • Screening for Co-Occurring Disorders
  • Making and Confirming a Psychiatric Diagnosis
  • Prognosis for Patients With Co-Occurring Disorders
  • Treatment Issues
  • Appendix 12-A. Internet Resources for Accessing Psychiatric Instruments
• Chapter 13. Medication-Assisted Treatment for Opioid Addiction During Pregnancy
  • Acceptance of Methadone Maintenance as the Standard of Care
  • Diagnosing Opioid Addiction in Pregnant Patients
  • Medical and Obstetrical Concerns and Complications
  • Methadone Dosage and Management
  • Postpartum Treatment of Mothers in MAT
  • Breast-Feeding
  • Effects on Neonatal Outcome
  • Use of Buprenorphine During Pregnancy
  • Importance of Integrated, Comprehensive Services
  • Nutrition Assessment, Counseling, and Assistance
• Chapter 14. Administrative Considerations
  • Staffing
  • Medication Diversion Control Plans
  • The Community Effort
  • OTPs and National Community Education Initiatives
  • Evaluating Program and Staff Performance
• Appendix A: Bibliography
• Appendix B: Abbreviations and Acronyms
• Appendix C: Glossary
• Appendix D: Ethical Considerations in MAT
• Appendix E: Resource Panel
• Appendix F: Field Reviewers

Suggested citation:

Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43. DHHS Publication No. (SMA) 12-4214. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005.

The opinions expressed herein are the views of the consensus panel members and do not necessarily reflect the official position of CSAT, SAMHSA, or DHHS. No official support of or endorsement by CSAT, SAMHSA, or DHHS for these opinions or for particular instruments, software, or resources described in this document is intended or should be inferred. The guidelines in this document should not be considered substitutes for individualized client care and treatment decisions.