At MyStreetHealth, we treat opioid use disorder using a patient-centered, evidence-based approach that balances access with safety. We use telehealth when it is clinically appropriate and apply the same core standards to telehealth and in-person care.
Care is delivered using the same principles applied to other chronic medical conditions that require ongoing management. Treatment is structured, documented, and adjusted over time based on clinical response, stability, and safety. Clinical decisions are made by a physician and reflect standard medical practice for the management of a controlled medication.
Initial evaluation
How we start care.
Every new patient receives a documented clinical evaluation that confirms opioid use disorder and includes:
- substance use history
- withdrawal history
- prior treatment and overdose history
- co-occurring psychiatric conditions
- current medications
We review the prescription monitoring program before prescribing and document that review in the chart, consistent with federal expectations outlined by the DEA buprenorphine prescribing guidance.
When available and appropriate, we prefer audio-video visits. Audio-only care may be used when allowed under current federal rules and when clinically appropriate, as described in SAMHSA telemedicine prescribing guidance.
Clinical structure
Structure and accountability.
Treatment follows a structured progression. Patients are evaluated more frequently during the stabilization phase, and visit intervals are extended only after clinical stability is demonstrated. Prescription duration is aligned with follow-up needs and the patient's clinical status.
Visit frequency and prescription duration are determined by clinical risk, including medication formulation, adherence, and indicators of instability.
All prescribing decisions are based on clinical judgment and documented in the medical record, including medication selection, dosing, and formulation. This is standard medical practice for a condition that requires ongoing monitoring and adjustment over time.
Safety
How we keep treatment safe.
We use limited initial prescription quantities when clinically indicated, especially for new patients or higher-risk presentations, consistent with clinical practice recommendations such as those outlined in the PCSS telehealth guidance.
Follow-up is scheduled closely during early treatment and adjusted as stability improves. During early treatment, shorter prescription durations and closer follow-up are used to support safe stabilization.
Urine drug testing is used as a clinical tool when feasible and appropriate. It is not used as a barrier to care, and treatment is not delayed solely because testing is not immediately available.
Evidence from telehealth buprenorphine programs shows that urine drug testing can be effectively implemented in remote care settings, with high participation and low rates of unexpected results, as described in this peer-reviewed study on telehealth-based opioid treatment.
Monitoring
What we watch for.
We monitor for clinical indicators of instability, including:
- unexpected prescription monitoring activity
- early refill requests
- inconsistent medication use
- missed follow-up visits
- testing results that do not align with the treatment plan
When risk increases
When concerns arise.
When clinical risk increases, care is adjusted rather than discontinued. This may include shorter prescription durations, increased visit frequency, additional monitoring, or coordination with other clinicians.
The goal is to maintain continuity of care while addressing clinical risk in a medically appropriate way.
Why this model
Why this matters.
This model balances access to treatment with appropriate clinical oversight. It reflects current medical standards for the treatment of opioid use disorder and is designed to be consistent, accountable, and sustainable over time. For more on how care is structured day to day, see our approach to care.
Care is delivered within established federal and state frameworks governing controlled substance prescribing, including telemedicine-based treatment supported by guidance from SAMHSA and the DEA.
Sources and regulatory references
Where this information comes from.
SAMHSA: Buprenorphine Telemedicine Prescribing Q&A
Federal guidance on telemedicine-based buprenorphine prescribing, visit requirements, and regulatory framework.
DEA prescribing requirements, prescription monitoring expectations, and documentation standards for buprenorphine.
Clinical practice recommendations for telehealth buprenorphine treatment, including prescription quantities and follow-up structure.
Urine Drug Screening in Telehealth-Based Opioid Treatment
Peer-reviewed study on implementation of urine drug testing in telehealth buprenorphine programs, participation rates and outcomes.
Related
Our approach to care · The science · Services · Starting Suboxone