Newly Released: Guidelines for Physicians Working in California Opioid Treatment Programs

The California Society of Addiction Medicine (CSAM) just released an update to its “Guidelines for Physicians Working in California Opioid Treatment Programs (OTPs)” developed to provide an overview and discussion of the matters of clinical care that fall under the responsibility of the Opioid Treatment Program (OTP) Medical Director and Program Physicians. The Guidelines were prepared and distributed first in 1998 and updated first in 2004, and again in 2008. The 2019 update was made possible through a SAMHSA Opioid State Targeted Response Grant through the California Department of Health Care Services (DHCS)

The updated Guidelines are a valuable resource for physicians working in California’s OTPs. “This update represents what has changed in opioid pharmacotherapy and the uniquely challenging medical environment in which the OTP physician is responding to a diverse array of medical, psychiatric, and social problems, said Walter Ling, MD, one of three co-editors who worked with a team of 36 contributors to complete the Guidelines update. “In recent years, OTP physicians are seeing a growing number of patients who are addicted to prescription opioids rather than, or in addition to, heroin. Many of these patients have chronic pain issues as well as Substance Use Disorder (SUD),” said Ling.

The Guidelines are intended to assist OTP physicians in understanding their role and responsibilities in treatment, including those areas governed by state or federal regulation. These describe the role of the physician in an OTP and the clinical judgment involved in the development of an appropriate treatment plan for the delivery of patient care. These describe responsibilities that should be carried out by the physician or the physician’s designee. These do not prescribe a standard of care, or specific treatment choices. Judgment regarding specific clinical situations must be made on the basis of the clinical information available and on the treatment options available.

The Guidelines provide guidance on general approaches to treating patients. “The physician working in the OTP is often the first medical provider with whom these patients establish a long-term therapeutic relationship so the OTP physician can be an important, even lifesaving, resource for patients enrolled in treatment, identifying the multiple medical problems that characterize chemical dependence and providing treatment or referrals to address these problems, said co-editor Deborah Stephenson, MD, MPH. When utilized by OTP physicians, the Guidelines serve to improve community safety and public health.

A copy of the updated Guidelines can be downloaded for free at [PDF download].  Qualified OTP clinicians may request a free print copy of the Guidelines by sending a request to CSAM at: or calling: 415-764-4855.