Opioid treatment programs (OTPs)

Overview

This educational web page was developed to provide support to providers and individuals seeking to gather information related to the use of medications to treat Opioid Use Disorder (OUD).  Persons with OUD are dependent upon opioids (e.g. prescription pain pills oxycodone and hydrocodone), or the illicit opiate heroin) and receive medication assisted treatment (MAT) through Opioid Treatment Programs (OTP’s).

In the United States, the treatment of opioid dependence with medications is governed by the Certification of Opioid Treatment Programs, 42 Code of Federal Regulations (CFR) 8. This regulation created a system to accredit and certify opioid treatment programs (OTPs).

OTPs provide medication-assisted treatment (MAT) for people diagnosed with an opioid-use disorder. MAT patients also must receive counseling, which can include different forms of behavioral therapy. Learn more about medication and counseling treatment for substance use disorders. 

The Behavioral Health Administration under the Colorado Department of Human Services further adds to the oversight of OTP’s in the Code of Colorado Regulations 2 CCR 502-1.  

Attention Providers: Are you accepting Medicare? Learn more about how to enroll as a Medicare provider and the benefits this would bring to your patient population here.  

Updated September 23, 2024

How to become an Opioid Treatment Program

Applying for Opioid Treatment Program Certification and Licensing

Opioid treatment programs (OTP) seeking to have their programs certified and licensed to dispense medications for the treatment of substance use disorders must complete the federal certification and state licensing process.

• Apply for SAMHSA OTP certification 
  Before obtaining SAMHSA certification, OTPs must complete the accreditation process and meet other requirements outlined in the Certification of Opioid Treatment Programs, 42 Code of Federal Regulations (CFR) 8. Learn about the federal legislation, regulations, and guidelines that apply to OTPs and medication-assisted treatment (MAT).
• Apply for Colorado controlled substances license and substance use disorder license
  Complete and submit applications to conduct addiction treatment activities using controlled substances. 

Colorado Central Registry 

Central Registry is an automated system used to admit and discharge Opioid Treatment Program clients. It is federally-mandated that States must maintain an OTP central registry. If you are a OTP clinic and you need access to Central Registry, email cdhs_bha_provider_support@state.co.us. You can also visit the BHA Technology web page for Central Registry resources. 

Opioid Treatment Program After Hours Contact

View site and after hours contact information for Opioid Treatment Programs here. 

Myths About Medication-Assisted Treatment, Opioid Treatment Programs, and Opioid Use Disorders

MAT is substituting one drug for another

Methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery. For more information visit here. 

The only people struggling with opioid use disorder are injection heroin users

Opioid Use Disorder does not discriminate and affects every socioeconomic status, race, sex, and ethnicity.  Most opioid use disorders begin with initial dependence on prescribed opiates which escalates to heroin for various reasons (e.g. physician stopped prescribing, cost of prescriptions where heroin is cheaper).  For more information visit here. 

Pregnant women shouldn’t enter MAT

Treatment of opioid-dependent pregnant women with methadone or buprenorphine IMPROVES OUTCOMES for their babies; MAT reduces symptoms of neonatal abstinence syndrome and length of hospital stay.  MAT is a recommended best practice for the care of pregnant women with opioid use disorder. 

Resource: https://ncsacw.samhsa.gov/files/Collaborative_Approach_508.pdf. National Institute on Drug Abuse.  Accessed 09/20/2017

MAT helps in other areas of life

• MAT DECREASES opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission.¹  
• We wouldn’t tell our loved ones they need to stop their diabetes medication-so why are we telling opioid use disorder patients they need to get off of their Opioid Treatment Program prescribed medication of Methadone/Buprenorphine/Suboxone/Naltrexone?  Because there is stigma attached to it and some are afraid of what they don’t know and are in need of education.  For some it can simply come down to personal bias. 
• This treatment is also the most regulated treatment ranging from the State, DEA, and Federal guidelines.  Please seek out information to keep yourself and your loved ones informed of the highest evidenced based treatment for opioid use disorder that is Medication Assisted Treatment.
• Resource:¹ Effective Treatments for Opioid Addiction, (updated) 2016. National Institute on Drug Abuse.  Accessed 09/20/2017. 

Frequently Asked Questions 

What is the difference between addiction, physical dependence and tolerance?

Clear terminology is necessary for effective communication regarding medical issues. Scientists, clinicians, regulators and the lay public use disparate definitions of terms related to addiction. These disparities contribute to a misunderstanding of the nature of addiction and the risk of addiction, especially in situations in which opioids are used, or are being considered for use, to manage pain. Confusion regarding the treatment of pain results in unnecessary suffering, economic burdens to society, and inappropriate adverse actions against patients and professionals. 

The American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, recognizes these terms and their definitions and recommend their use:

1. Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
2. Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
3. Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

Resource: ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use

What makes people more likely to get addicted to drugs?

• Trouble at home. If your home is an unhappy place, or was when you were growing up, you might be more likely to have a drug problem. When kids aren't well cared for, or there are lots of fights, or a parent is using drugs, the chance of addiction goes up.
• Mental health problems. People who have untreated mental health problems, such as depression or anxiety, or untreated attention deficit/hyperactivity disorder (ADHD) are more likely to become addicted. They might use drugs to try to feel better.
• Trouble in school, trouble at work, trouble with making friends. Failures at school or work, or trouble getting along with people, can make life hard. You might use drugs to get your mind off these problems.
• Hanging around other people who use drugs. Friends or family members who use drugs might get you into trouble with drugs as well.
• Starting drug use when you're young. When kids use drugs, it affects how their bodies and brains finish growing. Using drugs when you're young increases your chances of becoming addicted when you're an adult.
• Your biology. Everyone's bodies react to drugs differently. Some people like the feeling the first time they try a drug and want more. Other people hate how it feels and never try it again. Scientists don’t have a test yet that will predict how each person will react.
• Resource: The Science of Drug Use: Discussion Points, Revised February 2017. National Institute on Drug Abuse.  Accessed 09/20/2017.

What is addiction?

• Addiction is uncontrollable compulsive behavior caused by alterations of parts of the brain from repeated exposure to high euphoric responses.
• As a person takes opioids for an extended period of time, they become less sensitive to it and require more to achieve the same effect. Receptors in the brain become less sensitive. This means they need more and more opioid to achieve the same effect. This is called tolerance. When the body can no longer make enough natural opioids to satisfy the less sensitive receptors, the body becomes dependent on the external source. This is physical dependence.
• "Physical Dependence" is a physiological state of adaptation to a substance, the absence of which produces symptoms and signs of withdrawal. It is possible to be physically dependent on a drug without being addicted to it. Physical dependence is the result of physical changes in the brain. It is not a matter of willpower rather it is actual physiology.
• Addiction is defined as a behavioral syndrome characterized by the repeated, compulsive seeking (psychological dependence) or use of a substance despite adverse social, psychological, and/or physical consequences, along with the physical need for an increased amount of a substance as time goes on to achieve the same desired effect. Addiction is often (but not always, as with an addiction to gambling) accompanied by tolerance, physical dependence, and withdrawal syndrome.
• People are dependent on water and food but are not addicted to them. If a cancer patient is taking large doses of painkillers, he/she will become tolerant and physically dependent on them (meaning they will experience withdrawal symptoms if the drug is abruptly removed) but they are not necessarily addicted to it (meaning they will not seek out the drug despite adverse consequences once the drug is no longer needed for pain).
• Addiction is a disorder that requires treatment while physical dependence is not. This is important to understand in order to be able to discern between switching one addiction for another and treatment.
• Resource: Frequently Asked Questions and Answers, 2009. The National Alliance of Advocates for Buprenorphine Treatment.  Accessed 09/20/2017.

How do opioids work in the brain?

• Opioids attach to receptors in the brain. Normally these opioids are the endogenous variety that is created naturally in the body. Once attached, they send signals to the brain of the "opioid effect" which blocks pain, slows breathing, and has a general calming and anti-depressing effect. The body cannot produce enough natural opioids to stop severe or chronic pain nor can it produce enough to cause an overdose.
• Opioids can activate receptors because their chemical structure mimics that of a natural neurotransmitter. This similarity in structure "fools" receptors and allows the drugs to lock onto and activate the nerve cells. Although these drugs mimic brain chemicals, they don't activate nerve cells in the same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network.
• Opioids target the brain's reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who misuse drugs and teaches them to repeat the behavior.
• Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.
• Resource: Frequently Asked Questions and Answers, 2008. The National Alliance of Advocates for Buprenorphine Treatment.  Accessed 09/20/2017.

What is withdrawal?

• Withdrawal syndrome consists of a predictable group of signs and symptoms resulting from abrupt removal of, or a rapid decrease in the regular dosage of, a psychoactive substance. The syndrome is often characterized by over activity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug. In other words, opposite of what the drug did. Example, if the substance suppressed pain then the person will experience pain while in withdrawal.
• Withdrawal from opioids can be severe and excruciating. Withdrawal generally begins between 4 to 72 hours after the last opioid use (depending on dose and opioid), The symptoms are both physical and emotional and include: dilated pupils, goose bumps, watery eyes, runny nose, yawning, loss of appetite, tremors, panic, chills, nausea, vomiting, muscle cramps, insomnia, stomach cramps, diarrhea, shaking, chills or profuse sweating, depression, irritability, jitters, and increased sensitivity to pain.
• Withdrawal is a symptom of physical dependence. If you are not physically dependent on a substance you will not experience withdrawal from it. To achieve a comfortable transition off a medication you have become physically dependent on requires matching your taper off of the drug with your brain's ability to adapt to each decrease. Too fast will cause discomfort.
• Resource: Frequently Asked Questions and Answers, 2008. The National Alliance of Advocates for Buprenorphine Treatment. Accessed 09/20/2017. 

Resources 

National Resources

• Substance Abuse and Mental Health Services Administration | MATx Information Center
• Substance Abuse and Mental Health Services Administration | Publications
• National Institute on Drug Abuse
• National Institute on Alcohol Abuse and Alcoholism
• The National Alliance of Advocates for Buprenorphine Treatment
• Medicaid | Substance Use Disorders Tools and Resources

State Resources

• Prescription Drug Monitoring Program  Colorado Department of Regulatory Agencies
• Colorado Consortium for Prescription Drug Abuse Prevention
• Take Meds Seriously Colorado Consortium for Prescription Drug Abuse Prevention
• Lift The Label Colorado Office of Behavioral Health 

Consumer Resources

• Medication-Assisted Treatment for Opioid Addiction: Facts for Families and Friends, Revised 2011.  Substance Abuse and Mental Health Service Administration.
• Drugs, Brains, and Behavior: The Science of Addiction, 2007.  National Institute on Drug Abuse.
• Family Checkup: Positive Parenting Prevents Drug Abuse, (updated 2015). National Institute on Drug Abuse.
• Treatment Approaches for Drug Addiction, (Revised 2018).  National Institute on Drug Abuse. 
• Effective Treatments for Opioid Addiction. National Institute on Drug Abuse
• and Mental Health Services Administration
• The Facts about Buprenorphine for Treatment of Opioid Addiction, 2015.  Substance Abuse and Mental Health Services Administration.
• Decisions in Recovery: Treatment for Opioid Use Disorder Handbook, 2016. Substance Abuse and Mental Health Services Administration.

Provider Resources

• Naloxone (Narcotic Overdose Reversal Drug) Standing Orders, February 2017. Colorado Department of Public Health and Environment, Law Enforcement Officers
• Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs A Treatment Improvement Protocol TIP 43, Revised 2017. Substance Abuse and Mental Health Services Administration
• Healthcare Brief: Medication-Assisted Treatment for Opioid Addiction, 2012. Office of National Drug Control Policy.
• Medication Assisted Treatment Joint Bulletin, 2014. CMS, SAMHSA, CDC, NIDA, and NIAAA.
• SAMHSA Opioid Overdose Prevention Toolkit, 2016. Substance Abuse and Mental Health Services Administration
• CDC Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention
• Federal Guidelines for Opioid Treatment, 2015. Substance Abuse and Mental Health Services Administration
• Managing Chronic Pain in Adults With or in Recovery from Substance Use Disorders, A Treatment Improvement Protocol, TIP 54, 2012. Substance Abuse and Mental Health Services Administration.
• Opioid Use in the Older Adult Population Resources List, 2017. SAMHSA’s Center for the Application of Prevention Technologies.
• Advisory: Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update, 2016. Substance Abuse and Mental Health Services Administration

Services and Supports

• Colorado Crisis Services
• Suicide Prevention Lifeline
• Harm Reduction Action Center
• Grief Recovery After a Substance Passing (GRASP)
• The Compassionate Friends
• Broken No More Substance Use Forum

Education and Training Resources

• Medication Assisted Treatment Education and Training. Providers’ Clinical Support System for Medication Assisted Treatment. 
• Opioid Education and Training. Providers’ Clinical Support System for Opioid Therapies
• Knowledge Application Program (KAP) Substance Abuse and Mental Health Services Administration
• Knowledge Network. Substance Abuse and Mental Health Services Administration
• American Academy of Pain Medicine - Education  AAPM American Academy of Pain Medicine
• Preventiong Prescription Drug Abuse Center for Health, Work and Environment, Colorado School of Public Health

Associations/Societies

• American Academy of Pain Medicine, AAPM
• American Society of Addiction Medicine, ASAM
• American Academy of Addiction Psychiatry, AAAP

​Applets

OpiRescue 

Reports

Miles Away From Help: The Opioid Epidemic and Medication-Assisted Treatment in Colorado, May 2017.  Colorado Health Institute.

Contact

• Ryan Mueller, State Opioid Treatment Authority and Controlled Substance Administrator, Behavioral Health Administration
  • Email: ryan.Mueller.@state.co.us  
  • Phone: 720-215-8384