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Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2018. (Treatment Improvement Protocol (TIP) Series, No. 63.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Medications for Opioid Use Disorder

Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families [Internet].

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Executive Summary

The Executive Summary of this Treatment Improvement Protocol provides an overview on the use of the three Food and Drug Administration-approved medications used to treat opioid use disorder—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support recovery.

Foreword

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the U.S. Department of Health and Human Services agency that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

The Treatment Improvement Protocol (TIP) series fulfills SAMHSA's mission by providing science-based best-practice guidance to the behavioral health field. TIPs reflect careful consideration of all relevant clinical and health service research, demonstrated experience, and implementation requirements. Select nonfederal clinical researchers, service providers, program administrators, and patient advocates comprising each TIP's consensus panel discuss these factors, offering input on the TIP's specific topic in their areas of expertise to reach consensus on best practices. Field reviewers then assess draft content.

The talent, dedication, and hard work that TIP panelists and reviewers bring to this highly participatory process have helped bridge the gap between the promise of research and the needs of practicing clinicians and administrators to serve, in the most scientifically sound and effective ways, people in need of behavioral health services. We are grateful to all who have joined with us to contribute to advances in the behavioral health field.

Elinore F. McCance-Katz, M.D., Ph.D.
Assistant Secretary for Mental Health and Substance Use, SAMHSA

Executive Summary

The goal of treatment for opioid addiction or opioid use disorder (OUD) is remission of the disorder leading to lasting recovery. Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.1 This Treatment Improvement Protocol (TIP) reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat OUD—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support recovery for people with OUD.

Introduction

Our nation faces a crisis of overdose deaths from opioids, including heroin, illicit fentanyl, and prescription opioids. These deaths represent a mere fraction of the total number of Americans harmed by opioid misuse and addiction. Many Americans now suffer daily from a chronic medical illness called “opioid addiction” or OUD (see the Glossary in Part 5 of this TIP for definitions). Healthcare professionals, treatment providers, and policymakers have a responsibility to expand access to evidence-based, effective care for people with OUD.

Estimated cost of the OPIOID EPIDEMIC was $504 BILLION in 2015.2

An expert panel developed the TIP's content based on a review of the literature and on their extensive experience in the field of addiction treatment. Other professionals also generously contributed their time and commitment to this project.

An estimated 1.8M AMERICANS have OUD related to opioid painkillers; 626K have heroin-related OUD.3

The TIP is divided into parts so that readers can easily find the material they need. Part 1 is a general introduction to providing medications for OUD and issues related to providing that treatment. Some readers may prefer to go directly to those parts most relevant to their areas of interest, but everyone is encouraged to read Part 1 to establish a shared understanding of key facts and issues covered in detail in this TIP.

Following is a summary of the TIP's overall main points and brief summaries of each of the five TIP parts.

Overall Key Messages

Addiction is a chronic, treatable illness. Opioid addiction, which generally corresponds with moderate to severe forms of OUD, often requires continuing care for effective treatment rather than an episodic, acute-care treatment approach.

Opioid overdose caused 42,249 DEATHS nationwide in 2016—this exceeded the # caused by motor vehicle crashes.4,5

General principles of good care for chronic diseases can guide OUD treatment. Approaching OUD as a chronic illness can help providers deliver care that helps patients stabilize, achieve remission of symptoms, and establish and maintain recovery.

Patient-centered care empowers patients with information that helps them make better treatment decisions with the healthcare professionals involved in their care. Patients should receive information from their healthcare team that will help them understand OUD and the options for treating it, including treatment with FDA-approved medication.

Patients with OUD should have access to mental health services as needed, medical care, and addiction counseling, as well as recovery support services, to supplement treatment with medication.

The words you use to describe OUD and an individual with OUD are powerful. The TIP defines, uses, and encourages providers to adopt terminology that will not reinforce prejudice, negative attitudes, or discrimination.

There is no “one size fits all” approach to OUD treatment. Many people with OUD benefit from treatment with medication for varying lengths of time, including lifelong treatment. Ongoing outpatient medication treatment for OUD is linked to better retention and outcomes than treatment without medication. Even so, some people stop using opioids on their own; others recover through support groups or specialty treatment with or without medication.

The science demonstrating the effectiveness of medication for OUD is strong. For example, methadone, extended-release injectable naltrexone (XR-NTX), and buprenorphine were each found to be more effective in reducing illicit opioid use than no medication in randomized clinical trials, which are the gold standard for demonstrating efficacy in clinical medicine.6,7,8,9,10 Methadone and buprenorphine treatment have also been associated with reduced risk of overdose death.11,12,13,14,15

This doesn't mean that remission and recovery occur only through medication. Some people achieve remission without OUD medication, just as some people can manage type 2 diabetes with exercise and diet alone. But just as it is inadvisable to deny people with diabetes the medication they need to help manage their illness, it is also not sound medical practice to deny people with OUD access to FDA-approved medications for their illness.

Medication for OUD should be successfully integrated with outpatient and residential treatment. Some patients may benefit from different levels of care at different points in their lives, such as outpatient counseling, intensive outpatient treatment, inpatient treatment, or long-term therapeutic communities. Patients treated in these settings should have access to OUD medications.

2.1 MILLION people in the U.S., ages 12 and older, had OUD involving PRESCRIPTION OPIOIDS, HEROIN, or both in 2016.16

Patients treated with medications for OUD can benefit from individualized psychosocial supports. These can be offered by patients’ healthcare providers in the form of medication management and supportive counseling and/or by other providers offering adjunctive addiction counseling, recovery coaching, mental health services, and other services that may be needed by particular patients.

Expanding access to OUD medications is an important public health strategy.17 The gap between the number of people needing opioid addiction treatment and the capacity to treat them with OUD medication is substantial. In 2012, the gap was estimated at nearly 1 million people, with about 80 percent of opioid treatment programs (OTPs) nationally operating at 80 percent capacity or greater.18

Improving access to treatment with OUD medications is crucial to closing the wide gap between treatment need and treatment availability, given the strong evidence of effectiveness for such treatments.19

Data indicate that medications for OUD are cost effective and cost beneficial.20,21

Content Overview

The TIP is divided into parts to make the material more accessible according to the reader's interests.

Part 1: Introduction to Medications for Opioid Use Disorder Treatment

This part lays the groundwork for understanding treatment concepts discussed later in this TIP. The intended audience includes:

Healthcare professionals (physicians, nurse practitioners, physician assistants, and nurses).

Professionals who offer addiction counseling or mental health services.

Peer support specialists.

People needing treatment and their families.

People in remission or recovery and their families.

Hospital administrators.

Policymakers.

OPIOID-RELATED EMERGENCY DEPARTMENT visits nearly doubled from 2005–2014.22

In Part 1, readers will learn that:

Increasing opioid overdose deaths, illicit opioid use, and prescription opioid misuse constitute a public health crisis.

OUD medications reduce illicit opioid use, retain people in treatment, and reduce risk of opioid overdose death better than treatment with placebo or no medication.

Only physicians, nurse practitioners, and physician assistants can prescribe buprenorphine for OUD. They must get a federal waiver to do so.

Only federally certified, accredited OTPs can dispense methadone to treat OUD. OTPs can administer and dispense buprenorphine without a federal waiver.

Any prescriber can offer naltrexone.

OUD medication can be taken on a short- or long-term basis, including as part of medically supervised withdrawal and as maintenance treatment.

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

Several barriers contribute to the underuse of medication for OUD.

Part 2: Addressing Opioid Use Disorder in General Medical Settings

This part offers guidance on OUD screening, assessment, treatment, and referral. Part 2 is for healthcare professionals working in general medical settings with patients who have or are at risk for OUD.

OPIOID ADDICTION is linked with significant MORBIDITY and MORTALITY related to HIV and hepatitis C.23

In Part 2, readers will learn that:

All healthcare practices should screen for alcohol, tobacco, and other substance misuse (including opioid misuse).

Validated screening tools, symptom surveys, and other resources are readily available; this part lists many of them.

When patients screen positive for risk of harm from substance use, practitioners should assess them using tools that determine whether substance use meets diagnostic criteria for a substance use disorder (SUD).

Thorough assessment should address patients’ medical, social, SUD, and family histories.

Laboratory tests can inform treatment planning.

Practitioners should develop treatment plans or referral strategies (if onsite SUD treatment is unavailable) for patients who need SUD treatment.

Part 3: Pharmacotherapy for Opioid Use Disorder

This part offers information and tools for healthcare professionals who prescribe, administer, or dispense OUD medications or treat other illnesses in patients who take these medications. It provides guidance on the use of buprenorphine, methadone, and naltrexone by healthcare professionals in:

General medical settings, including hospitals.

Office-based opioid treatment settings.

Specialty addiction treatment programs, including OTPs.

In Part 3, readers will learn that:

OUD medications are safe and effective when used appropriately.

OUD medications can help patients reduce or stop illicit opioid use and improve their health and functioning.

Pharmacotherapy should be considered for all patients with OUD. Opioid pharmacotherapies should be reserved for those with moderate-to-severe OUD with physical dependence.

Patients with OUD should be informed of the risks and benefits of pharmacotherapy, treatment without medication, and no treatment.

Patients should be advised on where and how to get treatment with OUD medication.

Doses and schedules of pharmacotherapy must be individualized.

OPIOID-RELATED inpatient hospital stays INCREASED 64% nationally from 2005–2014.24

Part 4: Partnering Addiction Treatment Counselors With Clients and Healthcare Professionals

This part recommends ways that addiction treatment counselors can collaborate with healthcare professionals to support client-centered, trauma-informed OUD treatment and recovery. It also serves as a quick guide to medications that can treat OUD and presents strategies for clear communication with prescribers, creation of supportive environments for clients who take OUD medication, and ways to address other common counseling concerns when working with this population.

In Part 4, readers will learn that:

Many patients taking OUD medication benefit from counseling as part of treatment.

Counselors play the same role for clients with OUD who take medication as for clients with any other SUD.

Counselors help clients recover by addressing the challenges and consequences of addiction.

OUD is often a chronic illness requiring ongoing communication among patients and providers to ensure that patients fully benefit from both pharmacotherapy and psychosocial treatment and support.

OUD medications are safe and effective when prescribed and taken appropriately.

Medication is integral to recovery for many people with OUD. Medication usually produces better treatment outcomes than outpatient treatment without medication.

Supportive counseling environments for clients who take OUD medication can promote treatment and help build recovery capital.

OPIOID ADDICTION is linked with high rates of ILLEGAL ACTIVITY and INCARCERATION.25,26

Part 5: Resources Related to Medications for Opioid Use Disorder

This part has a glossary and audience-segmented resource lists to help medical and behavioral health service providers better understand how to use OUD medications with their patients and to help patients better understand how OUD medications work. It is for all interested readers.

In Part 5, readers will learn that:

Practice guidelines and decision-making tools can help healthcare professionals with OUD screening, assessment, diagnosis, treatment planning, and referral.

Patient- and family-oriented resources provide information about opioid addiction in general; the role of medication, behavioral and supportive services, and mutual-help groups in the treatment of OUD; how-tos for identifying recovery support services; and how-tos for locating medical and behavioral health service providers who specialize in treating OUD or other SUDs.

Notes

1.
Substance Abuse and Mental Health Services Administration. (2017). Recovery and recovery support [Webpage]. Retrieved November 17, 2017, from www​.samhsa.gov/recovery
2.
Council of Economic Advisers. (2017, November). The underestimated cost of the opioid crisis. Washington, DC: Executive Office of the President of the United States.
3.
Center for Behavioral Health Statistics and Quality. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration.
4.
Centers for Disease Control and Prevention. (2017). Drug overdose death data [Webpage]. Retreived January 9, 2018, from www​.cdc.gov/drugoverdose​/data/statedeaths.html
5.
National Safety Council. (2017). NSC motor vehicle fatality estimates. Retrieved October 31, 2017, from www​.nsc.org/NewsDocuments​/2017/12-month-estimates.pdf
6.
Johnson, R. E., Chutuape, M. A., Strain, E. C., Walsh, S. L., Stitzer, M. L., & Bigelow, G. E. (2000). A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. New England Journal of Medicine, 343(18), 1290–1297. [PubMed: 11058673]
7.
Krupitsky, E., Nunes, E. V., Ling, W., Illeperuma, A., Gastfriend, D. R., & Silverman, B. L. (2011, April 30). Injectable extended-release naltrexone for opioid dependence: A double-blind, placebo-controlled, multicentre randomised trial. Lancet, 377(9776), 1506–1513. [PubMed: 21529928]
8.
Lee, J. D., Friedmann, P. D., Kinlock, T. W., Nunes, E. V., Boney, T. Y., Hoskinson, R. A., Jr., … O'Brien, C. P. (2016). Extended-release naltrexone to prevent opioid relapse in criminal justice offenders. New England Journal of Medicine, 374(13), 1232–1242. [PMC free article: PMC5454800] [PubMed: 27028913]
9.
Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews, 2009(3), 1–19. [PMC free article: PMC7097731] [PubMed: 19588333]
10.
Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, 2014(2), 1–84. [PMC free article: PMC10617756] [PubMed: 24500948]
11.
Auriacombe, M., Fatséas, M., Dubernet, J., Daulouède, J. P., & Tignol, J. (2004). French field experience with buprenorphine. American Journal on Addictions, 13(Suppl. 1), S17–S28. [PubMed: 15204673]
12.
Degenhardt, L., Randall, D., Hall, W., Law, M., Butler, T., & Burns, L. (2009). Mortality among clients of a state-wide opioid pharmacotherapy program over 20 years: Risk factors and lives saved. Drug and Alcohol Dependence, 105(1–2), 9–15. [PubMed: 19608355]
13.
Gibson, A., Degenhardt, L., Mattick, R. P., Ali, R., White, J., & O'Brien, S. (2008). Exposure to opioid maintenance treatment reduces long-term mortality. Addiction, 103(3), 462–468. [PubMed: 18190664]
14.
Schwartz, R. P., Gryczynski, J., O'Grady, K. E., Sharfstein, J. M., Warren, G., Olsen, Y., … Jaffe, J. H. (2013). Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995–2009. American Journal of Public Health, 103(5), 917–922. [PMC free article: PMC3670653] [PubMed: 23488511]
15.
World Health Organization. (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva, Switzerland: WHO Press. [PubMed: 23762965]
16.
Center for Behavioral Health Statistics and Quality. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration.
17.
Department of Health and Human Services, Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General's report on alcohol, drugs, and health. Washington, DC: Department of Health and Human Services.
18.
Jones, C. M., Campopiano, M., Baldwin, G., & McCance-Katz, E. (2015). National and state treatment need and capacity for opioid agonist medication-assisted treatment. American Journal of Public Health, 105(8), e55–e63. [PMC free article: PMC4504312] [PubMed: 26066931]
19.
Jones, C. M., Campopiano, M., Baldwin, G., & McCance-Katz, E. (2015). National and state treatment need and capacity for opioid agonist medication-assisted treatment. American Journal of Public Health, 105(8), e55–e63. [PMC free article: PMC4504312] [PubMed: 26066931]
20.
Cartwright, W. S. (2000). Cost-benefit analysis of drug treatment services: Review of the literature. Journal of Mental Health Policy and Economics, 3(1), 11–26. [PubMed: 11967433]
21.
McCollister, K. E., & French, M. T. (2003). The relative contribution of outcome domains in the total economic benefit of addiction interventions: A review of first findings. Addiction, 98(12), 1647–1659. [PubMed: 14651494]
22.
Weiss, A. J., Elixhauser, A., Barrett, M. L., Steiner, C. A., Bailey, M. K., & O'Malley, L. (2017, January). Opioid-related inpatient stays and emergency department visits by state, 2009–2014. HCUP Statistical Brief No. 219. Rockville, MD: Agency for Healthcare Research and Quality.
23.
Wang, X., Zhang, T., & Ho, W. Z. (2011). Opioids and HIV/HCV infection. Journal of Neuroimmune Pharmacology, 6(4), 477–489. [PMC free article: PMC3937260] [PubMed: 21755286]
24.
Weiss, A. J., Elixhauser, A., Barrett, M. L., Steiner, C. A., Bailey, M. K., & O'Malley, L. (2017, January). Opioid-related inpatient stays and emergency department visits by state, 2009–2014. HCUP Statistical Brief No. 219. Rockville, MD: Agency for Healthcare Research and Quality.
25.
World Health Organization. (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva, Switzerland: WHO Press. [PubMed: 23762965]
26.
Soyka, M., Träder, A., Klotsche, J., Haberthür, A., Bühringer, G., Rehm, J., & Wittchen, H. U. (2012). Criminal behavior in opioid-dependent patients before and during maintenance therapy: 6-year follow-up of a nationally representative cohort sample. Journal of Forensic Sciences, 57(6), 1524–1530. [PubMed: 22845057]

TIP Development Participants

Expert Panelists

Each Treatment Improvement Protocol's (TIP's) expert panel is a group of primarily nonfederal addiction-focused clinical, research, administrative, and recovery support experts with deep knowledge of the TIP's topic. With the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Knowledge Application Program (KAP) team, they develop each TIP via a consensus-driven, collaborative process that blends evidence-based, best, and promising practices with the panel's expertise and combined wealth of experience.

TIP Chair

Robert P. Schwartz, M.D.—TIP Chair
Medical Director/Senior Research Scientist, Friends Research Institute, Baltimore, MD

TIP Expert Panelists

Sarah Church, Ph.D.
Executive Director, Montefiore Medical Center, Wellness Center at Waters Place, Bronx, NY
Diana Coffa, M.D., FM
Associate Professor, University of California School of Medicine, Family Community Medicine, San Francisco, CA
Zwaantje Hamming, M.S.N., FNP-C, CARN-AP
La Familia Medical Center, Santa Fe, NM
Ron Jackson, M.S.W., LICSW
Affiliate Professor, University of Washington School of Social Work, Seattle, WA
Hendree Jones, Ph.D.
Professor and Executive Director, Horizons Program, Chapel Hill, NC
Michelle Lofwall, M.D., DFASAM
Medical Director, University of Kentucky College of Medicine—Straus Clinic, Associate Professor of Behavioral Science and Psychiatry, Faculty in UK Center on Drug and Alcohol Research, Lexington, KY
Shannon C. Miller, M.D., DFASAM, DFAPA (ad hoc panelist)
Director, Addiction Services, Veterans Affairs Medical Center, Cincinnati, OH
Charles Schauberger, M.D.
Obstetrician-Gynecologist, Gundersen Health System, La Crosse, WI
Joycelyn Woods, M.A., CMA
Executive Director, National Alliance for Medication Assisted Recovery, New York, NY

SAMHSA's TIP Champion

Melinda Campopiano von Klimo, M.D.
Senior Medical Advisor, Center for Substance Abuse Treatment, SAMHSA, Rockville, MD

Scientific Reviewers

This TIP's scientific reviewers are among the foremost experts on the three medications discussed in this TIP to treat opioid use disorder. Their role in the collaborative TIP development process was to help the KAP team include current, accurate, and comprehensive information and instructions about the use of each of these medications.

Buprenorphine

David A. Fiellin, M.D.
Professor of Investigative Medicine and Public Health, Yale University School of Medicine, New Haven, CT

Naltrexone

Joshua D. Lee, M.D., M.Sc.
Associate Professor, Department of Population Health, Division of General Medicine and Clinical Innovation, NYU Langone Health, New York, NY

Methadone

Andrew J. Saxon, M.D.
Professor, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Director, Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, WA

Field Reviewers

Field reviewers represent each TIP's intended target audiences. They work in addiction, mental health, primary care, and adjacent fields. Their direct front-line experience related to the TIP's topic allows them to provide valuable input on a TIP's relevance, utility, accuracy, and accessibility.

William Bograkos, M.A., D.O., FACOEP, FACOFP
Adjunct Professor, Center for Excellence in the Neurosciences, University of New England (UNE), Clinical Professor of Medical Military Science, Family Practice and Emergency Medicine, UNE, Biddeford, ME
Meg Brunner, M.L.I.S.
Librarian, Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA
Kathryn Cates-Wessell
Chief Executive Officer, American Academy of Addiction Psychiatry, East Providence, RI
Mary Catlin, BSN, MPH, CIC
Public Health Nurse, Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA
Kelly J. Clark, M.D., M.B.A., DFASAM
President, American Society of Addiction Medicine, Rockville, MD
Marc Fishman, M.D.
Assistant Professor, Johns Hopkins University School of Medicine, Psychiatry/Behavioral Sciences Expert Team, Baltimore, MD
Katherine Fornili, D.N.P., M.P.H., RN, CARN
Assistant Professor, University of Maryland School of Nursing, Baltimore, MD
Adam Gordon, M.D., M.P.H., FACP, FASAM, CMRO
Associate Professor of Medicine and Advisory Dean, University of Pittsburgh School of Medicine, Pittsburgh, PA
Ellie Grossman, M.D.
Instructor in Medicine, Cambridge Health Alliance, Somerville Hospital Primary Care, Somerville, MA
Kyle Kampman, M.D.
Professor, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Center for Studies of Addiction, Philadelphia, PA
Janice Kauffman, M.P.H., RN, CAS, CADC-1
Vice President of Addiction Treatment Services, North Charles Foundation, Inc., Director of Addictions Consultation, Department of Psychiatry, Cambridge Health Alliance, Assistant Professor of Psychiatry, Harvard Medical School, the Cambridge Hospital, Cambridge, MA
Jason Kletter, Ph.D.
President, Bay Area Addiction Research and Treatment, President, California Opioid Maintenance Providers, San Francisco, CA
William J. Lorman, J.D., Ph.D., MSN, PMHNP-BC, CARN-AP
Vice President and Chief Clinical Officer, Livengrin Foundation, Inc., Bensalem, PA
Megan Marx-Varela, M.P.A.
Associate Director, The Joint Commission—Behavioral Health Care Accreditation, Oakbrook Terrace, IL
Alison Newman, MPH
Continuing Education Specialist, Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA
David O'Gurek, M.D., FAAFP
Assistant Professor, Family and Community Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
Yngvild Olsen, M.D., M.P.H, FASAM
Medical Director, Institutes for Behavior Resources, Inc./Recovery Enhanced by Access to Comprehensive Healthcare (REACH) Health Services, Baltimore, MD
Shawn A. Ryan, M.D., M.B.A., ABEM, FASAM
President & Chief Medical Officer, BrightView, Cincinnati, OH
Paul Stasiewicz, Ph.D.
Senior Research Scientist, Research Institute on Addictions, State University of New York-Buffalo, Buffalo, NY
Kenneth Stoller, M.D.
Director, Broadway Center for Addiction at the Johns Hopkins Hospital, Assistant Professor of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
Mishka Terplan, M.D., M.P.H., FACOG
Professor, Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA
Christopher Welsh, M.D.
Associate Professor of Psychiatry, University of Maryland Medical Center, Baltimore, MD
George E. Woody, M.D.
Professor of Psychiatry, Department of Psychiatry Center for Studies of Addiction, University of Pennsylvania's Perelman School of Medicine, Philadelphia, PA

Publication Information

Acknowledgments

This publication was prepared under contract number 270-14-0445 by the Knowledge Application Program (KAP) for the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Suzanne Wise served as the Contracting Officer's Representative, and Candi Byrne served as KAP Project Coordinator.

Disclaimer

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

Public Domain Notice

All materials appearing in this publication except those taken directly from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be ordered or downloaded from SAMHSA's Publications Ordering webpage at https://store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

Recommended Citation

Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Full Document. HHS Publication No. (SMA) 19-5063FULLDOC. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.

Originating Office

Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857.

Nondiscrimination Notice

SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad, o sexo.

HHS Publication No. (SMA) 19-5063FULLDOC

First released 2018. Revised 2019.

Copyright Notice

This is an open-access report distributed under the terms of the Creative Commons Public Domain License. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.

Bookshelf ID: NBK535275

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