What Is Office Based Opioid Treatment or OBOT?
OBOT is the treatment of opiate addiction with a medication in a physicians’ office and outside of the clinic system. Two medications are available methadone and buprenorphrine that was recently approved. Each medication has specific requirements and regulations before it can be dispensed.
Using buprenorphine the physician must submit a Notification of Intent to begin dispensing or prescribing. The federal code that regulates buprenorphine is DATA or Title XXXV.
- The physician or group practice may not have more than 30 patients at any one time.
- The physician has the capacity to refer addiction therapy patients for appropriate counseling and other non-pharmacologic therapies.
- The physician must meet the qualifying credentials.
A New Rule was passed that reformed methadone regulations and allows for physician to prescribes methadone under certain conditions. Physicians must follow the federal regulations or 42 CFR 8, Part 8.11(h) is the section that allows physicians to prescribe methadone.
- The physician must request an exemption.
- Office-based physicians shall maintain formal arrangements with established OTPs and patients who have been determined by a physician to be stabilized may be referred. (This is the Medical Maintenance Model.)
- The Medical Maintenance Model is intended only for long-term stable patients that would benefit by extended take homes and no longer needs the comprehensive services of the program.
- Other models have been proposed for rural areas such as to allow for pharmacies to dispense methadone when patients travel long distances daily to the program.
OBOT and Medical Maintenance Publications
Physicians’ Guide: Opioid Agonist Medical Maintenance Treatment (Draft Guidelines). Prepared by the Office of Pharmacologic and Alternative Therapies (OPAT), Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services (DHHS), 2000.
Manual for Methadone Medical Management. Fiellin, D.A., Pantalon, M.V. and O’Connor, P.G. 2000. 
Effective Medical Treatment of Opiate Addiction. Consensus Statement. November 1997; Vol. 15. No. 6. National Institute of Health. U.S. Dept. of Health and Human Services.
Principles of Drug Addiction Treatment. A Research-Based Guide. National Institute on Drug Abuse. Report, 1999. NIH Publication No. 99-1180.
Spanish Version.
Diagnosis and Treatment of Drug Abuse in Family Practice. Trachtenberg, A., Fleming, M.F. American Family Physician 1999. (Monograph). National Institute on Drug Abuse.
Methadone Medical Maintenance (MMM): Treating Chronic Opioid Dependence in Private Medical Practice – A Summary Report (1983-1998). Salsitz, E.A., Joseph, H. Frank, B., Perez, J., Richman, B.L. Salomon, N. Kalin, M.F., Novick, D.M. MT Sinai Journal of Medicine 1999 5: 388-397.
The Demedicalization of Methadone Maintenance. Marsha Rosenbaum. Journal of Psychoactive Drugs. 1995; 27: pp. 145-149.
MMT & Beyond Office-Based Methadone Prescribing. A.T.Forum Vol X #2, Spring 2001.
Treating Opioid Addiction in an Office-based Practice. RWJF Substance Abuse Policy Resrearch Ptogram, 2007.
New York State Models of Methadone Medical Maintenance. National Alliance of Methadone Advocates, 2007. Prepared by H. Joseph
Policy Statements
Methadone Maintenance in Private Practice. American Medical Association. Report 2 of the Council on Scientific Affairs (I-94), 1994.
Supporting the Concept and Further Development of a San Francisco Program For Office-Based Physician Prescription of Methadone and Other Effective Pharmacologic Agents For the Treatment of Opiate Addiction July 6, 1999. San Francisco Health Commission. Resolution #56-98.
Office Based Opioid Treatment. American Academy of Psychiatry. Policy approved May, 1999.
Office Based Opioid Treatment. American Society of Addiction Medicine, 2004. Policy.
NIDA Basic Teaching Packets
Introduction to the Brain. The Brain & the Actions of Cocaine, Opiates, and Marijuana. National Institute on Drug Abuse. (Section I). 
Introduction to the Reward System. The Brain & the Actions of Cocaine, Opiates, and Marijuana. National Institute on Drug Abuse. (Section II).
Introduction to Drugs of Abuse: Cocaine, Opiates (Heroin) and Marijuana (THC). The Brain & the Actions of Cocaine, Opiates, and Marijuana. National Institute on Drug Abuse. (Section III).
Introduction to Drugs of Abuse: Cocaine, Opiates (Heroin) and Marijuana (THC) – Continued . The Brain & the Actions of Cocaine, Opiates, and Marijuana. National Institute on Drug Abuse. (Section IV).
Agencies and Organizations
American Society of Addiction Medicine (ASAM)
American Osteopathic Association
American Academy of Addiction Psychiatry
American Psychiatric Association (APA)
American Medical Association (AMA)
Substance Abuse Methadone Health Services Administration (SAMHSA)
Center for Substance Abuse Treatment CSAT
National Institute on Drug Abuse NIDA