Medication-Assisted Treatment for Opioid Use Disorder Playbook

The AHRQ Academy developed the Medication-Assisted Treatment for Opioid Use Disorder Playbook (referred to as the MAT for OUD Playbook), a practical guide for implementing MAT in primary care and other ambulatory care settings. While the Playbook aims to help providers in rural primary care, the information in the Playbook should apply to other ambulatory care settings. This interactive, web-based product has the latest guidance, tools, and resources that address key aspects of implementation.

The MAT for OUD Playbook aims to address the growing need for guidance as more primary care practices and health systems begin to implement MAT. The Playbook’s framework is designed to be useful for practices implementing any array of MAT services.

You can work through the steps of the Playbook sequentially or customize your approach based on your setting’s Self-Assessment Checklist for Medication-Assisted Treatment for Opioid Use Disorder results. At each step of implementation, the Playbook provides tips, resources, and examples for implementing MAT in your setting. The Playbook will help you find your own path for implementation by applying knowledge about successful approaches and avoiding possible barriers. You can also access the 6 Tips from the MAT for OUD Playbook (PDF - 0.15 MB) infographic for an abbreviated list of things to avoid when implementing MAT for OUD services in primary care.

• Use the left navigation panel to access a particular section or select “Up Next” at the bottom of the Playbook pages to move through page by page.
• Tour the Playbook to orient yourself to the Playbook’s layout and features.

The process of implementation entails working toward a North Star of a seamlessly integrated MAT program and ambulatory care setting. As a user of the Playbook, we encourage you to revisit the implementation processes as often as needed to refine MAT in your setting.

This Playbook is intended for practices working to implement medication-assisted treatment (MAT) for opioid use disorder in primary care settings. While it is intended for primary care practices, it also can be used in other ambulatory care settings. The Playbook’s framework is designed to be useful for practices implementing any array of services along the MAT continuum. Individual providers or care team members, as well as larger health systems or organizations, should all be able to use the information, tools, and resources in the Playbook.

The use of medications as a major component of opioid use disorder treatment is growing rapidly in response to the opioid epidemic and as treatment expands beyond specialty substance use treatment settings. The preferred terminology has shifted over time and may continue to evolve after the publication of this Playbook.

The authors of this Playbook chose to continue to use the term MAT within this Playbook. MAT is the term that is familiar among various stakeholders, including legislators, medical school programs, addiction treatment programs, people with opioid use disorder, and others.

For the purposes of this Playbook, the authors opted to avoid terms that may reinforce stigma and instead use neutral terms with clinical utility. The Playbook does not use common but potentially stigmatizing terms, such as “clean” or “dirty” urines, “addict,” “substance abuse,” or “relapse.”

Providing MAT for opioid use disorder in primary care, which is the focus of this Playbook, represents a special case of integrating behavioral health care in primary care settings. Medical and behavioral health providers may be working closely together for the first time.

It is important to understand that medical clinicians use different language and may have different perspectives than behavioral health providers when they discuss substance use disorders, treatment, and recovery. Further, patients with substance use disorders and their families may also use and expect other terms that some clinicians do not use. All providers should recognize and appreciate these differences while working to develop shared language that can help build common understanding.

At its core, MAT is a biopsychosocial approach to opioid use disorder treatment that can include an array of services based on a patient’s needs and preferences, similar to managing any chronic relapsing disease such as diabetes, hypertension, or asthma.

MAT can be thought of as a continuum of care. On one end is a harm reduction approach that seeks to get patients fast access to medication and minimize morbidity and mortality associated with opioid use. On the other end are programs that offer comprehensive, integrated services that address many physical, psychological, and social aspects of addiction.

Holistic, comprehensive care that addresses the needs of the individual patient should always be the ultimate goal of treatment; however, practices may face resource constraints that limit the range of services they can provide. Some practices may need to connect patients with external behavioral health providers and other community resources to complement what they can offer within the practice setting.

It is also important to recognize that patients will vary widely in the types and intensity of supports they need and that those needs will change over the course of treatment and recovery. While patients with opioid use disorder may have complex medical, psychological, or social needs (such as co-occurring behavioral health disorders, infectious diseases, or chronic pain and increased risk for suicidality), others may recover with little more than medication management.

As a practical matter, clinicians and practices will vary in what is feasible for them to offer. Programs often need to decide which services they have the capacity to provide internally and which services will require collaboration with external providers. We encourage practices to offer what they can, even if they cannot readily provide all components of MAT or do not want develop a dedicated, comprehensive MAT for opioid use disorder program.

Generally, the Playbook takes a comprehensive approach to address all aspects of implementing MAT for opioid use disorder in primary or other ambulatory care settings. However, the structure allows users to select only those parts they are currently interested in, whether that is for the solo provider just starting to prescribe buprenorphine or the large practice looking to build capacity and proficiencies.

The Nation is in the midst of a public health crisis, and primary care practices are ideally positioned to help address it. At a minimum, physicians, nurse practitioners, and physician assistants can obtain a waiver to prescribe buprenorphine and connect patients with behavioral health therapies or psychosocial supports elsewhere in the community. This Playbook provides much of the information needed to begin this process.