Office Based Opioid Treatment (OBOT)

Office-based opioid treatment (OBOT) refers to outpatient treatment services provided beyond the scope of licensed Opioid Treatment Programs (OTPs). This program prevents opioid usage, overdose deaths, and the spread of infectious diseases. OBOTs is a comprehensive treatment program that is classified under the Medication-Assisted Treatment (MAT) services.

This program involves the use of prescription opioid medications such as naltrexone, buprenorphine, or methadone in conjunction with counseling and behavioral therapy. These medications function by offering relief from withdrawal symptoms while simultaneously reducing cravings for opioids. The most common type of OBOT uses the partial opioid agonist buprenorphine. OBOT allows more physicians the opportunity to treat opioid addiction and the possibility of a more private treatment experience for patients with an opioid use disorder.

OBOT provides various treatment programs and resources, including:

• Medication management
• Case management
• Counseling/therapy
• Relapse prevention
• Overdose education
• Care coordination

The OBOT clinics also frequently partner with other community resources to offer extra assistance to individuals seeking treatment.

The practice of OBOT was made possible by the Drug Addiction Treatment Act of 2000 (DATA, 2000). The act established a pathway for eligible physicians to apply for a waiver separate from the requirements of the Drug Enforcement Administration (DEA) for registration of OTPs.

DATA 2000 allows physicians to use certain Schedule III-V controlled drugs licensed by the Food and Drug Administration (FDA) to treat OUD patients. In 2002, the FDA approved the usage of buprenorphine, a Schedule III opioid, to manage opioid use disorder. The Comprehensive Addiction and Recovery Act of 2016 expanded on the DATA 2000 to enable nurse practitioners and physician assistants to qualify for the waiver.

OBOTs and OTPs (Opioid Treatment Programs) are the only treatment programs in the US that can recommend methadone for opioid use disorders. OTPs are accredited by the Centre for Substance Abuse Treatment (CSAT) of the HHS-SAMHSA division. They work under a physician’s direction to offer therapy and other rehabilitation assistance like medical services related to dosing and treatments on-site, which typically include daily visits to the facility.

However, OBOT services are provided by clinicians within their normal medical practice. This environment will help improve treatment access and offer a more private space for opioid use disorder patients. The OBOT programs have fewer requirements and regulations enforced on the patients, which makes receiving treatment much simpler. For example, OBOT can provide regular on-site dosing as appropriate, but it typically happens in the patient’s home and is not observed by a medical professional.

• Comprehensive assessment of substance use disorder.
• Induction of buprenorphine.
• Maintenance with buprenorphine or methadone.
• Group and individual counseling (from once a month to 10 hours a week).
• Case management services.
• Collaboration with community-based medical and psychiatric providers.
• Wrap-around services (e.g., recovery housing, co-management of chronic medical disorders, peer recovery advocates, integrated psychiatric assessment/treatment, and on-site occupational therapy.)

The OBOT programs help patients overcome their active addiction while in a comfortable environment, where they are willing to complete a wide range of intensive, co-ordinated OUD treatments.

In addition to the effective usage of controlled medications, the American Society of Addiction Medicine (ASAM) provides a series of guidelines for OBOT services that include the following treatment elements:

• General medical services
• Family support
• Education on addiction
• Individual, group, and family counseling
• Psychiatric care
• Vocational counseling
• Legal counseling

ASAM believes that OBOT is a positive development as it promotes the treatment of addiction in a primary care setting. Although It does not support the exclusive licensing of these sites, it does understand that the use of controlled substances to treat the disease introduces the possibility of misuse, and as such, some states may seek to regulate the practices that deliver such treatment.

Since not all medical centers that provide OBOT services can deliver all of the above-mentioned treatments within a single venue, it is important to develop working partnerships and referral pathways to providers who can offer a full continuum of care to patients with OUD. Besides the service elements, most OBOT services provide community support links like Narcotics Anonymous (NA), Refuge Recovery, or SMART Recovery.