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About Medication First

"Medication First" is a low-threshold approach to Opioid Use Disorder treatment that relies on four principles:
  1. People with OUD receive pharmacotherapy treatment as quickly as possible, prior to lengthy assessments or treatments planning sessions;
  2. Maintenance pharmacotherapy is delivered without arbitrary tapering or time limits;
  3. Individualized psychosocial services are continually offered but not required as a condition of pharmacotherapy;
  4. Pharmacotherapy is discontinued only if it is worsening the person’s condition.
Webinar explaining the rationale for the Medication First approach
Evaluation of the Medication First Approach
Banta-Green, C. J., Owens, M. D., Williams, J. R., Sears, J. M., Floyd, A. S., Williams-Gilbert, W., & Kingston, S. (2022). The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State. Addiction Science & Clinical Practice, 17(1), 1-8.
Winograd, R. P., Presnall, N., Stringfellow, E., Wood, C., Horn, P., Duello, A., ... & Rudder, T. (2019). The case for a medication first approach to the treatment of opioid use disorder. The American journal of drug and alcohol abuse, 45(4), 333-340.
Winograd, R. P., Wood, C. A., Stringfellow, E. J., Presnall, N., Duello, A., Horn, P., & Rudder, T. (2020). Implementation and evaluation of Missouri's Medication First treatment approach for opioid use disorder in publicly-funded substance use treatment programs. Journal of substance abuse treatment, 108, 55-64. is in ongoing development. Please email any questions, concerns, requests to If you are advocating for or implementing low-threshold OUD treatment in your agency, city, or state please share your experience. We want to hear about it!

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