Office-Based Opioid Treatment (OBOT) Model

In the office-based opioid treatment (OBOT) model, a primary care provider who has completed training and obtained their waiver prescribes medication for opioid use disorder (MOUD) within their own clinical setting. The OBOT model is a practice-based model that integrates MOUD into a patient's primary care setting. The primary care provider typically prescribes medication independently, although a staff person, such as a nurse or social worker, may help coordinate services. OBOTs can allow patients to take home buprenorphine and offer naltrexone onsite. Unlike opioid treatment programs (OTPs), OBOTs are not required to integrate behavioral health services into their model. However, connections to community-based mental health services are highly recommended if they are not available in-house.

Examples of Rural OBOT Programs

The Rural Access to MAT in Pennsylvania (RAMP) program aims to increase access to MOUD by educating and supporting primary care physicians in rural Pennsylvania. The program recognizes that “primary care providers can be part of the solution” when armed with the knowledge and skills needed to prevent and treat opioid use disorder (OUD).

Implementation Considerations

The availability of MOUD within the primary care setting, rather than only in OTPs or through residential or outpatient programs, can help improve access to primary care services, mental health counseling, and treatment services for people with OUD in rural areas. This is important in rural communities where residents experience barriers to healthcare access. While the number of OBOT programs has increased across the country, there remains a lack of OBOT programs in rural areas.

OBOT programs can improve access to care, especially for patients who may avoid MOUD services due to stigma. By housing MOUD services within a doctor's office or other care setting, programs can reduce the fear of stigma associated with obtaining services at a location that exclusively provides substance use disorder treatment. For example, an individual who does not want to be seen walking into an OTP may feel more comfortable accessing opioid treatment at their doctor's office.

Program Clearinghouse Examples

Resources to Learn More

Medications for Addiction Treatment: Providing Best Practice Care in a Primary Care Clinic
Document
A toolkit on providing medication for substance use disorders. Includes information regarding team roles and jobs, guidelines and policies, and treatment documents and workflows, among others.
Author(s): Bell, G.K. & Virva, S.
Organization(s): Camden Coalition of Healthcare Providers, The National Center for Complex Health & Social Needs
Date: 9/2019