Opioid Treatment Program Mortality Report Form
The Opioid Treatment Program (OTP) Mortality Report Form allows OTPs to voluntarily
report mortality data on patients who, at the time of death, were receiving medication-assisted
treatment (methadone or buprenorphine) at a SAMHSA-certified OTP.
In 2004, accidental poisoning became the second leading cause of injury death in
this country, with drug poisoning deaths being responsible for the large increases
seen in recent years, since 1999. While it is believed that most of this increase
has been among individuals taking a prescription narcotic and not in medication-assisted
treatment for opioid addiction, there has been no means of estimating the number
of patients dying while enrolled in OTPs and the causes of those deaths. Under the
statutory authority of The Public Health Service Act, SAMHSA is responsible for
supporting activities that will improve treatment for substance abuse and coordinating
Federal policy with respect to methadone. The proposed information gathering relating
to mortality is ultimately in adherence to this legislative mandate.
SAMHSA is requesting that this information be voluntarily reported to SAMHSA. We
also welcome feedback regarding use of the report form. Given national concerns
over drug poisoning deaths, and the belief that a SAMHSA-certified OTP should represent
safe and competent addiction treatment of patients who have become dependent on
heroin or prescription opioid drugs, SAMHSA may propose new rules requiring mandatory
A designated OTP staff member should complete and submit the form to SAMHSA within
48 hours of notification of a patient death. The OTP’s investigation into a patient
death should follow the policies and procedures set forth by the State and program.
Additional information pertinent to the cause(s) of death discovered after the initial
notification should be forwarded to SAMHSA immediately. All subsequent communication
should reference the initial report.
OTP mortality reports can be submitted to SAMHSA at the
SAMHSA OTP Extranet Web site (http://otp-extranet.samhsa.gov). Full instructions
for completing and submitting mortality reports are available on the site.
Note, all OTPs have an account on the SAMHSA
OTP Extranet Web site. For instructions on accessing your program's account,
contact the SAMHSA OTP Extranet Information Center at:
1-866-687-2728 (OTP-CSAT) or email@example.com.
Programs unable to submit at the SAMHSA OTP
Extranet Web site may download the OTP Mortality report form here and
mail or fax it to DPT.
For additional information or questions, please contact Alina Walizada, Public Health
Advisor, at (240) 276-2755 or by e-mail at