Federal Guidance/Clinical Treatment Recommendations
While NIDA’s principles provided a basic foundation for the treatment of this complex disorder, the underlying issue was how often would such principles be put into clinical practice using comprehensive treatment protocols. SAMHSA addressed this issue by applying NIDA’s principles for the treatment of this complex disorder in Treatment Improvement Protocol #43 (2005): Medication Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, Treatment Improvement Protocol #63: Medications for Opioid Use Disorder (2018) (10), and the Federal Guidelines for Opioid Treatment Programs published in March 2015.
SAMHSA’s Treatment Improvement Protocol #43 (2005) includes a discussion of whether opioid addiction is a medical disorder or a moral problem. Decades of findings support the view that OUD is a medical disorder that can be treated effectively with medications administered under conditions consistent with their pharmacological efficacy and when treatment includes comprehensive services, such as psychosocial counseling, treatment of co-occurring disorders, medical services, vocational rehabilitative services, and case management services. (11)
The National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use, published by the American Society of Addiction Medicine in 2015, further reiterates the point that treatment serves as a path to recovery in the following statement:
“Psychosocial treatment is recommended in conjunction with many pharmacological treatments of opioid use disorder. At a minimum, psychosocial treatment should include the following: psychosocial needs assessment, supportive counseling, links to existing family supports, and referrals to community services.” (12)
The Use of Buprenorphine to Treat Opioid Use Disorder
At the end of the 1990s, medication development research and clinical trials at NIDA enhanced the medication arsenal beyond methadone. The introduction of buprenorphine and other new medications led to the passage of the DATA 2000, which was signed into law by President Clinton at the end of his second administration. DATA 2000 reversed the Harrison Narcotic Act of 1914, which prohibited physicians from treating OUD, and expanded access to care and the use of schedule III, IV, and V opioids for OUD treatment. NIDA and SAMHSA invested considerable funds in research and in the training of practitioners to provide office-based opioid treatment.