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• Provider/network development (e.g., physician clinical support network/system
development and enhancement to inform physicians of established standards of
care);
• Quality improvement efforts; and
• Physician workforce development.
Physician Support Activities
Applicants must demonstrate the ability to provide consultative services, telephone
consultation, on-site training, observation of practice, and peer mentoring to physicians
on the indications and usage of FDA approved medications for opioid dependence
including methadone, buprenorphine (mono and combination), and naltrexone (oral and
extended release injectible). Applicants may propose other activities, such as
conducting a limited number of regional meetings, developing clinical guidelines, on-line
Web conferences, mobile applications, or other educational activities to improve
physician workforce performance.
Physician support activities must focus on the following content areas:
• Assessment and diagnosis using the Diagnostic and Statistical Manual, Fourth
Edition, Text Revision (DSM-IV-TR) (or the potential DSM-IV-TR successor);
• Induction, maintenance, and detoxification protocols;
• Strategies to avoid and treat complications;
• Ancillary medications;
• Recommended visit and monitoring schedules;
• Special psychosocial strategies on motivating patients, setting limits, or
implementing contingency plans;
• Medically supervised withdrawal and opioid withdrawal scales;
• Referrals to counseling, other ancillary services, or self-help groups;
• Diagnosis and treatment of psychiatric co-morbidities or co-occurring disorders,
including, but not limited to, chronic pain, poly-substance abuse, hepatitis, and
HIV disease;
• HIV and hepatitis screening, counseling, testing, and referrals;
• Referrals to higher levels of care;
• Special populations (e.g., pregnant, adolescent, elderly, pain patients, and
veterans); and
• Important patient recovery indicators.
According to the National Survey on Drug Use and Health, individuals who experience
mental illness or who use illegal drugs have higher rates of tobacco use than the total
population. Data from the National Health Interview Survey, the National Death Index,
and other sources indicate earlier mortality among individuals who have mental and
substance use disorders than among other individuals. Due to the high prevalence
rates of tobacco use and the early mortality of the target population for this grant
program, grantees are encouraged to promote abstinence from tobacco products
(except with regard to accepted tribal traditional practices) and to integrate tobacco
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