Last week, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a new Treatment Improvement Protocol 63 (TIP 63) on treatments for opioid use disorder (OUD). Certain parts of the TIP 63 were revised to include updates in the following areas:
- statistics from SAMHSA, the Centers for Disease Control and Prevention and other health authorities on opioid-related deaths, overdoses, accidents and hospitalizations;
- qualifications of practitioners who are eligible to apply for a waiver to prescribe buprenorphine (i.e., clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives) to include exceptions under the latest buprenorphine practice guidelines on obtaining a waiver;
- clarifications on whether references to naltrexone refer to the oral formulation or the extended-release injectable formulation;
- addition of recent citations that support induction onto extended-release naltrexone of people with positive urine tests for opioids so long as they pass the naloxone challenge;
- clarifications that naltrexone can result in decreased opioid cravings; and
- removal or replacement of broken hyperlinks to online sources.
The TIP seems designed to update changes on protocols involved in treating OUD with naltrexone, or Vivitrol.
The TIP was developed by an expert panel based on a review of the literature, and on experience in the field of addiction treatment.
“Some readers may prefer to go directly to those parts most relevant to their areas of interest, but everyone is encouraged to read Part 1 to establish a shared understanding of key facts and issues covered in detail in this TIP,” according to SAMHSA. The five main parts of the TIP are:
Part 1: Introduction to Medications for Opioid Use Disorder Treatment
Part 2: Addressing Opioid Use Disorder in General Medical Settings
Part 3: Medications for Opioid Use Disorder
Part 4: Bringing Together Addiction Treatment Counselors, Clients, and Healthcare Professionals
Part 5: Resources Related to Medications for Opioid Use Disorder
“Patients with OUD should have access to mental health services as needed, medical care, and addiction counseling, as well as recovery support services, to supplement treatment with medication,” the TIP states. “There is no ‘one size fits all’ approach to OUD treatment. Many people with OUD benefit from treatment with medication for varying lengths of time, including lifelong treatment. Ongoing outpatient medication treatment for OUD is linked to better retention and outcomes than treatment without medication. Even so, some people stop using opioids on their own; others recover through support groups or specialty treatment with or without medication.”
For the full TIP 63, which is free, go to https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-02-01-002.pdf.