Services

Services – Federal Law

42 CFR 8.12(f) Required Services.  Under federal law, the following are “required services” that must be provided by an Opioid Treatment Program (OTP). 

OTPs must provide adequate medical, counseling, vocational, educational, and other assessment and treatment services. Any assessments or treatments not directly provided at the facility must be assured via a formal documented agreement with the appropriate community providers.

Assessment begins during program admission and continues throughout treatment. Its purpose is to address the whole health and well-being of the patient (emphasis added). Assessment begins with a personal substance use history, physical examination, laboratory evaluation, and determination of disease morbidity.

All individuals who meet OTP admission criteria must receive a complete, fully documented physical evaluation prior to admission to the OTP. The purpose of the initial medical evaluation is to confirm the diagnosis of opioid use disorder and identify co-occurring medical and psychiatric conditions that may make medication-assisted treatment unsafe, limit its effectiveness, influence the selection of pharmacotherapy, or require prompt medical attention.

Screening should be conducted for common co-occurring conditions even if the patient has no personal history of them. Screening should establish the risk of undiagnosed conditions such as Hepatitis C, the human immunodeficiency virus (HIV), sexually transmitted infections (STIs), cardio-pulmonary disease, and sleep apnea in order to determine what further diagnostic testing such as laboratory studies, a cardiogram, and others are needed.

Initial toxicology tests are a part of the admission process. At a minimum, admission samples are tested for opioids, methadone, buprenorphine, amphetamines, cocaine, marijuana, and benzodiazepines. If there is a history of prescription opioid analgesic abuse, an expanded toxicology panel that includes these opioids should be administered.

Mental Health Disorders- An OTP identifies patients with mental health needs during the assessment process and refers them to appropriate treatment if such treatment is not available onsite.

42 CFR § 8.12(f) (5) Counseling services. Substance Abuse Counseling – Appropriately trained, experienced, and certified or licensed substance abuse counselors should provide services at the intensity and for the duration required to meet each patient’s needs as referenced in the individualized treatment plan.

Counseling for HIV, Hepatitis, and Other Infectious Diseases – OTPs should provide patients with counseling on HIV and other prevalent infectious diseases, such as hepatitis, sexually transmitted infections, and tuberculosis. Counseling also should include infectious disease prevention and risk reduction education for at-risk patients and emphasize the need for patients to adhere to treatment and communicate honestly with the provider when treatment has begun. 

OTPs must provide directly, or through referral to adequate and reasonably accessible community resources, vocational rehabilitation, education, and employment services for patients either who request such services or who have been determined by the program staff to be in need of such services.

HIV Prevention – Programs should develop and implement a plan for educating about and testing patients for HIV/AIDS. The information provided may address topics such as HIV/AIDS testing procedures, confidentiality, reporting, follow-up care, counseling, safer sex, social responsibilities, universal precautions, and sharing of drug injection equipment.

HCV Prevention – Consistent with resources, OTPs should screen and test for HCV and HBV either directly or by referral. Program staff should receive education on and teach patients how to treat and prevent the different forms of viral hepatitis, especially HCV, because it is the most common blood borne virus among persons who inject drugs. These viruses may affect patients’ health, mental health, and dosage levels of opioid medications. Messages that patients should receive regarding HCV include but are not limited to:

1. 1. HCV is four times as prevalent as HIV.
   2. You don’t have to look sick to be sick.
   3. HCV medications can be given safely with methadone and buprenorphine.
   4. Patients can be treated and often cured.

Women in Treatment – OTPs’ policies and procedures must reflect the specific needs of female patients and make provisions for the respectful and safe treatment of women. The option of single-sex group therapy based on gender identity or expression or sexual orientation should be available and each OTP’s physical space, including restrooms, should meet the needs of female patients. In addition, all staff members should be intensively trained in the characteristics and needs of the women participating in their particular program.

Family Involvement – The involvement of family members contributes to positive treatment outcomes while also providing benefits to the family members. It is useful to expand the concept of family to include the patient’s social network; significant others; persons in recovery, such as a sponsor; and resources from the community including the outpatient provider and others at the patient’s request. An OTP provides opportunities for family and significant others to become involved in therapy.

Alternative Therapies – OTPs should support patient choice in seeking alternative therapies, providing appropriate guidance in the process.

Medical (Physical Health) Services.  OTPs staff should provide care coordination, making referrals for medical and psychiatric treatment when indicated.

Substance Abuse and Mental Health Services Administration. Federal Guidelines for Opioid Treatment Programs. HHS Publication No. (SMA) PEP15-FEDGUIDEOTP (SMA). Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.  Accessed May 3, 2021 from

Substance Abuse and Mental Health Services Administration. Federal Guidelines for Opioid Treatment Programs. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.  Accessed on May 3, 2021 from Federal Guidelines for Opioid Treatment Programs (samhsa.gov).