Opioid Outpatient Treatment
Opioid outpatient treatment refers to treatment of people suffering from an opioid use disorder (OUD), a broad category that covers misuse of heroin and opioid prescription drugs. It is important to note that opioids are not the same as opiates: opioids refer to all opioid substances (natural, semisynthetic, and synthetic), while opiates are a subcategory of opioids and refer only to natural opioid substances (heroin, morphine, and codeine).
In outpatient treatment for opioid addiction, the patient lives at home and visits the treatment facility according to a schedule defined by their treatment plan.
The Importance of Treatment
According to an estimate of the Substance Abuse and Mental Health Service Administration (SAMHSA), there are around 2.1 million people in the U.S. who are suffering from OUD. Out of this number, 1.7 million people have a prescription pain reliever use disorder, while 0.7 million people have a heroin use disorder.1
Although data suggest that the number of opioid users in the U.S. is declining, the number of opioid-related deaths is still alarming. Moreover, the percentage of people who receive neither inpatient nor outpatient treatment for opioid addiction is worrying: out of the total number of 20.4 million people in the U.S. who are struggling with substance use disorder, as many as 89.7% receive no treatment whatsoever.2 As there is no one-size-fits-all solution for opioid outpatient treatment, it is important to provide more OUD patients with access to treatment services appropriate for their condition, treatment needs, and thus improve treatment outcomes and chances of recovery.
Opioid Outpatient Treatment as a Level of Care
Rather than classifying substance abuse treatment options into outpatient and inpatient categories, the American Society for Addiction Medicine (ASAM) has developed a continuum of levels of care. As treatment needs vary among patients, the intensity of treatment care should match these needs. Moreover, as a patient advances through treatment, they may step up and down the levels of care, which should match their condition at a given moment. In other words, outpatient and inpatient options are not opposite categories, but rather different aspects of a continuum.3
Level 1: Outpatient Services
Outpatient treatment for opioid addiction typically involves less than 9 hours per week for adults or less than 6 hours per week for adolescents. These therapies may be delivered in a variety of settings.3
Level 2: Intensive Outpatient Services
This model typically involves 9 or more hours per week for adults or 6 or more hours per week for adolescents. It includes services that can meet the needs of patients with co-occurring disorders. Treatment services are delivered during the day and do not interfere with work or school. A more intensive sub-level within Level 2 is partial hospitalization. It involves 20 or more hours of treatment services per week.3
Level 3: Clinically Managed Low-Intensity Residential Services
This type of care involves 24-hour residential support and at least 5 hours of clinical service per week provided by professionals for substance abuse treatment and mental health, as well as general personnel.3
Level 4: Medically Managed Intensive Inpatient Services
Finally, this level of care involves 24-hour nursing care and daily medical care for severe and unstable conditions. There are 16 hours of counseling per day available to the patient.3
Advantages of Opioid Outpatient Treatment
Outpatient treatment for opioid addiction has several important benefits:5
- The person is able to carry on with daily life during treatment. Individuals are able to keep going to work or school and take care of their children. Statistics say that around 1 in 5 people do not enter treatment because they think that it would have a negative effect on their job.1 If outpatient treatment allows them to carry on working, the likelihood they will enter treatment is higher.
- The person can stay in their home environment, which is beneficial if the environment is supportive.
- The person can immediately apply the newly acquired skills on a daily basis in real life.
- Treatment costs are lower than for inpatient treatment and the chances that insurance plans will cover them are better.
Disadvantages of Outpatient Treatment for Opioid Addiction
On the other hand, opioid outpatient treatment may have possible setbacks:5
- There is a risk of opioid abuse. The person still has access to opioids and may use them.
- It may be dangerous for patients with other psychological or physical conditions. Some withdrawal-related health complications can be potentially life-threatening. Moreover, some patients may be suicidal or homicidal.
- Transportation to treatment facilities can be an issue. Some people may not be able to travel to the appointment on a daily basis and may drop out from treatment as a result.
In Which Situations Is Opioid Outpatient Treatment Advised?
As in any substance abuse treatment, detoxification from opioid substances is the first stage in the process. The Treatment Improvement Protocol of the Center for Substance Abuse Treatment lists the issues that need to be considered when assessing whether outpatient detoxification is possible or inpatient services are necessary at this stage:6
- Is the patient able to arrive at a clinic on a daily basis? If yes, then opioid outpatient treatment is possible, at least technically.
- Does the patient have a history of delirium tremens or withdrawal seizures? If yes, this can make opioid outpatient treatment risky.
- Does the patient have the capacity for informed consent? If not, then outpatient services are not possible.
- Does the patient exhibit suicidal, homicidal, or psychotic conditions? If yes, they need a protective inpatient environment.
- Does the patient have the ability and willingness to follow treatment guidelines? If yes, outpatient detoxification is possible.
- Does the patient have any unstable co-occurring medical conditions (chronic diseases or pregnancy)? If yes, opioid outpatient treatment may pose a risk.
- Does the patient have supportive persons in their environment? If yes, their assistance is advisable for outpatient treatment.
There are also ASAM’s criteria for assessing individual cases and creating appropriate treatment plans on the continuum of levels of care. In some cases, opioid outpatient treatment will be possible, while in others the patient will need more intensive services. The following criteria apply:7
- Level of intoxication and risk of severe withdrawal
- Physical health
- Psychological (emotional, cognitive, behavioral) condition
- Motivation and readiness to change
- Likelihood of relapse or continued use
- Environment — support or threat to recovery
Frequently Asked Questions
The adopted standard for opioid addiction treatment is Medically assisted therapy (MAT).8 This means that medications used in combination with behavioral therapy give the best treatment results.
Medications applied in opioid addiction treatment may include methadone, buprenorphine, and naltrexone. If a patient is suffering from an additional medical condition that causes pain, then in addition to maintenance drugs during opioid outpatient treatment, they should also be provided with pain management therapy.9
Behavioral counseling is another common treatment component and can be done in various forms: individual or group sessions, using various approaches (e.g. cognitive-behavioral therapy, family therapy, contingency management, etc.).10
The National Survey on Drug Use and Health found that there are several predominant reasons why people do not enter treatment despite being aware that they have a substance abuse issue:1
- 39.7% are not ready to stop using the substance(s).
- 30.3% have no health coverage or could not afford to pay for treatment.
- 20.5% fear that entering treatment would have negative effects on their job.
- 17.2% fear the stigma of the social environment.
- 10.9% do not know how to access treatment.
- 9% have not found the kind of treatment they wanted.
Opioid outpatient treatment is offered by a number of treatment facilities in the U.S. The Opioid Use Treatment Program Directory is available on the website of SAMHSA. As with any disease, the person should see a healthcare professional who will assess the condition and recommend appropriate treatment options.
1. Substance Abuse and Mental Health Service Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
2. McCance-Katz, E. F. (2019). The National Survey on Drug Abuse and Health.
3. American Society of Addiction Medicine. (2015). What are the ASAM Levels of Care?
4. Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment (Treatment Improvement Protocol Series, No. 47).
5. WebMD. (2021). Outpatient vs. Inpatient Addiction Treatment: Which Is Right For You?
6. Center for Substance Abuse Treatment. (2006). Treatment Improvement Protocol Series, No. 45.
7. American Society of Addiction Medicine. About the ASAM Criteria.
8. National Institute on Drug Abuse. (2016). Effective Treatments for Opioid Addiction.
9. Tennant F. S. & Rawson R. A. (1982). Outpatient treatment of prescription opioid dependence: comparison of two methods. Arch Intern Med, 142(10), 1845–1877.
10. National Institute on Drug Abuse. (2019).Treatment Approaches for Drug Addiction.