Our Medication Assisted Treatment Policies and Procedures
Key Takeaways
- A trustworthy outpatient program discusses all three FDA-approved medications, buprenorphine, methadone, and extended-release naltrexone, and treats detox alone as insufficient care 3, 10.
- Counseling should be offered alongside medication, not required to receive it, since the 2024 guideline names buprenorphine and methadone as first-line treatment on their own 5.
- Dosing, toxicology testing, and naloxone are clinical tools meant to guide support and safety, not to punish slips or trigger discharge from care 4, 8.
- Duration is individualized through shared decision-making, and when calling a program, ask how they handle medication choice, missed appointments, dose adjustments, and dual-diagnosis needs 12.
What "policies and procedures" really mean when you're the patient
When you hear "policies and procedures," your mind probably jumps to fine print, clipboards, and hoops to jump through. That's a fair reaction. If you're reading this while considering treatment for yourself or someone you love, the last thing you need is more paperwork between you and feeling better.
Here's a different way to look at it. In a well-run outpatient program, every policy is a promise. A promise that you'll be offered real medicine, not just willpower. A promise that no one will force you to detox alone, which federal guidance is clear is not recommended on its own 3. A promise that your care will include the three FDA-approved medications for opioid use disorder, plus counseling and support, because the evidence points to comprehensive care rather than medication-only or therapy-only models 1.
Think of each procedure as a guardrail on a coastal road. It's not there to slow you down. It's there so you can keep driving in weather you didn't ask for.
The rest of this guide walks you through what those guardrails look like in practice, step by step. What the first phone call sounds like. How the medication choice actually gets made, with you in the room. How counseling fits in. How safety is handled. And who decides when, or if, you ever step down from medication.
You've already done the hardest part by looking. Let's keep going.
The three medications a good program will actually offer you
Buprenorphine, methadone, and naltrexone side by side
There are three FDA-approved medications for opioid use disorder: buprenorphine, methadone, and extended-release naltrexone 1. A program worth your time will talk with you about all three, not just the one that's easiest for them to prescribe 10.
Here's what each one actually does, in plain terms.
- Buprenorphine
- A partial opioid agonist. That means it quiets cravings and withdrawal by attaching to the same receptors opioids use, but without the strong high. You can get it as a daily film or tablet that dissolves under your tongue, or as a monthly injection. Most people start buprenorphine in an outpatient office and pick it up at a regular pharmacy. It's one of two medications the 2024 national guideline update names as first-line treatment 5.
- Methadone
- A full opioid agonist. It's been used for decades and, at the right dose, keeps withdrawal and cravings steady all day. Methadone for opioid use disorder is dispensed through federally certified opioid treatment programs, which is different from outpatient counseling. The 2024 guideline names methadone alongside buprenorphine as a preferred first-line option 5.
- Extended-release naltrexone
- The medicine that blocks opioids from working. It's a monthly shot. It doesn't cause withdrawal or a high, but you have to be fully off opioids for a stretch of days before you can start it, which is why timing matters. It's FDA-approved and appropriate for some people, though newer evidence for oral naltrexone is limited and discontinuation risk tends to be higher than with the agonist medications 5.
None of these medications are a shortcut, and none of them are moral failures. They're tools. A thoughtful clinician will walk you through the risks and benefits of each one, plus the option of no medication and the option of no treatment, because that's the clinical standard for this conversation 10.
You get to weigh in on which one fits your life.
Why detox alone isn't on the menu
If you've been told the answer is a quick medical detox and then "just stay off it," that advice hasn't caught up with the evidence. The CDC is direct on this point: detoxification on its own, without medications for opioid use disorder, is not recommended 3.
The reason is honest and worth hearing. Coming off opioids without ongoing medication leaves your tolerance low and your cravings high, which is a dangerous combination. People who go through detox alone are more likely to return to use, and returning to use after a break carries a higher overdose risk than continuing use ever did.
That's why current guidance asks clinicians to offer or arrange evidence-based medication as the first move, not the last resort 4. Medication reduces opioid use, eases the symptoms that pull you back, lowers the risk of infections tied to injecting, and keeps more people connected to care over time 11.
The first call, the assessment, and how the medication decision actually gets made
What intake and assessment cover before anything is prescribed
The first phone call is usually shorter and gentler than people expect. Someone asks a few basic questions about what you're using, how long, whether you have a safe place to sleep tonight, and what kind of schedule you're trying to protect. That's the beginning. It's not a test.
The assessment that follows is the real starting point, and federal guidance for opioid treatment programs lays out what it should cover: patient-centered care planning, a full assessment, admission, monitoring, and how medication will be administered 7. In plain language, that means a clinician sits down with you and asks about your opioid use history, other substances, mental health, medical conditions, past treatment, current medications, pregnancy status if relevant, home environment, and what you want your life to look like six months from now.
Dual-diagnosis screening matters here. If depression, anxiety, PTSD, or another mental health condition is part of the picture, the treatment plan has to account for it. Ignoring the mental health side is one of the ways well-intentioned care falls apart.
Nothing gets prescribed in a vacuum. The assessment is what tells the clinician which medication conversation to open first, and it's also what tells you whether this program is really listening.
Informed consent as a real conversation, not a signature
Informed consent is not the paper you sign at the front desk. It's the conversation that happens before you sign anything.
The clinical standard is clear: when a program discusses medication with you, that conversation should cover the risks and benefits of all three FDA-approved medications, plus the option of treatment without medication and the option of no treatment at all 10. You should hear about buprenorphine, methadone, and extended-release naltrexone even if the program can only prescribe one or two of them directly. If a medication isn't a fit for their setting, a good program tells you where else to go.
A real consent conversation sounds like questions, not a script. What are your work hours? Have you tried one of these medications before, and how did it go? Are you pregnant or planning to be? Do you have liver concerns, other prescriptions, or a history that changes what's safest? Would daily dosing feel steadying or exhausting? Would a monthly shot fit your life better?
You get to ask hard questions back. What happens if this dose isn't enough? What if I have a slip? What if I want to stop the medication in a year?
If you leave that first meeting understanding what you're choosing and why, consent worked. If you leave confused, ask again. That's your right, and every good policy is built around it.
How counseling and medication fit together (and what's changed)
Here's something you may not have heard yet: the rules about counseling and MAT have shifted, and the shift is in your favor.
For years, some programs treated counseling as a gate. Miss a group, lose your prescription. Skip a session, get discharged. That was never great policy, and current guidance has moved away from it. The 2024 national guideline update is direct on this point: both buprenorphine and methadone are first-line treatment, and psychosocial care should be offered but not required as a condition of receiving medication 5. Medication is not a reward you earn by showing up to therapy. It's the treatment.
That doesn't mean counseling doesn't matter. It matters a lot. Talking with someone trained in CBT, DBT, motivational interviewing, or trauma-informed care is where you sort out the pieces medicine alone can't reach: the sleep that's still off, the relationship that keeps pulling you sideways, the memories that show up when the cravings quiet down. For people with depression, anxiety, or PTSD alongside opioid use, integrated dual-diagnosis care is often the difference between white-knuckling it and actually feeling steadier.
What's changed is the tone of the offer. A good program says, "Here's the medication, and here's the counseling and skill-building we think will help. Let's talk about what fits your week." Not, "Take it or lose your spot."
You get to say yes to more support when you want it. You get to say "not this week" without losing your medication. That's what shared decision-making looks like on a real calendar.
Recovery Starts With a Conversation
Whether you’re exploring recovery for yourself or seeking guidance for someone you care about, Coastal Recovery Partners is here to help. Our team offers trauma-informed, evidence-based support grounded in structure, compassion, and real connection—without pressure or judgment.
When you’re ready, we’ll meet you where you are and help you take the next step forward.
Dosing, safety monitoring, and the role of toxicology testing
Individualized dosing and when doses get adjusted
There is no single "right dose" of buprenorphine, methadone, or naltrexone. Your body, your history with opioids, other medications you take, and what you're feeling day to day all shape what actually works for you. Federal guidance for opioid treatment programs is built around exactly this idea: assessment, monitoring, and medication administration should be patient-centered rather than one-size-fits-all 7.
In practice, this means your clinician starts at a dose meant to quiet withdrawal and cravings, then checks in with you and adjusts. If you're still waking up sick, still fighting cravings at 3 p.m., still using on top of your medication because the dose isn't holding you, that's not a failure on your part. That's information. A good program treats it as a reason to change the dose, not a reason to discharge you.
Dose changes get triggered by real things:
- withdrawal symptoms breaking through,
- side effects that interfere with sleep or work,
- a new prescription that interacts,
- pregnancy,
- or a stretch of unusual stress.
You should feel safe telling your clinician the truth so the dose can catch up to your life 6.
Take-home naloxone and the safety net around your medication
Naloxone is the nasal spray or injection that reverses an opioid overdose. Current CDC guidance asks clinicians to offer or arrange naloxone as part of routine care for opioid use disorder, not as an afterthought 4. A program worth trusting hands you naloxone, shows you how to use it, and makes sure someone in your household knows too.
This is not because anyone expects you to overdose. It's because tolerance changes, fentanyl is in almost everything sold on the street, and the people around you, including friends or family who don't use, may encounter someone who needs it. Naloxone in a bag by the door has saved lives that had nothing to do with the person carrying it.
CMS has even built billing codes for take-home nasal and injectable naloxone through opioid treatment programs, which is a signal that this is standard, expected care 9. If a program you're considering doesn't mention naloxone at all, ask about it. If they treat it as sensitive or shameful, that tells you something about their culture.
Carrying naloxone is not a prediction. It's a seatbelt.
What toxicology testing is for (and what it isn't)
Toxicology testing, the urine cup you'll get familiar with, is part of MAT care in most programs and is listed alongside medication, therapy, and counseling as a standard service 8. It's worth being honest about what it is for.
It's a clinical tool. It helps your team confirm that your medication is at a level that's working, catch a substance you might not have thought to mention, and understand whether something else, like benzodiazepines or alcohol, is raising your risk. In that sense, a test result is another piece of information, like blood pressure or a lab value.
What it isn't: a punishment, a moral report card, or a reason to lose your medication. A positive test in a well-run program starts a conversation, not a discharge. The question your clinician should ask is, "What was happening that day, and how can we adjust support?" not, "How do we get rid of you?"
How long you stay on medication is your decision, with clinical guidance
One of the questions that keeps people up at night before starting MAT is this one: "If I start, am I stuck on this forever?" The honest answer is no, and also, maybe longer than you think, and that's okay too.
Federal guidance is clear that lifelong medication treatment should be an option when it's clinically indicated, but it should not be the default for every patient 12. In other words, no one gets to hand you a preset timeline the day you walk in. Some people stay on buprenorphine or methadone for a year. Some for five. Some for the rest of their working life because it keeps them steady, and that's a valid outcome. Some taper off after a stretch of stability and do well. All of those paths are legitimate.
What good policy protects is the conversation. Tapering, if and when it happens, should be shared decision-making, not something scheduled around you 12. That means your clinician brings up duration at check-ins, listens to how your life is going, weighs the risk of coming off too soon, and moves at your pace. A slow, supported taper with the option to pause or go back up is very different from a forced countdown.
You don't have to decide today how long you'll be on medication. You just have to decide about this week. The rest gets figured out with people who are paying attention.
What a legitimate MAT program should never do
It's just as important to know the warning signs. If a program does any of the following, that's a signal to keep looking.
Refuse to talk about all three medications. The clinical standard is a conversation that covers buprenorphine, methadone, and extended-release naltrexone, plus the option of no medication and no treatment 10. If a clinician only pitches one and won't discuss the others, you're not getting real informed consent.
Push detox alone as the answer. CDC guidance is direct that detox by itself is not recommended for opioid use disorder 3. A program that promises to "clean you out in a week" and send you home without medication is not following the evidence.
Make counseling a condition of getting medication. The 2024 national guideline update is explicit that psychosocial care should be offered, not required, to receive buprenorphine or methadone 5. Losing your prescription because you missed a group is not clinical care. It's punishment dressed as policy.
Hand you a fixed timeline on day one. Federal guidance says lifelong medication should be an option when clinically indicated, and duration should be individualized, not preset 12. Anyone telling you "six months and you're done" before they know you is guessing.
Treat a positive test or a slip as grounds for discharge. Toxicology results are clinical information, meant to guide dose and support 8. A program that responds to a hard week by cutting you loose has confused their comfort with your care.
You deserve better than any of that. And better exists.
Staying in treatment: follow-up, support, and what retention policy protects
Getting started is one milestone. Staying in care long enough for your body and life to settle is another one entirely, and it's the milestone the research keeps pointing to. Staying in treatment is one of the clearest ways medication actually pays off: people on buprenorphine or methadone are more likely to remain in care, reduce opioid use, and lower their risk of infections and overdose over time 11.
That's why follow-up policy matters. A program that cares about you staying doesn't just book the next appointment and hope. It builds the small structural pieces that make coming back easier: reminder calls, flexible morning or evening slots so work and childcare aren't a barrier, warm handoffs when your counselor is out, and a way to reach someone between visits when a craving spikes or a dose feels off. AHRQ's evidence review on what actually helps people stay in MAT points squarely at these kinds of coordinated supports 14.
Retention policy also protects you from being written off on a hard week. Missing an appointment should trigger outreach, not a discharge letter. A rough stretch should mean more contact, not less. That's what a program is supposed to do with the information you give it.
Every week you stay is a week your brain and your routines get to keep healing. That counts.
Bringing it home: what to ask when you call a program in Southern Maine
You've read a lot. Here's what to actually do with it.
When you pick up the phone, you don't need a script. A few honest questions will tell you almost everything you need to know about how a program treats people.
Ask which of the three FDA-approved medications they can prescribe or coordinate, and how they'd help you decide between them 1. Ask whether counseling is required to keep your medication, or offered alongside it 5. Ask how they handle a hard week, a missed appointment, or a positive test. Ask whether they send you home with naloxone 4. Ask how dose adjustments work if the first number isn't holding you.
Then listen for the tone. A steady, warm answer that treats your questions as reasonable is the answer. If you also live with anxiety, depression, or trauma, ask how they handle dual-diagnosis care in the same schedule, because that integration is often what makes the difference.
You don't have to have this figured out before you call. Coastal Recovery Partners is here when you're ready to talk it through.
Frequently Asked Questions
Is medication-assisted treatment just replacing one drug with another?
It's okay if you've been carrying that worry, because a lot of people have. The honest answer is no. FDA-approved medications for opioid use disorder quiet cravings and withdrawal without producing the strong high that drives compulsive use, which is why federal sources describe them as treatment, not substitution 2. You're steadying your brain so the rest of recovery becomes possible.
Do I have to attend counseling to get medication?
No, and that's a real shift worth knowing about. The 2024 national guideline update is clear that both buprenorphine and methadone are first-line treatment, and psychosocial care should be offered but not required to receive medication 5. Counseling helps most people, and you're encouraged to try it, but a missed session shouldn't cost you your prescription in a program following current evidence.
How do I know whether buprenorphine, methadone, or naltrexone is right for me?
You figure it out with a clinician who walks you through all three. The clinical standard asks that the conversation cover the risks and benefits of each medication, plus the option of no medication and no treatment 10. Your work schedule, past experiences, pregnancy status, other prescriptions, and what feels sustainable all matter. There's no wrong answer here, only the one that fits your life.
How long will I need to stay on medication?
As long as it's helping you, and not a day chosen by someone who doesn't know you. Federal guidance says lifelong medication should be an option when clinically indicated, but not the default for everyone 12. Some people stay on for a year, some for many years, some taper off after a stretch of stability. Duration gets decided together, at check-ins, at your pace.
What happens if I have a slip or a positive toxicology test?
You have a conversation, not a discharge. Toxicology results are clinical information meant to guide dose and support, alongside therapy and counseling as standard MAT services 8. A hard week means your team looks at what's happening, considers a dose adjustment, and adds support. Telling the truth is safer than hiding it, and a good program earns that trust on purpose.
Can I keep working or caring for my family while in MAT?
Yes, and that's the whole point of an outpatient design. Buprenorphine and naltrexone fit around ordinary schedules, and outpatient MAT is built to help people reduce use, stay in care, and lower health risks while life keeps going 11. Morning, afternoon, and evening options exist so work, kids, and appointments don't collide. You get to recover and show up for your people.
References
- TIP 63: Medications for Opioid Use Disorder - Full Document. https://www.samhsa.gov/resource/ebp/tip-63-medications-opioid-use-disorder
- Medications for Opioid Use Disorder. https://nida.nih.gov/research-topics/medications-opioid-use-disorder
- Opioid Use Disorder: Treating | Overdose Prevention. https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-disorder-treating.html
- Guideline Recommendations and Guiding Principles - CDC. https://www.cdc.gov/overdose-prevention/hcp/clinical-guidance/recommendations-and-principles.html
- Management of opioid use disorder: 2024 update to the national guideline for adults with opioid use disorder. https://pmc.ncbi.nlm.nih.gov/articles/PMC11573384/
- Federal Guidelines for Opioid Treatment Programs. https://library.samhsa.gov/sites/default/files/federal-guidelines-opioid-treatment-pep24-02-011.pdf
- Federal Guidelines for Opioid Treatment Programs (2024). https://library.samhsa.gov/product/federal-guidelines-opioid-treatment-programs-2024/pep24-02-011
- Medicare Benefit Policy Manual Chapter 17 - Opioid Treatment Programs. https://www.cms.gov/files/document/chapter-17-opioid-treatment-programs-otps.pdf
- OTP Billing & Payment | CMS. https://www.cms.gov/medicare/payment/opioid-treatment-program/billing-payment
- Chapter 3A: Overview of Medications for Opioid Use Disorder. https://www.ncbi.nlm.nih.gov/books/NBK574908/
- Medications to Treat Opioid Use Disorder. https://nida.nih.gov/sites/default/files/21349-medications-to-treat-opioid-use-disorder.pdf
- Dear Colleague Letter MAT (MOUD) Guidance. https://www.samhsa.gov/sites/default/files/dear-colleague-letter-mat-moud-guidance.pdf
- Treatment of Opioid Use Disorder - NCBI Bookshelf - NIH. https://www.ncbi.nlm.nih.gov/books/NBK558319/
- Retention Strategies for Medications for Addiction Treatment in Adults With Opioid Use Disorder: A Rapid Evidence Review. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/mat-retention-strategies-rapid-review-1.pdf
- Opioids. https://www.ahrq.gov/sites/default/files/wysiwyg/topics/impact-opioid-final.pdf
- Retention in Opioid Agonist Treatment: A Systematic Review and Meta-Analysis Comparing Observational Studies and Randomized Controlled Trials. https://nida.nih.gov/international/abstracts/retention-in-opioid-agonist-treatment-systematic-review-meta-analysis-comparing-observational
- Retention in opioid agonist treatment: a rapid review and meta-analysis of the performance of buprenorphine and methadone. https://pmc.ncbi.nlm.nih.gov/articles/PMC8348786/
- Treatment Approaches for Opioid Use Disorder Offered in US Substance Use Treatment Facilities. https://pubmed.ncbi.nlm.nih.gov/38990551/
