OPIOID TREATMENT PROGRAMS

The Narcotic Addict Treatment Act of 1974² requires that methadone be administered to patients only through federally certified and regulated opioid treatment programs (OTPs), commonly referred to as methadone clinics. OTPs were originally created to provide methadone treatment, but today many of them also provide other medications for OUD. The Substance Abuse and Mental Health Services Administration (SAMHSA) began certifying OTPs in 2001, and between 2003 and 2015, the number of patients enrolled in methadone treatment increased by 57 percent.³ After the introduction of buprenorphine in 2002, the number of OTPs offering buprenorphine increased from 11 percent (121 OTPs) in 2003 to 58 percent (779 OTPs) in 2015. The number of OTPs that offer extended-release naltrexone also grew from 11 percent of the total (125 OTPs) in 2011 to 23 percent (315 OTPs) in 2015 (Alderks, 2017).

All OTPs must be certified by SAMHSA and registered by the Drug Enforcement Administration (DEA). Before certification, an OTP must first be evaluated in a peer-review process by a SAMHSA-approved accrediting organization, which conducts site visits and reviews the facility's policies, procedures, and practices. Even after accreditation, an OTP is not formally certified to administer methadone until SAMHSA has determined that the OTP conforms with federal regulations regarding patient admission criteria, recordkeeping guidelines, and required services, such as counseling and testing for drug use. After certification, the OTP must also apply separately for registration with the DEA, which has requirements around security, inventory, and recordkeeping. An OTP's registration from the DEA must be renewed on an annual basis (GAO, 2016). The regulations also require that most patients attend the clinic nearly every day to receive their doses of medication, which is an attempt to reduce diversion. See Chapter 5 for a detailed discussion on how some of the regulations around methadone are a barrier to treatment.

OFFICE-BASED OPIOID TREATMENT

Expanding the delivery of medications for OUD through medical office–based treatment settings has been a strategy for increasing access to medications for OUD (see Box 4-1). Currently, naltrexone can be prescribed by any physician, nurse practitioner (NP), or physician assistant (PA) within a scope of practice. In contrast, the Drug Addiction Treatment Act of 2000⁴ stipulates that buprenorphine can only be prescribed by providers with additional DEA certification, unless they are working in an OTP setting. Moreover, to qualify for a waiver from the DEA to prescribe buprenorphine, federal law requires that physicians take an 8-hour course and that NPs and PAs complete 24 hours of training. In addition, the number of patients that providers are allowed to treat is restricted. Specialist physicians are allowed to treat up to 100 patients in the first year and 275 patients thereafter, provided they have a waiver and meet additional criteria (e.g., board certification in addiction medicine or psychiatry), while NPs and PAs can treat no more than 100 patients each (SAMHSA, 2016, 2018a,b).

BOX 4-1

Office-Based Methadone Treatment.

A systematic review of studies that assessed different primary care and specialty care models for delivering medication-based treatment for OUD did not reach any strong conclusions regarding which specific delivery models led to better patient outcomes (Lagisetty et al., 2017). However, the review did note that studies in which the treatment was successful, with high treatment retention and good-quality care measures, tended to use multidisciplinary care (i.e., specialty addiction services integrated with primary care) or coordinated care (i.e., physicians supported by care management).

In the United States, medications for treating OUD are typically delivered through high-threshold, low-tolerance models that require patients to comply with a number of strict requirements, such as frequent urine testing and weekly counseling sessions, in order to receive treatment. A patient's response in the first month of treatment is often predictive of longer-term response (Weiss and Rao, 2017). For example, patients who submit drug-positive urine specimens or miss their appointments early in treatment are usually associated with poorer outcomes. However, it has been argued that these requirements can have counterproductive effects on treatment outcomes (McElrath, 2018) and that lower-threshold models, which do not place additional requirements on individuals trying to access medication-based treatment, hold promise in lowering the bar for entry into treatment (Socias et al., 2018). Individualized treatment using measurement-based care can help support patients during the early stages of treatment. This involves repeatedly measuring variables and adapting treatment in response to a patient's progress or lack thereof. While this practice is widely used throughout medicine, it is used infrequently in the treatment of SUDs, including OUD (Trivedi and Daly, 2007).

Community health centers (CHCs) can also play an important role in improving access to OUD treatment among people who are medically underserved. A survey of CHCs found that many had expanded their OUD treatment services to respond to the escalating epidemic. Almost half of all CHCs offered at least one medication for OUD, and nearly two-thirds of the CHCs providing medication-based treatment offered at least two of the three FDA-approved medications. Buprenorphine, the most commonly prescribed medication for opioid withdrawal, was available at 87 percent of CHCs that provided any medication for OUD (Zur et al., 2018). However, many CHCs face ongoing challenges related to insufficient treatment capacity—63 percent reported that they did not have the capacity to treat all of their patients with OUD, and 68 percent of centers reported shortages of referral providers (Zur et al., 2018).

ACUTE CARE SETTINGS

The number of people treated for opioid-related conditions, including opioid overdose, in emergency departments and hospitals in the United States has increased substantially in recent years. Between the third quarter of 2016 and the third quarter of 2017, the number of emergency department visits for opioid overdoses increased almost 30 percent, according to data captured through the National Syndromic Surveillance Program of the U.S. Centers for Disease Control and Prevention (CDC) (Vivolo-Kantor et al., 2018). Furthermore, people with OUD are overrepresented in the population of hospitalized patients compared with their prevalence in the general population (Peterson et al., 2018). Therefore, acute care settings provide opportunities to intervene with patients who have OUD. Even though most providers in emergency departments and hospitals are not waivered to prescribe buprenorphine, non-waivered providers are permitted to administer buprenorphine or methadone to patients under their care for other medical reasons.⁵

Various studies indicate that effective medication-based treatment for OUD can be initiated in acute care settings and that patients can be successfully transferred to outpatient medication-based treatment after hospital discharge. The emergency department visit is a chance to treat people with OUD for withdrawal symptoms with medication and to bridge those patients to longer-term medication-based treatment plans (Chamberlin et al., 2018). For example, in one recent study, buprenorphine treatment initiated in the emergency department was associated with improved short-term treatment engagement and decreased illicit opioid use (D'Onofrio et al., 2015). In a randomized trial of hospitalized patients with OUD, patients who received an intervention that included induction, stabilization, and transitioning to long-term outpatient buprenorphine treatment had improved linkage to treatment after they were discharged compared with patients who received only a 5-day buprenorphine taper (Liebschutz et al., 2014). Although initiating treatment with methadone or buprenorphine in the hospital represents an important opportunity to engage patients in longer-term care, the rates of linkage to treatment after patients are discharged have been low (Naeger et al., 2016; Rosenthal and Goradia, 2017; Trowbridge et al., 2017). In one study, only 28 percent of opioid overdose survivors seen in an emergency department or hospital were afterward linked to medication-based treatment for OUD (Larochelle et al., 2018).

OTHER CARE SETTINGS

Other care settings that could provide or enable access to medication-based treatment for OUD include residential facilities, nursing homes, outpatient facilities, supportive housing, and homeless shelters. More than 500,000 people with OUD in 2016 entered these care settings,⁶ many of which focus primarily on “cold turkey” detoxification and impose a zero-tolerance policy for opioid use of any kind—with no exception for evidence-based medications like methadone and buprenorphine. The continued popularity of treatment settings that ban or discourage medication persists despite the lack of evidence for this approach and the known potential for harmful effects (NARR, 2018). Return-to-use rates following medically supervised withdrawal (also known as “detox”) have been reported to be as high as 65 to 91 percent; this approach also carries a high risk of overdose due to a reduced tolerance for opioids if patients return to use (Broers et al., 2000; Chutuape et al., 2001). Many funding streams for these facilities are tied to the criminal justice system or housing authorities, creating strong incentives to steer patients toward non-medication-based treatment approaches (Andersen and Kallestrup, 2018).

CRIMINAL JUSTICE SETTINGS

While OUD is highly prevalent in criminal justice settings in the United States, few justice-involved individuals can access medication-based treatment while in jail or prison. In addition, justice settings rarely have systems in place to transition individuals with OUD to medication-based treatment at the time of release. More than half of the people in U.S. prisons have a diagnosis of SUD with or without co-occurring serious mental illness,⁷ with the rate of OUD in jails and prisons estimated to be around 15 percent (Baillargeon et al., 2009; James and Glaze, 2006; Peters et al., 1998). A 2007–2009 summary from the Bureau of Justice Statistics indicated that 58 percent of state prisoners and 63 percent of sentenced jail inmates met the criteria for a SUD, versus around 5 percent of the total adult population in the country (Bronson et al., 2017). However, only around 28 percent of prisoners and 22 percent of jail inmates participated in a drug treatment program (Bronson et al., 2017). Using 2014 National Treatment Episode Data Set data, Krawczyk and colleagues examined the use of methadone and buprenorphine treatment among people referred through the judicial system to specialty treatment for OUD; only 4.6 percent of justice-referred clients received either medication (Krawczyk et al., 2017). A survey of 51 prison systems across the country found great variation by state, but, overall, most corrections systems do not offer any medication to incarcerated individuals with OUD, nor do they provide referral to treatment upon release (Nunn et al., 2009). Methadone was available in about half of the systems surveyed, but around half of those facilities limited methadone treatment to pregnant women or for chronic pain management; only 14 percent of systems provided buprenorphine. Few prison systems offered all three medications as treatment options for OUD (Nunn et al., 2009).

For people with OUD involved with the criminal justice system, a lack of access to medication-based treatment leads to a greater risk of returning to use and overdose after they are released from incarceration (Chandler et al., 2016). People with a history of OUD have a demonstrably high risk of mortality following release from incarceration. One study found an all-cause mortality rate of 737 per 100,000 person-years among former prisoners, with opioids related to almost 15 percent of all deaths (Binswanger et al., 2013). In a randomized trial of participants already receiving methadone treatment at arrest, those who were forced to withdraw from methadone were less likely to resume methadone treatment after release (Rich et al., 2015). Another retrospective cohort analysis examined the implementation of a comprehensive medication-based treatment program in the Rhode Island corrections systems. Results indicated a 60.5 percent reduction in the proportion of all overdose deaths of people who had recently been incarcerated following release, relative to the proportion of overdose deaths in the period before the program was initiated (Green et al., 2018). Randomized trials have also compared the outcomes of people who initiate methadone treatment prior to release from incarceration versus those who were referred to treatment upon release. Participants who initiated treatment while incarcerated were more likely to engage in treatment after release, and they reported less illicit drug use after 6 months (McKenzie et al., 2012). A recent meta-analysis of experimental and quasi-experimental studies examining provision of medications for OUD in correctional settings found that methadone significantly improved engagement in treatment postrelease, reduced illicit use, and use by injection; however, reductions in recidivism were not consistently observed (Moore et al., 2019), likely due to state differences in probation and parole, among others. The authors noted too few experimental studies involving buprenorphine (n = 3) and naltrexone (n = 3) to perform meta-analysis of the data for these outcomes. Nevertheless, critical review of the individual studies indicated that buprenorphine and naltrexone were either superior to placebo or to methadone, or were comparable to methadone in reducing illicit use postrelease (Moore et al., 2019). Researchers at three study sites in the Studies on Medications for Addiction Treatment in Correctional Settings collaborative are pooling data from randomized effectiveness trials comparing extended-release naltrexone to methadone with enhanced treatment among people with OUD who are incarcerated; they are also looking at the benefits of a patient navigation program when added to medication (Chandler et al., 2016). Given their impact on mortality, it has been argued that withholding medications for OUD during incarceration is unethical, as would be withholding insulin or blood pressure medication (Bruce and Schleifer, 2008).

Civil commitment is not incarceration, but its alignment with the court system creates important considerations related to people with OUD and their access to medication-based treatment. The practice of civil commitment for opioid use is a legal provision that permits a judge to mandate opioid treatment (typically to an inpatient setting) for individuals whose opioid use poses a high likelihood of serious harm to self or to others, such as overdose, incapacitation, or other substantial danger (Christopher et al., 2015). A majority of U.S. states permit civil commitment for SUDs, and the use of civil commitments has been increasing in recent years (Cavaiola and Dolan, 2016). Like other criminal justice practices involving people with OUD, civil commitment procedures typically do not involve the provision of medication-based treatment, and research demonstrates high rates both of return to use and of overdose postcommitment under these practices. Postcommitment remission rates can be improved by a number of factors, including postcommitment medication-based treatment (Christopher et al., 2018).

According to one study, 56 percent of drug courts refer to treatment programs that offer at least one type of medication for OUD (Matusow et al., 2013). However, many of those programs require that medications be used only for tapering or as a bridge to completely stopping opioid use of any kind, including methadone or buprenorphine; this is not consistent with the evidence base for the most effective treatment strategy for OUD. A number of recent studies have found support for the use of injectable naltrexone in criminal justice settings. Despite the high discontinuation rates for injectable naltrexone, it may be more acceptable to judges and other correctional officials than methadone or buprenorphine (Lee et al., 2015, 2016; Lincoln et al., 2018). Notably, when all three FDA-approved medications are available, only a small number of incarcerated patients select naltrexone (Green et al., 2018).

INNOVATIVE SETTINGS FOR OUD TREATMENT

Expanding treatment to settings outside of the medical and specialty addiction sectors has the potential to increase treatment access for traditionally hard-to-reach and socially disenfranchised populations. A broader definition of treatment settings may be necessary to connect people with medications in those populations, which include people who have never previously engaged in treatment, people who inject drugs, people who have severe OUD, people who are homeless, people who have recently been released from jails or prisons, and people who have other conditions that may make it challenging to access treatment (Hall et al., 2014). Examples of innovative treatment settings include

• mobile medication units to provide medication-based treatment directly to people's homes or communities (Gordon et al., 2017; Torrens et al., 2013);
• group-based treatment to homeless individuals (Doorley et al., 2017);
• treatment within syringe exchange programs (Bachhuber et al., 2018; Fox et al., 2015; Kuo et al., 2003);
• physician–pharmacist collaborative models (DiPaula and Menachery, 2015); and
• low-threshold “transitions clinics” or methadone linkage programs for people recently released from jail or prison (Fox et al., 2014; Rich et al., 2005).

The “hub and spoke” model, which involves collaborative care provided through coordinated treatment across OTPs to office-based outpatient treatment, offers another innovative approach to improved care integration (Brooklyn and Sigmon, 2017). Although new treatment strategies are emerging for connecting hard-to-reach populations with OUD to medication-based treatment, few of these have been rigorously tested.

REFERENCES

• Alderks CE. Trends in the use of methadone, buprenorphine, and extended-release naltrexone at substance abuse treatment facilities: 2003-2015 (update). 2017. [February 12, 2019]. https://www​.samhsa.gov​/data/sites/default​/files/report_3192/ShortReport-3192​.html. [PubMed: 29200242]
• amfAR (The Foundation for AIDS Research). National opioid epidemic: Facilities providing substance abuse services. 2018. [January 15, 2019]. http://opioid​.amfar.org/indicator/SA_fac.
• Andersen KJ, Kallestrup CM. The New Republic. 2018. [June 27]. Rejected by A. A.
• ASAM (American Society of Addiction Medicine). Public policy statement on office-based opioid agonist treatment (OBOT). 2005. [February 12, 2019]. https://www​.asam.org​/advocacy/find-a-policy-statement​/view-policy-statement​/public-policy-statements​/2011/12/15/office-based-opioidagonist-treatment-(obot)
• Bachhuber MA, Thompson C, Prybylowski A, Benitez J, Mazzella S, Barclay D. Description and outcomes of a buprenorphine maintenance treatment program integrated within Prevention Point Philadelphia, an urban syringe exchange program. Substance Abuse. 2018;39(2):167–172. [PMC free article: PMC9333078] [PubMed: 29474119]
• Baillargeon J, Giordano TP, Rich JD, Wu ZH, Wells K, Pollock BH, Paar DP. Accessing antiretroviral therapy following release from prison. JAMA. 2009;301(8):848–857. [PMC free article: PMC2936238] [PubMed: 19244192]
• Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD. Public sector low threshold office-based buprenorphine treatment: Outcomes at year 7. Addiction Science & Clinical Practice. 2017;12(1):7. [PMC free article: PMC5331716] [PubMed: 28245872]
• Binswanger IA, Blatchford PJ, Mueller SR, Stern MF. Mortality after prison release: Opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009. Annals of Internal Medicine. 2013;159(9):592–600. [PMC free article: PMC5242316] [PubMed: 24189594]
• Brochu S, Guyon L, Desjardins L. Comparative profiles of addicted adult populations in rehabilitation and correctional services. Journal of Substance Abuse Treatment. 1999;16(2):173–182. [PubMed: 10023617]
• Broers B, Giner F, Dumont P, Mino A. Inpatient opiate detoxification in Geneva: Follow-up at 1 and 6 months. Drug and Alcohol Dependence. 2000;58(1-2):85–92. [PubMed: 10669058]
• Bronson J, Stroop J, Zimmer S, Berzofsky M. Drug use, dependence, and abuse among state prisoners and jail inmates, 2007-2009. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics; 2017.
• Brooklyn JR, Sigmon SC. Vermont hub-and-spoke model of care for opioid use disorder: Development, implementation, and impact. Journal of Addiction Medicine. 2017;11(4):286–292. [PMC free article: PMC5537005] [PubMed: 28379862]
• Bruce RD, Schleifer RA. Ethical and human rights imperatives to ensure medication-assisted treatment for opioid dependence in prisons and pre-trial detention. International Journal on Drug Policy. 2008;19(1):17–23. [PMC free article: PMC2366202] [PubMed: 18226517]
• Cavaiola AA, Dolan D. Considerations in civil commitment of individuals with substance use disorders. Substance Abuse. 2016;37(1):181–187. [PubMed: 25832824]
• Chamberlin M, Herring A, Luftig J, Glenn M. Treating opioid withdrawal in the ED with buprenorphine: A bridge to recovery. 2018. [January 3, 2019]. https://www​.aliem.com​/2018/05/treating-opioid-withdrawal-buprenorphine.
• Chandler RK, Finger MS, Farabee D, Schwartz RP, Condon T, Dunlap LJ, Zarkin GA, McCollister K, McDonald RD, Laska E, Bennett D, Kelly SM, Hillhouse M, Mitchell SG, O'Grady KE, Lee JD. The SOMATICS collaborative: Introduction to a National Institute on Drug Abuse cooperative study of pharmacotherapy for opioid treatment in criminal justice settings. Contemporary Clinical Trials. 2016;48:166–172. [PMC free article: PMC5454801] [PubMed: 27180088]
• Christopher PP, Pinals DA, Stayton T, Sanders K, Blumberg L. Nature and utilization of civil commitment for substance abuse in the United States. Journal of the American Academy of Psychiatry and Law. 2015;43(3):313–320. [PubMed: 26438809]
• Christopher PP, Anderson B, Stein MD. Civil commitment experiences among opioid users. Drug and Alcohol Dependence. 2018;193:137–141. [PMC free article: PMC6239959] [PubMed: 30384320]
• Chutuape MA, Jasinski DR, Fingerhood MI, Stitzer ML. One-, three-, and six-month outcomes after brief inpatient opioid detoxification. American Journal of Drug and Alcohol Abuse. 2001;27(1):19–44. [PubMed: 11373035]
• Cunningham CO, Giovanniello A, Li X, Kunins HV, Roose RJ, Sohler NL. A comparison of buprenorphine induction strategies: Patient-centered home-based inductions versus standard-of-care office-based inductions. Journal of Substance Abuse Treatment. 2011;40(4):349–356. [PMC free article: PMC3081891] [PubMed: 21310583]
• DiPaula BA, Menachery E. Physician–pharmacist collaborative care model for buprenorphine-maintained opioid-dependent patients. Journal of the American Pharmacists Association. 2015;55(2):187–192. [PubMed: 25749264]
• D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency department–initiated buprenorphine/naloxone treatment for opioid dependence: A randomized clinical trial. JAMA. 2015;313(16):1636–1644. [PMC free article: PMC4527523] [PubMed: 25919527]
• Doorley SL, Ho CJ, Echeverria E, Preston C, Ngo H, Kamal A, Cunningham CO. Buprenorphine shared medical appointments for the treatment of opioid dependence in a homeless clinic. Substance Abuse. 2017;38(1):26–30. [PMC free article: PMC5592108] [PubMed: 27897918]
• Dowding D, Randell R, Gardner P, Fitzpatrick G, Dykes P, Favela J, Hamer S, Whitewood-Moores Z, Hardiker N, Borycki E, Currie L. Dashboards for improving patient care: Review of the literature. International Journal of Medical Informatics. 2015;84(2):87–100. [PubMed: 25453274]
• Fox AD, Anderson MR, Bartlett G, Valverde J, Starrels JL, Cunningham CO. Health outcomes and retention in care following release from prison for patients of an urban post-incarceration transitions clinic. Journal of Health Care for the Poor and Underserved. 2014;25(3):1139–1152. [PMC free article: PMC4138598] [PubMed: 25130230]
• Fox AD, Chamberlain A, Frost T, Cunningham CO. Harm reduction agencies as a potential site for buprenorphine treatment. Substance Abuse. 2015;36(2):155–160. [PMC free article: PMC4706457] [PubMed: 25837290]
• GAO (U.S. Government Accountability Office). Opioid addiction: Laws, regulations, and other factors can affect medication-assisted treatment access. Washington, DC: U.S. Government Accountability Office; 2016. [February 12, 2019]. https://www​.gao.gov/assets/690/680050​.pdf.
• Gordon MS, Vocci FJ, Fitzgerald TT, O'Grady KE, O'Brien CP. Extended-release naltrexone for pre-release prisoners: A randomized trial of medical mobile treatment. Contemporary Clinical Trials. 2017;53:130–136. [PMC free article: PMC5274608] [PubMed: 28011389]
• Green TC, Clarke J, Brinkley-Rubinstein L, Marshall BDL, Alexander-Scott N, Boss R, Rich JD. Postincarceration fatal overdoses after implementing medications for addiction treatment in a statewide correctional system. JAMA Psychiatry. 2018;75(4):405–407. [PMC free article: PMC5875331] [PubMed: 29450443]
• Gunderson EW, Wang XQ, Fiellin DA, Bryan B, Levin FR. Unobserved versus observed office buprenorphine/naloxone induction: A pilot randomized clinical trial. Addictive Behaviors. 2010;35(5):537–540. [PMC free article: PMC2830372] [PubMed: 20106601]
• Hall G, Neighbors CJ, Iheoma J, Dauber S, Adams M, Culleton R, Muench F, Borys S, McDonald R, Morgenstern J. Mobile opioid agonist treatment and public funding expands treatment for disenfranchised opioid-dependent individuals. Journal of Substance Abuse Treatment. 2014;46(4):511–515. [PubMed: 24468235]
• Harris KA Jr, Arnsten JH, Joseph H, Hecht J, Marion I, Juliana P, Gourevitch MN. A 5-year evaluation of a methadone medical maintenance program. Journal of Substance Abuse Treatment. 2006;31(4):433–438. [PMC free article: PMC2692058] [PubMed: 17084798]
• Huhn AS, Dunn KE. Why aren't physicians prescribing more buprenorphine? Journal of Substance Abuse Treatment. 2017;78:1–7. [PMC free article: PMC5524453] [PubMed: 28554597]
• James DJ, Glaze LE. Mental health problems of prison and jail inmates. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics; 2006.
• Krawczyk N, Picher CE, Feder KA, Saloner B. Only one in twenty justice-referred adults in specialty treatment for opioid use receive methadone or buprenorphine. Health Affairs. 2017;36(12):2046–2053. [PMC free article: PMC6035729] [PubMed: 29200340]
• Kuo I, Brady J, Butler C, Schwartz R, Brooner R, Vlahov D, Strathdee SA. Feasibility of referring drug users from a needle exchange program into an addiction treatment program: Experience with a mobile treatment van and LAAM maintenance. Journal of Substance Abuse Treatment. 2003;24(1):67–74. [PubMed: 12646332]
• Lagisetty P, Klasa K, Bush C, Heisler M, Chopra V, Bohnert A. Primary care models for treating opioid use disorders: What actually works? A systematic review. PLOS ONE. 2017;12(10):e0186315. [PMC free article: PMC5645096] [PubMed: 29040331]
• Langan NP, Pelissier BM. Gender differences among prisoners in drug treatment. Journal of Substance Abuse. 2001;13(3):291–301. [PubMed: 11693453]
• Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, Bagley SM, Liebschutz JM, Walley AY. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study. Annals of Internal Medicine. 2018;169(3):137–145. [PMC free article: PMC6387681] [PubMed: 29913516]
• Lee JD, Grossman E, DiRocco D, Gourevitch MN. Home buprenorphine/naloxone induction in primary care. Journal of General Internal Medicine. 2009;24(2):226–232. [PMC free article: PMC2628995] [PubMed: 19089508]
• Lee JD, Friedmann PD, Boney TY, Hoskinson RA Jr, McDonald R, Gordon M, Fishman M, Chen DT, Bonnie RJ, Kinlock TW, Nunes EV, Cornish JW, O'Brien CP. Extended-release naltrexone to prevent relapse among opioid dependent, criminal justice system involved adults: Rationale and design of a randomized controlled effectiveness trial. Contemporary Clinical Trials. 2015;41:110–117. [PMC free article: PMC4380547] [PubMed: 25602580]
• Lee JD, Friedmann PD, Kinlock TW, Nunes EV, Boney TY, Hoskinson RA Jr, Wilson D, McDonald R, Rotrosen J, Gourevitch MN, Gordon M, Fishman M, Chen DT, Bonnie RJ, Cornish JW, Murphy SM, O'Brien CP. Extended-release naltrexone to prevent opioid relapse in criminal justice offenders. New England Journal of Medicine. 2016;374(13):1232–1242. [PMC free article: PMC5454800] [PubMed: 27028913]
• Liebschutz JM, Crooks D, Herman D, Anderson B, Tsui J, Meshesha LZ, Dossabhoy S, Stein M. Buprenorphine treatment for hospitalized, opioid-dependent patients: A randomized clinical trial. JAMA Internal Medicine. 2014;174(8):1369–1376. [PMC free article: PMC4811188] [PubMed: 25090173]
• Lincoln T, Johnson BD, McCarthy P, Alexander E. Extended-release naltrexone for opioid use disorder started during or following incarceration. Journal of Substance Abuse Treatment. 2018;85:97–100. [PubMed: 28479011]
• Matusow H, Dickman SL, Rich JD, Fong C, Dumont DM, Hardin C, Marlowe D, Rosenblum A. Medication assisted treatment in U.S. drug courts: Results from a nationwide survey of availability, barriers and attitudes. Journal of Substance Abuse Treatment. 2013;44(5):473–480. [PMC free article: PMC3602216] [PubMed: 23217610]
• McElrath K. Medication-assisted treatment for opioid addiction in the United States: Critique and commentary. Substance Use & Misuse. 2018;53(2):334–343. [PubMed: 28862903]
• McKenzie M, Zaller N, Dickman SL, Green TC, Parihk A, Friedmann PD, Rich JD. A randomized trial of methadone initiation prior to release from incarceration. Substance Abuse. 2012;33(1):19–29. [PMC free article: PMC3278074] [PubMed: 22263710]
• Mojtabai R, Mauro C, Wall MM, Barry CL, Olfson M. Medication treatment for opioid use disorders in substance use treatment facilities. Health Affairs. 2019;38(1):14–23. [PMC free article: PMC6816341] [PubMed: 30615514]
• Moore KE, Roberts W, Reid HH, Smith KMZ, Oberleitner LMS, McKee SA. Effectiveness of medication assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review. Journal of Substance Abuse Treatment. 2019;99:32–43. [PMC free article: PMC6391743] [PubMed: 30797392]
• Naeger S, Mutter R, Ali MM, Mark T, Hughey L. Post-discharge treatment engagement among patients with an opioid-use disorder. Journal of Substance Abuse Treatment. 2016;69:64–71. [PubMed: 27568512]
• NARR (National Alliance for Recovery Residences). MAT capable recovery residences: How state policy makers can enhance and expand capacity to adequately support medication assisted recovery. 2018. [February 28, 2019]. https://narronline​.org​/wp-content/uploads​/2018/09/NARR_MAT_guide​_for_state_agencies.pdf.
• Novick DM, Pascarelli EF, Joseph H, Salstiz EA, Richman BL, Des Jarlais DC, Anderson M, Dole VP, Nyswander ME. Methadone maintenance patients in general medical practice: A preliminary report. JAMA. 1988;259(22):3299–3302. [PubMed: 3373662]
• Nunn A, Zaller N, Dickman S, Trimbur C, Nijhawan A, Rich JD. Methadone and buprenorphine prescribing and referral practices in U.S. prison systems: Results from a nationwide survey. Drug and Alcohol Dependence. 2009;105(1-2):83–88. [PMC free article: PMC2743749] [PubMed: 19625142]
• Patterson Silver Wolf DA. The new social work. Journal of Evidence-Informed Social Work. 2018;15(6):695–706. [PubMed: 30211667]
• Peters RH, Greenbaum PE, Edens JF, Carter CR, Ortiz MM. Prevalence of DSM-IV substance abuse and dependence disorders among prison inmates. American Journal of Drug and Alcohol Abuse. 1998;24(4):573–587. [PubMed: 9849769]
• Peterson C, Xu L, Mikosz CA, Florence C, Mack KA. U.S. hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011-2015. Journal of Substance Abuse Treatment. 2018;92:35–39. [PMC free article: PMC6084454] [PubMed: 30032942]
• Ramsey A. Integration of technology-based behavioral health interventions in substance abuse and addiction services. International Journal of Mental Health and Addiction. 2015;13(4):470–480. [PMC free article: PMC4492163] [PubMed: 26161047]
• Rich JD, McKenzie M, Shield DC, Wolf FA, Key RG, Poshkus M, Clarke J. Linkage with methadone treatment upon release from incarceration: A promising opportunity. Journal of Addictive Diseases. 2005;24(3):49–59. [PubMed: 16186082]
• Rich JD, McKenzie M, Larney S, Wong JB, Tran L, Clarke J, Noska A, Reddy M, Zaller N. Methadone continuation versus forced withdrawal on incarceration in a combined U.S. prison and jail: A randomised, open-label trial. Lancet. 2015;386(9991):350–359. [PMC free article: PMC4522212] [PubMed: 26028120]
• Rosenthal RN, Goradia VV. Advances in the delivery of buprenorphine for opioid dependence. Drug Design, Development and Therapy. 2017;11:2493–2505. [PMC free article: PMC5584886] [PubMed: 28894357]
• Salsitz EA, Joseph H, Frank B, Perez J, Richman BL, Salomon N, Kalin MF, Novick DM. Methadone medical maintenance (MMM): Treating chronic opioid dependence in private medical practice—A summary report (1983-1998). Mount Sinai Journal of Medicine. 2000;67(5-6):388–397. [PubMed: 11064489]
• SAMHSA (Substance Abuse and Mental Health Services Administration). Facing addiction in America: The Surgeon General's report on alcohol, drugs, and health. Washington, DC: U.S. Department of Health and Human Services; 2016. Reports of the Surgeon General. [PubMed: 28252892]
• SAMHSA. Buprenorphine training for physicians. 2018a. [January 15, 2019]. https://www​.samhsa.gov​/medicationassisted-treatment​/training-resources​/buprenorphine-physician-training.
• SAMHSA. Qualify for nurse practitioners (NPs) and physician assistants (PAs) waiver. 2018b. [January 15, 2019]. https://www​.samhsa.gov​/programs-campaigns​/medication-assisted-treatment​/training-materials-resources​/qualify-np-pa-waivers.
• Scheuermeyer FX, Grafstein E, Buxton J, Ahamad K, Lysyshyn M, DeVlaming S, Prinsloo G, Van Veen C, Kestler A, Gustafson R. Safety of a modified community trailer to manage patients with presumed fentanyl overdose. Journal of Urban Health. 2018 [October 15]; [Epub ahead of print] [PMC free article: PMC6391297] [PubMed: 30324356]
• Schwartz RP, Kelly SM, O'Grady KE, Gandhi D, Jaffe JH. Interim methadone treatment compared to standard methadone treatment: 4-month findings. Journal of Substance Abuse Treatment. 2011;41(1):21–29. [PMC free article: PMC3110526] [PubMed: 21353445]
• Socias ME, Wood E, Kerr T, Nolan S, Hayashi K, Nosova E, Montaner J, Milloy MJ. Trends in engagement in the cascade of care for opioid use disorder, Vancouver, Canada, 2006-2016. Drug and Alcohol Dependence. 2018;189:90–95. [PMC free article: PMC6062451] [PubMed: 29894910]
• Torrens M, Fonseca F, Castillo C, Domingo-Salvany A. Methadone maintenance treatment in Spain: The success of a harm reduction approach. Bulletin of the World Health Organization. 2013;91(2):136–141. [PMC free article: PMC3605010] [PubMed: 23554526]
• Trivedi MH, Daly EJ. Measurement-based care for refractory depression: A clinical decision support model for clinical research and practice. Drug and Alcohol Dependence. 2007;88(Suppl 2):S61–S71. [PMC free article: PMC2793274] [PubMed: 17320312]
• Trowbridge P, Weinstein ZM, Kerensky T, Roy P, Regan D, Samet JH, Walley AY. Addiction consultation services—Linking hospitalized patients to outpatient addiction treatment. Journal of Substance Abuse Treatment. 2017;79:1–5. [PMC free article: PMC6035788] [PubMed: 28673521]
• Tuchman E, Drucker E. MMT & beyond—Office-based methadone prescribing. 2001. [February 12, 2019]. http://www​.methadone​.org/downloads/documents​/atf_2001_mmt_&_beyond.pdf.
• Vivolo-Kantor AM, Seth P, Gladden RM, Mattson CL, Baldwin GT, Kite-Powell A, Coletta MA. Vital signs: Trends in emergency department visits for suspected opioid overdoses—United States, July 2016–September 2017. Morbidity and Mortality Weekly Report. 2018;67(9):279–285. [PMC free article: PMC5844282] [PubMed: 29518069]
• Weintraub E, Greenblatt AD, Chang J, Himelhoch S, Welsh C. Expanding access to buprenorphine treatment in rural areas with the use of telemedicine. American Journal of Addiction. 2018;27(8):612–617. [PubMed: 30265425]
• Weiss RD, Rao V. The prescription opioid addiction treatment study: What have we learned. Drug and Alcohol Dependence. 2017;173(Suppl 1):S48–S54. [PMC free article: PMC6866670] [PubMed: 28363320]
• Zur J, Tolbert J, Sharac J, Markus A. The role of community health centers in addressing the opioid epidemic. Kaiser Family Foundation; 2018. [February 12, 2019]. https://www​.kff.org/medicaid​/issue-brief​/the-role-of-community-health-centers-in-addressing-the-opioid-epidemic.