Opioid treatment programs

What it is

An opioid treatment program is a clinic certified by the federal government and licensed by its state to treat opioid use disorder with medicine and counseling. What sets it apart from other clinics is methadone: only a certified OTP may dispense methadone for opioid use disorder. Most also offer buprenorphine, and many offer naltrexone.

The medicine does the medical work. Methadone and buprenorphine ease withdrawal and cravings so a person can stop using and get on with life. Naltrexone blocks the effect of opioids. Counseling and other support come alongside. Together this is often called medication for opioid use disorder, and it is a standard treatment, not a substitute for one.

Who it is for

OTPs are for people with opioid use disorder who want a medicine-based treatment, and for people who have tried other approaches without success. Methadone in particular suits people who have not done well on buprenorphine, who use heavily, or who want the structure of a daily visit. Many programs serve pregnant women, and treatment with methadone or buprenorphine during pregnancy is standard care, planned together with the person's prenatal provider.

A person does not need to be in withdrawal or to have finished detox to start. In fact, starting medicine early is often the point.

What to expect

Admission includes a medical exam, a review of history, and lab work. If methadone is the choice, dosing begins at the clinic under a nurse's eye and is adjusted over the first weeks. Early on, most people come to the clinic every day to take their dose. As a person becomes steady, programs allow take-home doses, so visits become weekly or less frequent. Buprenorphine and naltrexone follow their own rules, and a program will explain them.

Counseling is part of the program, individual or group, and many programs offer medical care, case management, and help with housing or work. Drug testing is routine. Programs open early in the morning so people can dose before work.

How long it takes

As long as it helps. Many people stay on methadone or buprenorphine for years, and that is normal. Stopping early carries real risk, so any taper is slow and planned with the program. There is no set length, and a program that pushes people off medicine on a schedule is worth asking hard questions of.

Cost and coverage

Medicaid and Medicare both cover treatment at opioid treatment programs. Private plans generally cover it, though in-network programs are fewer in some areas. Many programs receive federal and state funding and charge on a sliding scale, and some offer treatment free of charge for people who qualify. Each listing on this site shows what the program reports accepting. Ask the program to confirm your coverage and what you will owe, if anything, per week.

How it compares

An OTP is a form of outpatient care: no one lives there, and visits fit around daily life. It differs from a general clinic in that it can provide methadone and usually offers all three medicines in one place. Some people combine an OTP with an intensive outpatient program for more counseling. Residential programs vary in whether they allow these medicines, which is worth asking before choosing one.

How to choose

Questions to ask a program:

• Which medicines do you offer: methadone, buprenorphine, naltrexone?
• How soon can I start after my first visit?
• What are your dosing hours, and how do take-home doses work?
• What counseling is included, and how often?
• Do you have a plan if I miss a day, travel, or move?
• Do you take my insurance, and what will I owe each week?

Every state page on this site can be filtered to facilities that report being an opioid treatment program. Pick a state from the list on this page, or start from the full list of states.