Original Medicare (Parts A & B): Opioid Use Disorder (OUD) Treatment Services

Opioid use disorder (OUD) comprises:

• An overpowering desire to use opioids

• Increased opioid tolerance (it takes more and more of the drug to achieve the desired effect)

• Withdrawal syndrome when stopped (mood swings, flu-like symptoms, sweating, shaking, nausea and vomiting, diarrhea, and full body aches and pain, as well as more severe symptoms).

OUD can occur in older adults, especially those who use opioids for chronic pain control.

OUD treatment includes the following services:

• FDA-approved opioid agonist and antagonist medication-assisted treatment (MAT), which are methadone, buprenorphine, or naltrexone.

• Dispensing and administration of MAT medications (if applicable)

• Substance use counseling

• Individual and group therapy

• Toxicology testing

• Intake activities

• Periodic assessments

OUD programs are conducted at both inpatient and outpatient hospital-based and sometimes university-based treatment sites and rehabilitation centers, and may be delivered in conjunction with drug therapy at independent MAT clinics (once commonly referred to as “methadone clinics” or “drug depots”).  In more rural settings, outpatient counseling may be delivered in more community-based settings such as activity centers, churches, and legion-type facilities (VFW, Elk’s Club, etc.).

Not all OUD programs are medication-assisted.  There are also programs (commonly called “detox”)  that rely on abstinence-based treatment wherein there is no medication transition, though these are typically inpatient programs lasting from 21-28 days or residential programs lasting more than 30 days.  However, there are inpatient and residential programs that are also MAT.  Be sure to ask about the facility’s approach (abstinence or MAT) before intake and admission.

Outpatient programs, which are generally MAT, may vary in intensity and duration, but typically last anywhere between 3 months and a year.