SAMHSA Updates MOUD Guidance, Says Medication-Only Opioid Treatment Models Are Insufficient

May 18, 2026

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) recently updated its guidance on treatment for opioid use disorder (OUD), stating that treatment models providing only medication for opioid use disorder (MOUD) are insufficient. SAMHSA said its funding, training, and technical assistance efforts will prioritize comprehensive care models that address the broader psychosocial and recovery support needs of individuals with OUD.

Under the updated guidance, SAMHSA said grant funding should support integrated treatment models that combine MOUD with behavioral health treatment, recovery support services, care coordination, and ongoing clinical monitoring. The guidance discourages models focused primarily on medication prescribing without broader recovery and psychosocial support services.

The U.S. Food and Drug Administration (FDA) has approved three medications to treat OUD: buprenorphine, methadone, and naltrexone.

According to the guidance, SAMHSA funding should support comprehensive treatment and recovery support services, rather than medication alone. Funding may also support individualized tapering and discontinuation planning for MOUD when clinically appropriate.

After an individual is stabilized and has developed sufficient recovery supports, clinical professionals are encouraged to reassess treatment and recovery goals, including continued MOUD use, at least annually. Decisions regarding continuation of treatment should consider the individual’s progress toward treatment goals, stability in treatment, recovery capital, and personal preferences.

SAMHSA stated that discontinuation of MOUD should occur gradually and be accompanied by intensified support and monitoring to reduce the risk of resumed substance use. The agency emphasized that tapering or discontinuation should occur only within the context of ongoing comprehensive care.

To communicate these updated clinical principles and prepare grantees for revised fiscal year 2026 funding requirements, SAMHSA issued a Dear Colleague Letter outlining the agency’s updated expectations for OUD treatment programs.

In the letter, SAMHSA stated that it remains committed to expanding access to MOUD and recovery support services. However, the agency stated that MOUD should not automatically be treated as a life-long intervention for every individual receiving treatment. Rather, SAMHSA described MOUD as part of a pathway toward long-term recovery, sobriety, self-sufficiency, and improved functioning.

The agency acknowledged that research does not establish a single optimal duration for MOUD treatment. SAMHSA also noted that abrupt discontinuation or arbitrary treatment limits are associated with poor outcomes and increased relapse risk. The letter stated that while some individuals may require long-term or lifelong MOUD treatment, others may benefit from tapering and eventual discontinuation once sufficient recovery and social supports are established.

The full text of the SAMHSA Dear Colleague Letter: Updated Guidance On Medication Assisted Treatment/Medication For Opioid Use Disorder is in the OPEN MINDS Circle library.

For more information, contact: Christopher Carroll, MSc, Principal Deputy Assistant Secretary, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, Maryland 20857; Fax: 240-276-2135; Email: media@samhsa.hhs.gov; Website: https://www.samhsa.gov/