Opioid Treatment Program (OTP) Model

Opioid treatment programs (OTPs) use medication to treat patients with opioid use disorder (OUD). OTPs typically only dispense methadone, though some also offer buprenorphine and naltrexone. OTPs are the only setting within which methadone can be legally prescribed. OTPs can be established in several different settings, including intensive outpatient programs, residential programs, and hospital locations.

Generally, patients must visit an OTP daily to take medication under staff supervision onsite. However, in some cases, patients are allowed to take medication home. In addition to medication, OTPs are required to provide counseling and other behavioral care services for patients with OUD.

The Substance Abuse and Mental Health Services Administration (SAMHSA) regulates OTPs at the federal level and outlines certification requirements and standards for the accreditation process. These federal regulations require that OTPs offer both behavioral health and HIV counseling. OTPs are also subject to individual state laws and regulations.

Examples of Rural OTP Programs

• The Washington State Medication-Assisted Treatment Prescription Drug and Opioid Addiction (WA-MAT-PDOA) Program implemented OTPs to prescribe buprenorphine to patients in two rural areas in Washington. The South Sound Clinic (SSC) in Olympia and Grays Harbor Clinic (GHC) in Hoquiam also offer telehealth options to reach more patients in these rural communities.

Implementation Considerations

OTPs can be a valuable asset for expanding access to medication for opioid use disorder (MOUD) programs because only OTPs can deliver methadone. However, there is a shortage of OTPs across the United States, especially in rural areas, which is a major barrier to MOUD access in rural communities. The scarcity of OTPs, coupled with the required daily visits, can result in long travel distances and high transportation costs, making access to MOUD at an OTP especially burdensome for patients in rural areas. Communities with existing OTPs may consider expanding to a hub and spoke model to enhance services across the state. Areas with fewer OTPs may instead consider enhancing telehealth infrastructure to support access to OTPs and other MOUD services outside of the community.