substance and addiction prevention branch

Treatment for Opioid Use Disorder (OUD)

Medications for Opioid Use Disorder (MOUD)

MOUD is a safe, effective, and evidence-based treatment which uses FDA-approved medication to treat OUD.
FDA-approved treatment for OUD includes:

Benefits of MOUD

reduces or eliminates cravings to use opioids
reduces or eliminates withdrawal symptoms
blocks the effects of opioids
reduces illicit opioid use
supports people in treatment
reduces the risk of overdose

Medication Assisted Treatment (MAT) is sometimes used instead of MOUD. MAT can include both counseling and medication to support people with OUD. However, the term MOUD is sometimes preferred to emphasize that the opioid use disorder is what is being treated.
It is best when patients with OUD have access to counseling, mental health services, medical care, and support services to meet the specific needs of the whole person as part of treatment.

Treatment for Stimulant Use Disorder (StUD)

Contingency Management (CM)

CM is a behavioral intervention that positively reinforces recovery-related behaviors, such as abstinence, by providing items of value as incentives (e.g., gift cards or prizes).
CM has been shown to be effective at reducing stimulant use, and is the current standard of care for treatment of StUDs.
CM can be combined with other interventions and behavioral therapies, such as cognitive behavioral therapy (CBT).
The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (Guideline): Aims to assist clinicians in treating individuals with StUD (including adolescents and individuals who are pregnant), as well as individuals experiencing stimulant intoxication or withdrawal, and individuals who are at high risk of developing StUD. This Guideline draws on existing empirical evidence and clinical judgment with the goal of improving the quality of care for people with StUD.
CA Bridge - Emergency Management of Methamphetamine Crisis: Clinical protocol that highlights needed changes in providing care to people with methamphetamine use disorder, offers practical interventions for healthcare providers, and addresses a clinical need and gap in the treatment landscape.

Treatment Resources

Call the California Substance Use Warm Line at (855) 300-3595. The call line is available Monday - Friday 6 a.m.–5 p.m. PT, and provides teleconsultation services for California physicians, nurses, and other clinicians with questions about substance use prevention and treatment efforts.
Visit the California Department of Health Care Service’s Choose Change California to search for MAT providers by ZIP code. More information about the treatment process, including patient participation, is available on the same website.
Locate certified practitioners who treat substance use disorder (SUD) using the Substance Abuse and Mental Health Services Administration's (SAMHSA) Substance Use Treatment Locator and Buprenorphine Practitioner Locator.

Note: A DATA Waiver (X-Waiver) is no longer required to prescribe medications, like buprenorphine, to treat OUD. For more information visit SAMHSA's Waiver Elimination webpage.

Online Trainings for Providers and Continuing Education

CDC 2022 Clinical Practice Guideline for Prescribing Opioids for Pain: Highlights the 12 recommendations and contains information on implementation as well as patient scenarios. Continuing education (CE) credits are available.

CDC Addiction Medicine Toolkit: Provides an overview of SUDs and the field of addiction medicine, including diagnosis and treatment of SUD, linkage to care, methods to reduce stigma, and communication strategies that foster trust and help to build a collaborative patient relationship. Free CE credit is available.

CA Bridge On Demand Training: The CA Bridge Program works to provide access to medication for SUD in emergency departments, and offers evidence-based on demand trainings for providers and clinicians on various topics: clinical treatment, navigation to care, and culture of harm reduction. MDs, DOs, PAs, and NPs can earn CME credits through the Bridge Academy, which can be applied to the one-time DEA license renewal requirements. Nurses can use the Bridge Academy to watch trainings and earn CE Contact Hours.
Management of Opioids and Chronic Pain in the Primary Care Setting - Online Curriculum: The Center for Innovative Academic Detailing on Opioids & Stimulants (CIAO) has prepared online on-demand course modules designed for health professionals who care for patients who use opioids, with potential for CME credits.
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides training and resources on MOUD and other treatment options for SUD.

Opioid Prescribing and Stewardship Resources

Center for Disease Control and Prevention's (CDC) Clinical Practice Guidelines for Prescribing Opioids for Pain: These guidelines focus on prescribing opioids for treating chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
CDC Linking People with Opioid Use Disorder to Medication Treatment offers guidance for linkage to care strategies for health care professionals and other community leaders.
Opioids and Chronic Pain: A Guide for Primary Care Providers (PDF): This California edition guide provides information on prescribing opioids for chronic pain, opioid stewardship, and information on OUD management. Visit the CIAO webpage for more resource materials, trainings, and services to support clinicians.
Recommendations for Providers who Inherit Patients on Opioids (PDF): Providers may inherit patients receiving treatment with opioid therapy for several reasons, including clinic closures and provider shortages. In these instances, providers are encouraged to consider these best practices:

Continue opioid therapy for patients in transition,
Develop a patient-centered, individualized care plan,
Use caution when tapering opioid therapy,
Document patient care decisions, and
Prescribe buprenorphine (or another MOUD) when appropriate.

For more information on this topic, see CIAO’s What Do I Do With Inherited Patients on Opioids?: A Webinar for Providers. CIAO also created a shorter six-minute video: Inheriting Patients on Long Term Opioids: A Quick Primer for Clinicians.

CURES/California's Prescription Drug Monitoring Program

The Controlled Substance Utilization Review and Evaluation System or CURES is the name of California's Prescription Drug Monitoring Program (PDMP).

Purpose

CURES tracks all Schedule II - IV controlled substances dispensed to patients in California. CURES helps health care providers make informed prescribing and dispensing decisions to reduce prescription medication misuse, lower the risk of substance use disorders, and prevent opioid overdoses and deaths.

CURES Registration Requirements for Providers

California licensed health care providers authorized to prescribe Schedule II - V controlled substances and California licensed pharmacists must register for CURES. Prescribers and pharmacists may register by completing the CURES User Registration Form. Registered users can visit the CURES login page.