When to Refer Patients to Specialized Substance Abuse Treatment

Primary care providers who do not prescribe buprenorphine should refer opioid-dependent patients to a specialist either another provider or a substance abuse treatment center whenever:

  • A brief assessment and intervention is not an adequate treatment.
  • You suspect or confirm that patients are using or abusing opioids or other illicit drugs.
  • Patients have a complicated medical or substance abuse history and require intensive treatment.
  • Patients request a referral to substance abuse treatment.

Primary care providers who are prescribing buprenorphine should consider referral to an addiction specialist or substance abuse treatment center in certain cases:

  • Patient has a complicated medical, psychiatric, social, or substance abuse history and requires more intensive or structured treatment than you can provide in the office setting.
  • Patient is non-compliant with your office policies or treatment protocol.
  • Patient is requesting transfer from high-dose methadone maintenance or is dependent on other high-dose long-acting opioids or short-acting opioids.
  • You are over your patient-prescribing limit (providers can treat up to 30 patients simultaneously during the first year that they are waivered. You can apply for a waiver to treat 100 patients per year after that, and then apply to treat 275 patients after being waivered for 100 patients for a year).

Remember that all providers who are prescribing buprenorphine and managing patient care themselves should refer patients to psychosocial treatment services.

Related Resources: 
This chapter discusses the treatment approaches and models available to those working with patients with substance abuse disorders.
Substance Abuse and Mental Health Services Administration (SAMHSA)
Physician stage in practice: 

CTI Referral Form for Substance Abuse Treatment

Form3used for referral to substance abuse treatment or counseling.

This form is for use by a primary care provider to refer a patient for substance abuse treatment. It could also be used to refer the patient for counseling.