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MOUD PLAYBOOK
← Back to all Playbooks

Medications for Opioid Use Disorder Playbook

Medicine and heart monitor

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.

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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.

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Navigating the Playbook

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.

Getting Started

Get Started with MOUD

Plan Your Program

Next Step

Engage & Treat

Engage Patients

Implement Treatment

Next Step

Recovery & Care

Recovery Support & Counseling

Coordinate Care


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Intended Audience

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.

For Clinicians

Quick Start Guide

Pharmacotherapy

Screening and Diagnosis

Mitigating Overdose Risk

Prevention and Response to Recurrence of Use

For Staff

Principles of Person-Centered MOUD Treatment

Engaging Patients in MOUD

Mitigating Overdose Risk

Challenging Patient Behaviors

Care Coordination and Patient Referral Sources

For Management

Financing MOUD

General Operations

Pre-Implementation Planning

Training Providers and Staff

Monitoring Outcomes


What is the North Star?


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. 

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"[Recovery is] a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. - SAMHSA1

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).

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 in the Clinicwide Orientation to Treating Patients with OUD section of the Playbook.

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.

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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

EHR

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.

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The Playbook is reviewed quarterly to reflect new developments in the field. 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, and update some resources as new ones become available. Readers should note important milestones that may not be reflected in resources published before certain dates. Some significant recent changes in the MOUD landscape include: 

  • Pending – December 2026 – Federal Register :: Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications – This rule allows providers to prescribe buprenorphine to treat patients with OUD via telemedicine, without first meeting in-person with the patient. Treatment provided under this rule is less restrictive than treatment allowed under the Two Final Rules effective December 31, 2025. These temporary flexibilities currently remain effect until December 31, 2026.
  • December 2025 - Federal Register :: Expansion of Buprenorphine Treatment via Telemedicine Encounter and Continuity of Care via Telemedicine for Veterans Affairs Patients  – These “Two Final Rules” allow providers to prescribe buprenorphine to treat patients with OUD via telemedicine, but include several requirements. The Expansion of Buprenorphine Treatment via Telemedicine Encounter stipulates specific conditions under which this treatment can be provided. The Continuity of Care via Telemedicine for Veterans Affairs Patients is limited to veterans receiving treatment from Veterans Affairs providers.
  • December 2024 – Federal Register :: Modifications to Labeling of Buprenorphine-Containing Transmucosal Products for the Treatment of Opioid Dependence – FDA clarifies that there is no agreed-upon maximum dose for treating OUD with transmucosal buprenorphine (i.e., neither 16mg nor 24 mg), and recommends that manufacturers clarify this.
  • September 2024 - Parity Laws - The Mental Health Parity and Addiction Equity Act (MHPAEA) now prohibits health plans and health insurance companies from imposing greater restrictions on mental health/substance use disorder (MH/SUD) benefits than on medical/surgical (M/S) benefits. This includes financial requirements such as copays and treatment limitations such as visit limits or prior authorization requirements.
  • February 2024 (Effective April 2024) - Fact Sheet 42 CFR Part 2 Final Rule  | HHS.gov – Recent changes in federal regulations governing the Confidentiality of SUD Patient Records aim to increase protections for patients receiving treatment for SUD by making “Part 2” more consistent with HIPAA, particularly regarding consent and the management of breaches and penalties. Key changes include, but are not limited to, (1) SUD counseling notes having similar protections as psychotherapy notes under HIPAA and (2) de-identified data from Part 2 programs can be shared with public health authorities.
  • May 2023 - FDA Approves New Buprenorphine Treatment Option for Opioid Use Disorder | FDA -  Extended-release injectable buprenorphine was approved by the FDA for the treatment of OUD.
  • January 2023 - Elimination of the X-Waiver (PDF - 6.4 MB) - Section 1262 of the Consolidated Appropriations Act of 2023 removed the federal requirement for practitioners to apply for a special waiver prior to prescribing buprenorphine for the treatment of opioid use disorder.
  • January 2023 - Naloxone Prescription (PDF - 6.4 MB) – As of January 2023, people can purchase naloxone without an individual prescription.

Note that this list is not exhaustive of all changes in the field, and quarterly reviews will often capture smaller changes like new published literature that supports prior research or introduces new tools and resources. See below for review dates to this point:

  • Original Publication – July 2025: Publications scanned through July 2024.
    • See Delivering Medications for Opioid Use Disorder in Primary Care: Environmental Scan (PDF – 815 KB).
  • Quarterly Review #1 – October 2025: Publications scanned from August 2024 through June 2025.
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  • Wendy Kissin, PhD — Principal Research Associate, Westat
  • Garrett Moran, PhD — Principal, Moran Consulting
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  • Danielle Durant, PhD, MS, MS, MBA — Principal Research Associate, Westat
  • Sophia Tsakraklides, PhD — Principal Research Associate, Westat
  • Alec Hester, PMP — Research Associate, Westat
  • Annaka Paradis, ScM — Lead Research Associate, Westat
  • Laurin Brown, MPH — Research Associate, Westat
  • Tiffiany Portacio, MPH — Research Analyst, Westat
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We thank members of the MOUD Playbook Technical Expert Panel for their substantive input:

  • Gavin Bart, MD, PhD, FACP, DFASAM — Professor of Medicine, University of 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 — Assistant Professor at the Department of Health Policy and Management, UCLA Fielding School of Public Health
  • 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
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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
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We also thank our former AHRQ Colleagues, Parivash Nourjah, PhD; Nora Mueller, PhD; Julia Zucco, 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.

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Kissin W, Moran G, et al. Medications for Opioid Use Disorder Playbook. Rockville, MD: Agency for Healthcare Research and Quality; June 2025. https://integrationacademy.ahrq.gov/products/playbooks/moud-playbook.

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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

Next Steps
Get Started With MOUD

MOUD Playbook Menu

  • Get Started Expand Get Started menu.
    • Quick Start Guide
    • Principles of Person-Centered OUD Treatment
  • Plan Your Program Expand Plan Your Program menu.
    • Pre-Implementation Planning
    • Training Providers and Staff
    • Financing MOUD
    • General Operations
  • Engage Patients Expand Engage Patients menu.
    • Screening and Diagnosis
    • Engaging Patients in Treatment for OUD
    • Person-Centered Care Plans
    • Person-Centered Treatment Considerations
    • Engaging and Educating Patients and Families
  • Implement MOUD Treatment Expand Implement MOUD Treatment menu.
    • Pharmacotherapy
    • Mitigating Overdose Risk
    • Infectious Diseases
    • Chronic Pain
    • Monitor Patient Outcomes
  • Recovery Support & Counseling Expand Recovery Support & Counseling menu.
    • Counseling and Other Psychosocial Supports
    • Prevent and Respond to Recurrence of Use
    • Suicidality
    • Challenging Patient Behaviors
  • Coordinate Care Expand Coordinate Care menu.
    • Care Coordination and Patient Referral Sources
    • Community Resources and Recovery Supports

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