5600 Fishers Lane • Rockville, MD 20857 

www.samhsa.gov • 1‐877‐SAMHSA‐7 (1‐877‐726‐4727) 

May 3, 2022 

Dear State Opioid Treatment Authorities, 

The Substance Abuse and Mental Health Services Administration (SAMHSA) aims to promote 

comprehensive Opioid Use Disorder (OUD) treatment services for all people who need it. In 

pursuit of this goal, SAMHSA has released numerous practice-based guidelines to foster best 

practices, particularly among special populations such as pregnant and postpartum women with 

OUD. The recently updated TIP 63 - Medications for Opioid Use Disorder (MOUD), 

exemplifies this and complements several other SAMHSA resources (see Clinical Guidance for 

Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants, and 

Medications to Treat Opioid Use Disorder During Pregnancy) . These guides include evidencebased information about the management of OUD with medications for opioid use disorder 

(MOUD) during pregnancy. They specify that doses of MOUDs, particularly methadone, should 

be carefully monitored during pregnancy because pregnancy can affect the rate at which these 

medications are metabolized. This may require increased doses during the pregnancy and 

peripartum period to achieve and sustain stability. 

Dividing the dose of methadone or buprenorphine in two daily doses (also known as “split 

dosing”) taken 10-12 hours apart, rather than a single daily dose, can help manage the impact of 

metabolic changes on serum levels, particularly for women in the third trimester of pregnancy. 

Split dosing can also make medications for opioid use disorder more tolerable for people 

experiencing nausea, and it may be needed for people taking other medications or with certain 

physiologic profiles that might lead to rapid metabolism of MOUDs. As SAMHSA continues to 

operate under the current take-home flexibilities, we want to ensure that you are aware that the 

take-home supply related to a split dosing regimen falls within these flexibilities. 

The take-home flexibilities statement issued in March 2020 indicated: The state may request a 

blanket exception for all stable patients in an OTP to receive 28 days of take-home medication 

and they may request up to 14 days of take-home medication for those patients who are less 

stable but who the OTP believes can safely handle this level of take-home medication. Based on 

this guidance, a take-home exception is not automatically required to initiate or continue split 

dosing regimens. If exceptions are needed, they can be processed via the OTP Extranet at 

https://otp-extranet.samhsa.gov . 

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover 
 

 

 

 

 

 

The follow up guidance issued last fall extends the flexibilities beyond the end of the public 

health emergency, adds some defining language to “stable” and “less stable” and states: It 

remains within the OTP provider’s discretion to determine the number of take-home doses within 

each category of ‘stable’ or ‘less stable’. 

We are grateful for your state’s willingness to take advantage of the Federal take-home 

flexibilities. If your state wants to prepare for the end of the public health emergency and opt 

into the extended flexibilities, please remember to notify us of your concurrence by emailing 

DPT@samhsa.hhs.gov. 

If you have any questions about your state’s status regarding the extended flexibilities, please 

contact Nichole Smith at Nichole.Smith@samhsa.hhs.gov for guidance. 

Sincerely, 

/Yngvild K. Olsen/ 

Yngvild K. Olsen, M.D., M.P.H.
 

Director, Center for Substance Abuse Treatment
 

Substance Abuse and Mental Health Services Administration
 

1‐877‐SAMHSA‐7 (1‐877‐726‐4727) • 1‐800‐487‐4889 (TDD) • www.samhsa.gov