Email Updates
Purpose
The AHRQ Integration Academy developed the Medications for Opioid Use Disorder Playbook as a practical guide for providing medications for opioid use disorder (MOUD) and immediate care for patients with opioid use disorder (OUD) in primary care and other ambulatory care settings. This interactive, web-based product has the latest guidance, tools, resources, tips, and examples that address key aspects of MOUD implementation. The Playbook will help you find your own path for implementation by applying knowledge about successful approaches and navigating possible barriers.
The MOUD Quick Start Guide covers the essentials of low-threshold care, while the balance of the Playbook offers more in-depth resources and guidance for those practices interested in working toward more comprehensive, whole-person care. The low-threshold approach ensures immediate access to MOUD, eliminating barriers for both patients and providers.
Buprenorphine saves lives and any provider with a DEA license can prescribe it.
- The Playbook focuses on providing buprenorphine to treat OUD and naloxone to reverse opioid overdose. Other medications for OUD are described in less detail.
- Although the focus of the Playbook is treating patients with OUD, much of the general information about addictions, comorbidities, and non-pharmacologic treatment applies to other substance use disorders (SUDs) as well.
Using the Playbook
You can go directly to the Quick Start Guide, work through the steps of the Playbook sequentially, or customize your approach.
Intended Audience and Users
The Playbook is intended to help you, and your primary care practice team provide effective treatment for people with OUD. The intent is to provide information that is useful for a wide range of primary care settings, including smaller independent practices, community health clinics like Federally Qualified Health Centers (FQHCs), or practices affiliated with larger health care systems. Whether you are offering medication-only treatment or integrating more comprehensive care, the Playbook provides a flexible framework that supports all points along the treatment continuum. You will find information, tools, and resources to support you, your team, and others working to expand access to OUD treatment in primary care.
The North Star—or ideal approach to treatment for patients with OUD for your medical practice—may vary from other practices. Incorporate treating patients with OUD into your practice in a way that supports the unique mission, values, and capabilities of your organization.
If you are new to using medication to treat patients with OUD, the Playbook's steps may require new efforts, while users who have already begun integrating behavioral health care and providing MOUD can use the Playbook to refine ongoing implementation efforts. Regardless of your practice's present range of services for patients with OUD, you can revisit the Playbook as a resource as you approach a more comprehensive array of services for people with OUD.
The preferred terminology to describe medications and other treatments for OUD has shifted over time and may continue to evolve after the publication of the Playbook. The Playbook uses the term MOUD to refer to the medications used to treat OUD. Whole-person, person-centered treatment for patients with OUD is comprised of MOUD and other services appropriate to help the patient achieve recovery. The term medication-assisted treatment (MAT) is not used in this updated Playbook (except in some references and resource links). Similarly, some suggested resources cannot keep up with rapid changes in regulations, medications, the drug supply, and so forth, so we include dates for resources, to the extent possible.
The Playbook uses neutral, clinically accurate terms and avoids using common but potentially stigmatizing terms, such as "clean" or "dirty" urines, "addict," "substance abuse," or "relapse."" For more information on the role of stigma as a barrier to treatment, see Confront Stigma as a Barrier to Care.
Medical and behavioral health providers often use different language—and may have different perspectives—when talking about SUDs, treatment, and recovery. Further, patients and families may also have their own vocabulary and may expect to hear certain terms that do not always align with clinical language. Recognizing and appreciating these differences while working to develop shared language can help support mutual understanding.
The following abbreviations are used throughout the Playbook.
Abbreviation* | Full Term |
|---|---|
AHRQ | Agency for Healthcare Research and Quality |
ASAM | American Society for Addiction Medicine |
CDC | Centers for Disease Control and Prevention |
DEA | U.S. Drug Enforcement Administration |
HER | Electronic health records |
FDA | Food and Drug Administration |
FQHC | Federally Qualified Health Center |
The Integration Academy | AHRQ Academy for Integrating Behavioral Health and Primary Care |
LAI | Long-acting injectable |
n.d. | No date |
NIDA | National Institute of Drug Abuse |
MOUD | Medications for opioid use disorder |
OBOT | Office based opioid treatment |
OTP | Opioid treatment program |
OUD | Opioid use disorder |
PCSS | Providers Clinical Support System |
SAMHSA | Substance Abuse and Mental Health Services Administration |
SUD | Substance use disorder |
WHO | World Health Organization |
*Note - Abbreviations listed in boldface are used frequently throughout the Playbook. | |
- Wendy Kissin, PhD — Principal Research Associate, Westat
- Garrett Moran, PhD — Principal, Moran Consulting
- Danielle Durant, PhD, MS, MS, MBA — Principal Research Associate, Westat
- Sophia Tsakraklides, PhD — Principal Research Associate, Westat
- Annaka Paradis, ScM — Lead Research Associate, Westat
- Alec Hester, PMP — Research Associate, Westat
- Laurin Brown, MPH — Research Associate, Westat
- Tiffiany Portacio, MPH — Research Analyst, Westat
We thank members of the MOUD Playbook Technical Expert Panel for their substantive input:
- Gavin Bart, MD, PhD, FACP, DFASAM — Professor of Medicine, Minnesota Medical School
- Jeffrey Bratberg, PharmD, FAPhA — Clinical Professor of Pharmacy Practice and Clinical Research. University of Rhode Island College of Pharmacy
- John Brooklyn, MD — Physician, University of Vermont
- Erika Crable, PhD, MPH — Associate Clinical Professor of Family Medicine and Psychiatry University of Vermont
- Mark H. Duncan, MD — Assistant Professor and Attending Psychiatrist, University of Washington
- Stephanie Kirchner, MSPH, RD — Practice Transformation Program Manager, University of Colorado
- Stephen Martin, MD, FASAM — Professor and Medical Director, University of Massachusetts
- Julie Griffin Salvador, PhD — Associate Professor, University of New Mexico
- Christopher Shanahan, MD, MPH, FACP — Clinical Associate Professor, Boston University
- Jack Westfall, MD — Vice President of Medical Affairs, DARTNet Institute
We thank our colleagues at the Agency for Healthcare Research and Quality, for their support, insightful comments, and guidance.
- Elisabeth Kato, MD, MR — Medical Officer, Agency for Healthcare Research and Quality
- Matthew Simpson, MD, MPH — Physician, Agency for Healthcare Research and Quality
We also thank our new AHRQ Colleague, Julia Zucco, PhD, and former AHRQ Colleagues, Parivash Nourjah, PhD; Nora Mueller, PhD; and Mary Nix, MS, as well as former Technical Expert Panel members, Tracie Gardner and Lori Ducharme, PhD for their early contributions to this edition of the Playbook. We would also like to thank Caroline Snyder, an author of the first iteration of the Playbook, as well as our other Westat colleagues Rebecca Noftsinger and Joshua Noda, and all members of the National Integration Academy Council who contributed to that first iteration. We thank Pantheon and the Westat Interactive Design Team for Playbook web design and development.
1. Substance Abuse and Mental Health Services Administration. SAMHSA's Working Definition of Recovery | SAMHSA Publications and Digital Products. 2012. Accessed March 10, 2025. https://library.samhsa.gov/product/samhsas-working-definition-recovery/pep12-recdef