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Reference: Summary of letter issued by the Department of Health & Human Services, SAMHSA, September 1, 2000
In the United States the Federal Government closely regulates "substitution treatment" of opioid addiction. It determines the number of patients, where the treatment can be accessed, patient drug testing requirements and more. Even after the Federal government sets the regulations, each state can choose to set up a sub-set of more stringent requirements. In fact, the treatment of opioid addiction using methadone is actually prohibited in several US States. The information below covers federal information only; please see the separate listing for specific information by state.
Any physician seeking to prescribe any controlled substance for the treatment of addiction must seek and receive special DEA (Drug Enforcement Agency) registration. Such registration will not be available for any medication for which "treatment standards" have not been established by Health & Human Services.
The Narcotic Addict Treatment Act of 1974 limited opiate agonist treatment primarily to regulated treatment programs. The current system accommodates far fewer than the estimated Americans addicted to opiates. Recently the National Institute on Drug Abuse and the Center for Substance Abuse Treatment have focused on the development of Office-Based Opioid Treatment (OBOT) to make agonist treatment more available. The initiative has significant potential to improve quality of life and reduce the spread of infection in the untreated population of opiate addicts by accommodating more patients.