TIP 43: Opioid Treatment

By Ellen Robinson

SAMHSA recently released new guidelines on medication-assisted treatment in Opioid Treatment Programs (OTPs), which largely provide services to people addicted to heroin or prescription drugs containing opiates.

Targeted to treatment providers and administrators in OTPs, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, SAMHSA's Treatment Improvement Protocol 43 (TIP 43), provides updated information on effective treatment practices and care.

The TIP emphasizes the importance of support services such as counseling, mental health, and related medical services, as well as vocational rehabilitation. TIP 43 consolidates and updates earlier TIPs on methadone treatment for opioid dependence. The new TIP also complements TIP 40, Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction.

Currently, there are more than 1,100 OTPs operating in the United States. According to the guide, medication-assisted treatment offers a more comprehensive, individually tailored program than other types of treatment. Medication-assisted treatment includes pharmacotherapy integrated with psychosocial and medical treatment and support services.

The guide emphasizes that opioid dependence is a treatable medical disorder. To support patients in recovery, TIP 43 highlights ways to combat the effects of stigma in communities.

Representative chapters include:

Chapter 1: Introduction provides an overview of medication-assisted treatment, an update on the changing field of treatment for opioid dependence, and possibilities for the future.

Chapter 2: History of Medication-Assisted Treatment for Opioid Addiction reviews the background of opioid addiction and treatment. This chapter also includes information on new regulations affecting opioid addiction treatment.

Chapter 3: Pharmacology of Medications Used To Treat Opioid Addiction compares the types of medications used and includes detailed descriptions of the pros and cons of these medications. This chapter also outlines best practices for the use of three specific medicines—methadone, buprenorphine, and naltrexone—to treat those addicted to opioids.

Methadone is a synthetic opioid that has been successful over many years in treating addiction to opiates. Buprenorphine can be prescribed—in office-based settings—by physicians with appropriate certification. Naltrexone blocks the effects of heroin or prescription drugs containing opiates.

Chapter 4: Initial Screening, Admission Procedures, and Assessment Techniques discusses the procedures used to screen, admit, and assess patients in OTPs. This chapter also offers assessment techniques and considerations that are important to ongoing medication-assisted treatment.

Chapter 5: Clinical Pharmacotherapy explains the distinct stages of opioid pharmacotherapy and offers recommendations on induction, stabilization, appropriate dosage, and medically supervised withdrawal.

Chapter 6: Patient-Treatment Matching: Types of Services and Levels of Care offers an in-depth strategy for matching patients with types of treatment and presents ways to accommodate special populations.

Chapter 7: Phases of Treatment outlines each phase of the treatment process in detail—acute, rehabilitative, supportive care, medical maintenance, tapering, and readjustment and continuing care.

Chapter 8: Approaches to Providing Comprehensive Care and Maximizing Patient Retention looks at the use of a combination of pharmacotherapy and other services when needed—for example, psychosocial counseling and medical care—as a way to achieve maximum effectiveness in OTPs. This chapter also describes ways to increase patient retention and avoid administrative discharge and non-compliance.

Chapter 9: Drug Testing as a Tool updates earlier published information on methods for drug testing in OTPs. This chapter describes the benefits and limitations of a variety of testing methods—urine, oral-fluid, blood, sweat, and hair. Most discussion, however, focuses on urine drug testing—the most common method in OTPs.

Chapter 10: Associated Medical Problems outlines diagnosis and treatment of the medical conditions most commonly seen in patients in medication-assisted treatment. These conditions include HIV/AIDS, hepatitis C, and tuberculosis.

To obtain TIP 43, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, contact SAMHSA's National Clearinghouse for Alcohol and Drug Information at P.O. Box 2345, Rockville, MD 20847-2345. Telephone: 1 (800) 729-6686 (English), 1 (877) 767-8432 (Spanish) or 1 (800) 487-4889 (TDD). Ask for NCADI No. BKD524. Online, TIP 43 is available at www.kap.samhsa.gov/products/manuals/tips/
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