Office Based opioid Maintenance Therapy

Public Policy Statement on the Regulation of Office-Based Opioid Treatment Background Office-based opioid treatment (OBOT) commonly refers to outpatient treatment services provided outside of licensed Opioid Treatment Programs (OTPs) by clinicians to patients with addiction involving opioid use, and typically includes a prescription for the partial opioid agonist buprenorphine, the provision of naltrexone, or the dispensing of methadone, in concert with other medical and psychosocial interventions to achieve and sustain remission.

OBOT permitted more physicians the opportunity to treat and bill for the treatment of opioid addiction within their regular medical practice. This provided for expanded access to treatment, potential payment mechanisms for physicians in practice as is appropriate for the treatment of chronic diseases, and a more private treatment experience for the patient with an opioid use disorder. The Comprehensive Addiction and Recovery Act (CARA) of 2016 expanded on DATA 2000 to allow nurse practitioners (NPs) and physician assistants (PAs) to become eligible for a waiver as well.

Regulatory Considerations

OBOT is a positive development in that it promotes the treatment of addiction in the primary care setting. As such it does not support the exclusive licensing of these sites but rather supports oversight from state medical boards and departments of health as superior to specific licensing.

If a state feels thus compelled, any regulatory framework should be developed from the perspective of what is best for the patient and feasible for the provider while not neglecting the safety of a household or the community at large. Thus, the development of such regulations should include perspective from all of those involved including patients, so that successful balancing can occur between feasibility of implementation and maintenance of safety in these environments. It is vital that timely access to addiction treatment occurs, and thus unnecessary and over-burdensome barriers to treatment should be avoided

It recommends:

  • States and local jurisdictions should not enact non-evidence-based oversight of OBOT, such as required mandatory medication taper schedules or limits on dosages.
  • States seeking to regulate OBOT should consult with addiction specialist physicians in designing regulations which balance treatment effectiveness with patient and public safety.
  • States that choose to regulate OBOT should study the effects of its regulations on access to treatment and diversion of buprenorphine.
  • Any licensing should be overseen by the state board of medicine and/or department of health.
  • Providers that treat 100 or fewer patients should be exempt from any additional regulatory requirements beyond what it is included in the Drug Addiction Treatment Act of 2000, as amended by the Comprehensive Addiction and Recovery Act of 2016.

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Service Recipient Says

Oxmox advised her not to do so, because there were thousands of bad Commas, wild Question Marks and devious.

Kolis Muller NY Citizen
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Oxmox advised her not to do so, because there were thousands of bad Commas, wild Question Marks and devious.

Kolis Muller NY Citizen
Client Image

Oxmox advised her not to do so, because there were thousands of bad Commas, wild Question Marks and devious.

Kolis Muller NY Citizen
Client Image