ASAM Provider Guide

4 Treatment Treatment Setting Î The choice of available treatment options for addiction involving opioid use should be a shared decision between clinician and patient. Î Clinicians should consider the patient's preferences, past treatment history, and treatment setting when deciding between the use of methadone, buprenorphine, and naltrexone in the treatment of addiction involving opioid use. • The treatment setting described as Level 1 treatment in the ASAM Criteria may be a general outpatient location such as a clinician's practice site. • The setting as described as Level 2 in the ASAM Criteria may be an intensive outpatient treatment or partial hospitalization program housed in a specialty addiction treatment facility, a community mental health center, or another setting. • The ASAM Criteria describes Level 3 or Level 4 treatment respectively as a residential addiction treatment facility or hospital. Î The venue in which treatment is provided is as important as the specific medication selected. • Opioid Treatment Programs offer daily supervised dosing of methadone, and increasingly of buprenorphine. • Naltrexone can be prescribed in any setting by any clinician with the authority to prescribe any medication. • In accordance with federal law (21 CFR §1306.07), Office-Based Opioid Treatment (OBOT), which provides medication on a prescribed weekly or monthly basis, is limited to buprenorphine. • Clinicians should consider a patient's psychosocial situation, co-occurring disorders, and risk of diversion when determining whether Opioid Treatment Programs (OTP) or OBOT is most appropriate. Î OBOT may not be suitable for patients with active alcohol use disorder or sedative, hypnotic, or anxiolytic use disorder (or who are in the treatment of addiction involving the use of alcohol or other sedative drugs, including benzodiazepines or benzodiazepine receptor agonists). It may also be unsuitable for persons who are regularly using alcohol or other sedatives but do not have addiction or a specific substance use disorder related to that class of drugs. • The prescribing of benzodiazepines or other sedative-hypnotics should be used with extreme caution in patients who are prescribed methadone or buprenorphine for the treatment of an OUD. Î Methadone is recommended for patients who may benefit from daily dosing and supervision in an OTP, or for patients for whom buprenorphine for the treatment of OUD has been used unsuccessfully in an OTP or OBOT setting.

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