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OUD

CE / CME

Module 6: Opioid Use Disorder

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Optometrists: 1.00 COPE CE credit 

ABP MOC: maximum of 1.00 MOC point

ABS MOC: maximum of 1.00 Continuous Certification credit

ABOHNS MOC: maximum of 1.00 Part II Self-Assessment Credit

ABPath MOC: maximum of 1.00 Lifelong Learning point

Dental Professionals: 1.00 ADA CERP credit

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: May 31, 2023

Expiration: May 30, 2026

Timothy Atkinson
Timothy Atkinson, PharmD, BCPS, CPE
CME/CE Information

Activity

Progress
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Course Completed

Treatment Settings in OUD

There are many treatment settings for OUD.30

A certified opioid treatment program (OTP) is sometimes called a methadone clinic. These are federally regulated institutions that can provide buprenorphine and naltrexone in addition to methadone. These programs are generally a more intensive treatment setting.

A setting that has become very popular over the past 20 years is office based opioid treatment (OBOT). In this approach, medications for OUD are provided in a primary care or specialty setting, for example, a pain management clinic. This was made possible initially by the Data 2000 legislation, when the X waiver was nullified.

The Comprehensive Addiction Recovery (CARE) Act helped to expand OUD treatment in primary care by allowing advanced practice providers—nurse practitioners and physician associates—to engage in prescribing as well. Now, buprenorphine and naltrexone can be prescribed by anyone with a Drug Enforcement Administration license (pending state regulations) in a generalized OBOT program.

Active Ingredient Pharmacology/Pharmacokinetics

Buprenorphine, methadone, and naltrexone are medications that are commonly used for the treatment of OUD.30,31

Naltrexone is an opioid antagonist. Buprenorphine is a partial agonist with unique properties. Methadone is a strong opioid with properties that make it very effective for neuropathic pain. However, there is increased risk of drug interactions with methadone, due to cytochrome P450 enzymes and pharmacodynamic interactions.

When using these drugs, we must understand equivalent dosing. A buprenorphine 2 mg sublingual tablet is roughly equivalent to 30 mg of oral morphine. A 7.5-mg dose of methadone also equates to approximately 30 mg of methadone. Standard dosing of buprenorphine, however, is 16 mg and methadone is 100 mg. Therefore, we are using fairly high doses of opioids to treat OUD. The reason we use such high doses is to ensure opioid receptors are being saturated to reduce cravings and discourage other forms of abuse.

Outpatient Treatment Program

Methadone clinics are the most common outpatient treatment programs.32 This is a more intensive approach that includes mandatory psychiatric and counseling options. These programs also have case management on site, and medications are administered daily in a directly observed manner.

Patients can earn the right to take a few doses home based on their stability, but this will never progress to a monthly supply, as can be the case in an OBOT program.

Outpatient treatment programs can provide buprenorphine as well as methadone, but most often they provide methadone.

Office-Based Opioid Treatment

Office‑based opioid treatment can take place in any general or specialty care setting.33 The removal of the X waiver that governed prescriptions of buprenorphine in 2022 greatly increased the number of eligible providers that can now address OUD in their general medical setting. It also removed patient limits to prescribing

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