The Ohio Department of Mental Health and Addiction Services (OhioMHAS) submitted changes and added new rules to Ohio Administrative Code (O.A.C.) 5122-40, which governs Opioid Treatment Programs (OTP) in Ohio. These new and modified rules went into effect on January 31, 2025. These updated rules will allow for OTPs to better serve their cliental through a person-centered, supportive treatment environment that promotes recovery, engagement, and trust.
Aligning with federal rules
The first goal of the updated rules is to bring Ohio in line with federal rules for OTPs that can be found in the Code Of Federal Regulations (CRF) Title 42 part 8. The Center for Community Solutions previously wrote about the federal rule changes for OTPs that worked to increase access in November 2023, when the new rules became effective.
Ohio’s updated rules make the state congruent with federal rules in four separate ways.
Ohio’s updated rules make the state congruent with federal rules in four separate ways. The first is related to OTP admission criteria. Previously, a clinical diagnosis of opioid use disorder (OUD) was the only admission criteria accepted. Now an individual can also be admitted if they are at an elevated risk of OUD recurrence or an overdose.
The second rule update that the state is now consistent with the federal government on is take-home medication. In response to the infeasibility of daily trips to OTPs during the pandemic, in March and April of 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued flexibilities for OTPs to reduce the risk of COVID infections among patients and providers. This included methadone take-home flexibilities and an in-person physical evaluation exemption. While the state concurred with the flexibilities during the pandemic and in November 2023, the federal government had made the flexibilities permanent, the state has officially updated their rules to continue the flexibilities allowed during the pandemic. This will allow individuals to continue with treatment with as few barriers as possible.
The final two ways that the state is now congruent with federal rules are related to scope of practice and toxicology screening. For scope of practice, physician assistants and nurse practitioners are now allowed to prescribe methadone within an OTP. For toxicology screening, the presence of drugs detected in urine does not necessarily limit a participant's take-home medication unless the drug use increases the risk of an overdose.
Modified rules
Ohio has changed the existing rules surrounding OTPs in several different ways, there are three worth highlighting. The first is that medication delivery to carceral and other residential settings, such as long-term care or nursing facilities, has been expanded to encourage continuation of treatment regardless of the setting. This continues the work Ohio has engaged in to improve medicated-assisted treatment in correctional settings. The next is to expand access to mobile and non-mobile medication units. Individuals engaged with an OTP might have to travel upwards of an hour to the closest OTP and by expanding access to mobile and non-mobile medication units, the medication can be closer to the patients. The third and final modification that will be highlighted is that Ohio now allows for the use of a trusted third-party pickup of medication, which is consistent with the Drug Enforcement Administration (DEA) guidelines. All three of these modified rules aim to increase access to OTPs and encourage continued participation with the program.
Medication delivery to carceral and other residential settings, such as long-term care or nursing facilities, has been expanded to encourage continuation of treatment regardless of the setting.
The Center for Community Solutions will continue to highlight the actions Ohio takes to increase access to OTP for individuals with OUD and advocate for policies that will save lives.
Resources
- Free Naloxone/Fentanyl Test Strips: NaloxoneOhio or Project DAWN (Deaths Avoided With Naloxone)
- SAMHSA’s National Helpline: 1-800-622-4357. Confidential, free, 24 hours day, 365 days a year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.
- Ohio’s Take Charge Helpline: 1-877-275-6364. Confidential, free, 8:00am – 6:00pm, Monday – Friday. To get information about addiction and to get a referral to treatment.
- Ohio’s Crisis Text Line: Text 4hope to 741741 and a trained crisis counselor will text you within five minutes to confidentially help you.
- Never Use Alone: 877-696-1996. Toll-free national overdose prevention, detection, life-saving crisis response and medical intervention services for people who use drugs while alone. Available 24 hours a day, 7 days a week, 365 days a year.
