KAP Keys Based on TIP 43 

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs 

43 

CSAT’s 

Knowledge Application Program 

KAP Keys 

For Clinicians 

Based on TIP 43 

Medication-Assisted 

Treatment for Opioid 

Addiction 

Medication-Assisted Treatment in Opioid 

For Opioid Addiction in 

Opioid Treatment Programs Treatment A Treatment 

Improvement 

Protocol 

TIP 

Programs
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

Introduction 

KAP Keys were developed to accompany the Treatment 

Improvement Protocol (TIP) Series published by the Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and 

Mental Health Services Administration (SAMHSA). These KAP 

Keys are based entirely on TIP 43 and are designed to meet 

the needs of the busy clinician for concise, easily accessed 

“how to” information. 

For more information on the topics in these KAP Keys, see TIP 43. 

Other Treatment Improvement Protocols (TIPs) 

that are relevant to these KAP Keys: 

TIP 37: Substance Abuse Treatment for Persons With 

HIV/AIDS (2000) (SMA) 08-4137 

TIP 40: Clinical Guidelines for the Use of Buprenorphine 

in the Treatment of Opioid Addiction (2004) (SMA) 07-3939 

TIP 42: Substance Abuse Treatment for Persons With 

Co-Occurring Disorders (2005) (SMA) 08-3992 

TIP 53: Addressing Viral Hepatitis in People With Substance 

Use Disorders (2011) (SMA) 11-4656 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

1 

Information Obtained About and Provided 

to Patients During Screening and Admission 

Essential Information Obtained About Patients 

•	 Risk of suicide and other emergencies

•	 Age (patients younger than 18 must meet Federal and State

eligibility requirements for admission to an opioid treatment 

program [OTP]) 

•	 Method and level of opioid use and pattern of daily preoc

cupation with opioids 

•	 Other substances of abuse (e.g., alcohol, nicotine, illicit

drugs) and prescription and OTC medicines used 

•	 Treatment history, preferably from previous providers

(requires patient’s informed written consent) 

•	 Recovery environment (i.e., do living environment, social

network, co-residents, and housing status support or

jeopardize treatment and recovery?) 

•	 Other recovery resources (e.g., family, friends, significant

others, neighbors, co-workers, insurance status, employ

ment, education, spirituality) 

•	 Other compulsive behaviors (e.g., gambling, sexual

disorders) 

•	 Patient motivation and reasons for seeking treatment

Essential Information Provided to Patients 

•	 Orientation to medication-assisted treatment (MAT): treat

ment methods, optional programs, treatment requirements, 

roles and responsibilities of all those involved 

•	 Handbook (in patient’s first language): information needed

to comply with treatment requirements 

•	 OTP information requirements and methods: written con

sent to treatment, program recordkeeping and confidential

ity, patient rights, grievance procedures, discharge policies 

•	 Facility safety instructions and rules

•	 Information on family planning, gynecological health, meno

pause, pregnancy testing (for women) 

See TIP 43, pages 43–53. 

­

­

­

­

­

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KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

2 

Medical Assessment 

•	 Physical examination

•	 Laboratory tests (possibly including TB, hepatitis, HIV, STD 

tests plus initial drug test and 8 random drug tests per year)

• Determination of opioid addiction and treatment history, 

extent of other substance use and treatment, medical

history 

Induction Assessment 

• At least daily checks for signs of overmedication (intoxication

or sedation) or undermedication (withdrawal symptoms) 

during initial dosing 

•	 Assurance that patients are not using benzodiazepines 

or alcohol during induction 

•	 Observed dosing to ensure medication ingestion 

•	 Dosage adjustments until steady state is reached 

Comprehensive Assessment 

•	 Determination of patient motivation 

•	 Continuing assessments of substance use 

•	 Cultural background assessment

•	 Assessment of psychosocial factors (e.g., mental health, 

sociodemographic status, family and social network,

spiritual support, physical or sexual abuse history, housing,

legal status, employment and military status, sexual

orientation, insurance and financial status, recreational 

activities) 

See TIP 43, pages 49–60. 

MAT Assessments 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

3 

Pharmacotherapeutic Medications for 

Opioid Addiction Treatment 

Methadone LAAM Buprenorphine 

Buprenorphine/

Naloxone Naltrexone 

AvailableFormulations 

Oral solution, liquid concentrate, tablet/ diskette, and powder

Oral solution Sublingual tablet Sublingual tablet Oral tablet 

ReceptorPharmacology 

Full mu opioid agonist 

Full mu opioid agonist 

Partial mu opioid agonist 

Partial mu opioid agonist/muantagonist 

Mu opioidantagonist 

FDA Approval Never formally 

approved by FDA 

1993 2002 2002 1984

DEA Schedule II II III III Not scheduled TreatmentSettings 

OTP OTP Physician’s office,

OTP, or other health care setting 

Physician’s office,OTP, or other health care setting 

Physician’s office,OTP, or any substance abuse treatmentprogram 

See TIP 43, pages 26–32. 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

4 

Possible Side Effects of Opioid Agonist 

and Partial Agonist Therapy 

Whole Body Effects 

•	 Weakness, loss of energy

(asthenia) 

•	 Back pain, chills

•	 Fluid accumulation 

(edema) 

•	 Hot flashes 

•	 Flu syndrome and malaise 

•	 Weight gain 

Gastrointestinal Effects 

•	 Constipation 

•	 Dry mouth 

•	 Nausea and vomiting 

•	 Abdominal pain 

Musculoskeletal Effects 

•	 Joint pain (arthralgia) 

•	 Muscle pain (myalgia) 

Nervous System Effects 

•	 Abnormal dreams 

•	 Anxiety

•	 Decreased sex drive

•	 Depression 

•	 Euphoria 

•	 Headache 

•	 Decreased sensitivity to 

tactile stimulation 

(hypesthesia) 

•	 Insomnia 

•	 Nervousness 

•	 Somnolence 

Respiratory Effects 

•	 Cough

•	 Rhinitis

•	 Yawning 

Cardiac Effects 

•	 Electrocardiogram

changes (possible 

QT prolongation with 

LAAM or high doses 

of methadone) 

•	 Postural hypotension 

•	 Slowed heart rate 

(bradycardia) 

Hepatic Effects 

•	 Abnormal liver function 

tests 

Endocrine Effects 

•	 Hyperprolactinemia 

•	 Absence of menstrual 

periods (amenorrhea) 

Skin and Appendage Effects

•	 Sweating

•	 Rash

Special Sensory Effects 

•	 Blurred vision 

Urogenital Effects

•	 Difficult ejaculation 

•	 Impotence 

See TIP 43, pages 33–36. 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

5 

Reported Drug Interactions With 

Methadone 

Agent Effect on Methadone 

Amitriptyline Decreased clearance 

Amprenavir Decreased serum levels; possible 

decreased opioid effects 

Amylobarbitone Increased clearance 

Ciprofloxacin Increased opioid effects 

Diazepam Increased opioid effects 

Efavirenz Decreased plasma levels and opioid 

effects 

Ethanol Increased opioid effects and added 

sedation 

Fluconazole Decreased methadone clearance and 

increased SMLs* 

Fluoxetine Increased SMLs 

Fluvoxamine Increased SMLs and increased opioid 

effects 

Fusidic acid Decreased opioid effects 

Moclobemide Increased opioid effects 

Nelfinavir Decreased SMLs 

Nevirapine Decreased SMLs and opioid effects 

Paroxetine Increased SMLs 

Phenobarbital Decreased SMLs and opioid effects 

Phenytoin Decreased SMLs and opioid effects 

Rifampin Decreased SMLs and opioid effects 

Ritonavir Decreased SMLs and opioid effects 

Sertraline Increased SMLs 

Spironolactone Increased clearance 

*Serum methadone levels 

See over for strategies to prevent harmful drug interactions. 

See TIP 43, pages 36–40. 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

6 

•	 Obtain a thorough drug and medication history, including 

results of drug and other laboratory tests. 

•	 When adding any drugs to a therapeutic regimen, start 

with low doses, increase slowly, and monitor patient 

reactions closely. 

•	 Educate patient about the risks of drug interactions,

potentially lethal drugs or medications during agonist-based 

pharmacotherapy, possible cardiovascular risks, and

possible effects of deviating from dosage schedules and 

amounts. 

•	 Substitute alternative medications that do not interact with 

opioid treatment medications or have the least potential for 

interaction. 

•	 Consider whether administering other medications with or 

without food or altering dosing schedules might reduce the 

risk of drug interactions.

•	 Simplify the medication regimen to make it easier for

patient to adhere to it. 

•	 Adjust opioid medication dosage based on patient response 

to avoid drug interaction, but be vigilant for signs of with

drawal or sedation. 

•	 Increase drug testing and monitoring of drug serum levels. 

Advise patient of the physical signs of adverse interactions, 

and explain what to do if these occur.

•	 Be aware of concomitant diseases (e.g., liver disease) that 

might influence the potential for adverse drug interactions. 

See TIP 43, pages 40–42. 

­

Strategies To Prevent or Minimize 

Harmful Drug Interactions in MAT 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

7 

Criteria for Take-Home Medications 

and Maximum Take-Home Dose 

SAMHSA Criteria To Allow Take-Home Medication Privileges 

•	 Absence of recent drug and alcohol abuse, behavioral problems, criminal activity 

•	 Regular OTP attendance

•	 Stable home environment and social relationships 

•	 Acceptable time in comprehensive maintenance treatment 

•	 Assurance of safe storage of medication 

•	 Benefits of decreased OTP attendance clearly outweigh 

risks of diversion

Source: 42 Code of Federal Regulations, Part 8 § 12(i).

Continuous Time in Treatment 

Maximum Doses of TakeHome Medication Allowed 

First 90 days (months 1–3) 1 dose per week

Second 90 days (months 4–6) 2 doses per week

Third 90 days (months 7–9) 3 doses per week

Fourth 90 days (months 10–12) 6 days’ supply per week

After 1 year of treatment 2 weeks’ supply

After 2 years of treatment 1 month’s supply (monthly 

OTP visits are still required) 

•	 Any patient may receive take-home medication for days

when treatment facilities are closed, including Sundays and 

holidays. 

• State requirements may vary. 

•	 No patient in short-term detoxification or interim mainte

nance may receive take-home maintenance medication.

­

Source: 42 Code of Federal Regulations, Part 8 § 12(i).

See TIP 43, pages 81–85.
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

8 

Patient Counseling in MAT 

Recommended Focuses 

•	 Providing support and guidance, especially to eliminate sub

stance abuse 

•	 Monitoring other problem behaviors 

•	 Helping patients comply with OTP rules 

•	 Identifying problems needing referral and extended services

•	 Identifying and removing treatment barriers 

•	 Providing motivational enhancement 

Standard Components 

•	 Identification of problems needing immediate attention 

(e.g., homelessness) 

•	 Help locating and joining mutual-help groups (e.g., Narcotics 

Anonymous, Methadone Anonymous) 

•	 Education about addiction and effects of substance abuse 

•	 Education about relapse prevention strategies 

•	 Information about stress- and time-management techniques 

•	 Assistance in developing a healthy lifestyle (e.g., exercise,

good nutrition, smoking cessation, avoidance of risky sexual

behaviors) 

•	 Assistance in joining socially constructive groups (e.g., 

community and faith-based organizations) 

•	 Continuing education on health issues (e.g., HIV/AIDS, 

hepatitis) 

Types of Group Counseling in MAT 

•	 Psychoeducational groups 

•	 Skill development groups (e.g., relapse prevention, stress

management, substance use cessation) 

•	 Cognitive–behavioral groups 

•	 Interpersonal-process groups 

•	 Support groups 

­
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

9 

Common Topics for Patient Educational 

Sessions in MAT 

•	 Physical and psychological effects of opioid and other 

substance abuse 

•	 Health information, including medical problems related 

to addiction, smoking cessation, improving nutritional habits

(including special needs of persons with HIV), and exercise,

including aerobic and meditative exercises (e.g., yoga)

•	 Effects of drug use on family and other relationships 

•	 Introduction to mutual-help groups such as Methadone 

Anonymous 

•	 Effects and side effects of addiction treatment medications 

and interactions with other drugs 

•	 Symptoms of co-occurring disorders 

•	 Compulsive behaviors besides substance abuse 

(e.g., gambling, sexual behaviors)

•	 Skills to attain and sustain abstinence, such as anger

management and coping with cravings 

•	 Developing non–drug-related leisure activities 

•	 Stress management and relaxation

•	 Communication skills and assertiveness training

•	 Time management 

•	 Parenting skills

•	 Avoidance of STDs and promotion of responsible sexual

behavior 

•	 Vocational planning and employment (sometimes linked with

cognitive testing and conducted with vocational agencies) 

See TIP 43, pages 124–133. 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

10 

Characteristics of a Treatment Plan 

and a Multidisciplinary Team 

Treatment Plan 

•	 Is based on a thorough patient history and assessment 

•	 Is tailored to each patient’s needs 

•	 Has short- and long-term goals that reflect awareness of the 

patient’s abilities and limitations 

•	 Describes actions needed to reach goals 

•	 Indicates which goals require referral and followup 

•	 Includes specific, measurable objectives 

•	 Incorporates strategies for building therapeutic relationships 

with patients 

•	 Uses motivational enhancement to involve patients 

•	 Is written in the patient’s own words 

•	 Describes the patient’s strengths, abilities, and challenges 

•	 Includes assessment of linguistic or cultural factors that 

affect treatment 

Multidisciplinary Team 

•	 A physician trained in addiction psychiatry 

•	 Nonphysician medical staff members (e.g., registered nurse, 

nurse practitioner, physician’s assistant) 

•	 A pharmacist or pharmacy assistant 

•	 Nonmedical professional staff members (e.g., case coor

dinator, social worker, psychologist, vocational and educa

tional specialist) 

•	 A certified or licensed addiction specialist or drug counselor 

•	 Nontreatment and administrative staff members (e.g., office 

manager, clerical staff, receptionist, secretary) 

•	 Security personnel who ensure the safety and well-being of 

patients and staff on site 

See TIP 43, pages 95–100. 

­

­
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

11 

Acute Infections 

•	 Endocarditis 

•	 Soft-tissue infections (e.g., cellulitis, abscesses) 

•	 Necrotizing fasciitis 

•	 Wound botulism 

Infectious Diseases 

•	 TB 

•	 Syphilis 

•	 Genital chlamydia 

•	 Gonococcus infections 

•	 Hepatitis A, B, and C* 

•	 HIV/AIDS 

Chronic Diseases 

•	 Diabetes 

•	 Asthma 

•	 Hypertension 

•	 Chronic obstructive pulmonary disease

•	 Coronary artery disease

Pain 

•	 Acute (e.g., associated with traumatic injury, labor and 

delivery) 

•	 Chronic (e.g., associated with cancer, arthritis, disc disease) 

*See TIP 53: Addressing Viral Hepatitis in People With 

Substance Use Disorders for additional information. 

See TIP 43, pages 163–173. 

Associated Medical Problems 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

Cutoff Concentrations and Detection 

Times for Substances of Abuse 

12 

Drug 

Cutoff 

Concentrations 

(ng/mL*) 

Initial 

Testing 

Cutoff 

Concentrations 

(ng/mL*) 

Confirmation 

Analytes 

Tested in 

Confirmation 

Urine 

Detection 

Time 

(Days) 

Amphetamine 1,000 500 Amphetamine 2–4 

Barbiturates 200 200 Amobarbital, 

secobarbital, 

other barbiturates 

2–4 for 

short acting; 

up to 30 for 

long acting 

Benzodiazepines 200 200 Oxazepam,

diazepam, others 

Up to 30 for 

long acting 

Cocaine 300 150 Benzoylecgonine 1–3 for sporadic use; 

up to 12 for 

chronic use 

Codeine 300 300, 300 Codeine, 

morphine 

1–3 

Heroin 300 300, 10 Morphine, 

6-acetylmorphine 

1–3 

Marijuana 100, 50, 

20 

15 Tetra-hydro 

cannabinol 

(THC) 

1–3 for 

casual use; 

up to 30 for 

chronic use 

Methadone 300 300 Methadone 2–4 

Methamphetamine 1,000 500, 200 Methamphetamine, amphetamine 2–4 

Phencyclidine 25 25 Phencyclidine 2–7 for 

casual use; 

up to 30 for 

chronic use 

*ng/mL: nanograms per milliliter

Adapted from Cone 1997.
 

See TIP 43, pages 144–146.
 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

13 

Urine Drug Testing Guidelines 

General Preparation 

•	 Perform specimen collection in a therapeutic, humane

environment. 

•	 Clean bathrooms frequently, and supply with soap and toilet 

articles. 

•	 Inform patients at admission of testing and collection proce

dures, including whether and when observed dosing may be 

used, and their responsibility. 

•	 Use clinical judgment about need for direct observation 

of specimen collection (vs. temperature strips, adulterant 

checks, ambient-temperature guns, substitution of oral

swabs) unless mandated by State. 

•	 Put testing policies and procedures in writing, and give each 

patient a copy. 

•	 Protect patients’ dignity and privacy. 

•	 Minimize opportunities for falsification (monitor bathrooms, 

have patients leave parcels outside, allow only one patient 

in bathroom at a time). 

•	 Ensure confidentiality by storing specimens and records so 

only authorized personnel can access them. 

•	 Maintain universal safety precautions when handling 

specimens. 

Specific Procedures 

•	 Staff member greets patient and decides whether a 

specimen is required (based on judgment or random list) 

before patient receives medication. 

•	 Patient is sent to bathroom with a labeled container to 

provide specimen. 

•	 Staff member receives container and ensures a valid 

specimen (checks warmth or uses temperature strips,

adulterant checks, ambient-temperature guns).

•	 Staff member packages specimen and sends it to the lab.

See TIP 43, pages 146–149. 

­
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

Common Immunoassays Used in 

Drug Testing 

14 

Assay 

Brand 

Name(s) Maker(s) Comments 

EIA EMIT, 

CEDIA 

Syva, 

Boehringer 

Mannheim/ 

Microgenics 

Used widely; inexpensive;

equipment available for 

automated, high-volume 

rapid analysis; sensitive 

to some adulterants 

Fluorescence 

polarization 

Adx, TDx Abbott 

Diagnostics 

Resistant to several

adulterants; reasonably good quantitative 

estimates of concentrations; slower and more 

expensive than EIA and

KIMS 

Kinetic interaction of 

microparticles (KIMS) 

OnTrak,

TesTcup, 

OnLine 

Roche

Diagnostics 

Equipment available for 

automated, high-volume 

rapid analysis; used by 

some large laboratories 

Colloidal 

metal (CMI) 

Triage Biosite 

Diagnostics 

Used in onsite testing 

RIA Abuscreen Roche

Diagnostics 

Labor intensive; resistant to several adulterants; not used widely 

Adapted from Swotinsky and Smith 1999, with permission of Medical Review

Officer Certification Council.
 

See TIP 43, pages 149–151.
 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

Frequently Used Substance Combinations 

and Common Reasons for Use 

15 

Combination Reasons 

Heroin plus alcohol Enhance a high; create 

euphoria or sedation 

Heroin followed by alcohol Medicate opioid withdrawal; 

medicate cocaine overstimulation (e.g., anxiety, paranoia)

Heroin plus cocaine (“speedball”) Enhance or alter cocaine 

euphoria 

Heroin followed by cocaine Medicate opioid withdrawal 

Cocaine plus alcohol Enhance high; reduce 

cocaine overstimulation (e.g., 

anxiety, paranoia)

Cocaine followed by heroin Reduce cocaine overstimulation (e.g., anxiety, paranoia);

modulate the cocaine “crash” 

Methadone plus alcohol Create a high; sedate 

Methadone plus cocaine Reduce cocaine overstimulation (e.g., anxiety, paranoia); 

moderate the cocaine “crash” 

Methadone plus 

benzodiazepines 

Create a high; sedate 

Any opioid plus any nonbenzodiazepine sedative Create a high; sedate 

Any opioid followed by any 

nonbenzodiazepine sedative 

Medicate opioid withdrawal 

Any opioid plus amphetamine Create a high 

See TIP 43, pages 181–182.
 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

Common Medical and Obstetrical 

Complications Among Pregnant Women 

16 

Medical Complications 

Anemia 

Bacteremia/septicemia 

Cardiac disease, especially 

 endocarditis 

Cellulitis 

Depression and other mental 

 disorders 

Edema 

Gestational diabetes 

Hepatitis (acute and chronic)* 

Hypertension/tachycardia 

Phlebitis 

Pneumonia 

Poor dental hygiene 

STDs

Chlamydia

 Condyloma acuminatum

Gonorrhea

Herpes 

HIV/AIDS

Syphilis 

Tetanus 

TB 

Urinary tract infections

Cystitis 

Pyelonephritis 

Urethritis 

Adapted from Finnegan 1979. 

Obstetrical Complications 

Abruptio placentae 

Chorioamnionitis 

Intrauterine death 

Intrauterine growth retardation 

Intrauterine passage of

 meconium 

Low Apgar scores 

Placental insufficiency 

Postpartum hemorrhage 

Preeclampsia 

Premature labor/delivery 

Premature rupture of

 membranes 

Septic thrombophlebitis 

Spontaneous abortion 

Reprinted from Obstetrics and Gynecology Clinics of North America, 25(1),

Kaltenbach et al., Opioid dependence during pregnancy. Effects and management, pp. 139–151, 1998, with permission from Elsevier.

See TIP 43, pages 212–215. 

*See TIP 53: Addressing Viral Hepatitis in People With

Substance Use Disorders for additional information. 
KAP Keys Based on TIP 43

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs

17 

Laboratory Tests for Pregnant Women 

Who Are Opioid Addicted 

­

•	 Complete blood count with differential and platelets

•	 SMA-12 chemistry screen 

•	 Hepatic panel (liver function tests) 

•	 Hepatitis B surface antigen (full panel if positive) 

•	 Hepatitis C antibody 

•	 Rubella titer

•	 Serology (Venereal Disease Research Laboratory or

Rapid Plasma Reagin tests)

•	 Sickle prep (if appropriate)

•	 Blood type; Rh and indirect Coombs Varicella (if unsure

of history) 

•	 HIV (with counseling) 

•	 Urine tests 

– Urinalysis—routine and microscopic 

– Urine culture and sensitivity 

– Urine drug screen 

•	 Tuberculin skin test (Mantoux)

•	 Alpha-fetoprotein between 15 and 21 weeks’ gestation

(optimal, 16 to 18 weeks)

• 1-hour, 50 milligrams (mg) glucose challenge test at 

24 to 28 weeks’ gestation (at initial visit if risk factors)

•	 Repeat complete blood count and serology at

24 to 28 weeks’ gestation

•	 Group B Strep vaginal-rectal culture at 35 to 37 weeks’

gestation 

Reprinted from Obstetrics and Gynecology Clinics of North America, 25(1),

Kaltenbach et al., Opioid dependence during pregnancy. Effects and manage

ment, pp. 139–151, 1998, with permission from Elsevier.

See TIP 43, pages 214–215. 
Ordering Information 

TIP 43 

Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs 

KAP Keys Based on TIP 43 

Medication-Assisted Treatment for Opioid Addiction 

in Opioid Treatment Programs 

HHS Publication No. (SMA) 12-4108

First printed 2005 

Revised 2007, 2011, and 2012

Three Ways to Obtain FREE Copies 

of all TIPs Products: 

1. Call SAMHSA: 1-877-SAMHSA-7 (1-877-726-4727) 

(English and Español) 

2. Visit SAMHSA’s Publications Ordering Web page at 

http://store.samhsa.gov 

3. Access TIPs online: http://kap.samhsa.gov 

Do not reproduce or distribute this publication for a fee 

without specific, written authorization from the Office of 

Communications, Substance Abuse and Mental Health 

Services Administration, U.S. Department of Health and 

Human Services.