Download Medications for Opioid Use Disorder PDF

TitleMedications for Opioid Use Disorder
LanguageEnglish
File Size8.6 MB
Total Pages306
Table of Contents
                            TOC all
OUDTIP_ExecSum
	Executive Summary
		Foreword
		Introduction
		Overall Key Messages
		Content Overview
			Part 1: Introduction to Medications for Opioid Use Disorder Treatment
			Part 2: Addressing Opioid Use Disorder in General Medical Settings
			Part 3: Pharmacotherapy for Opioid Use Disorder
			Part 4: Partnering Addiction Treatment Counselors With Clients and Healthcare Professionals
			Part 5: Resources Related to Medications for Opioid Use Disorder
		TIP Development Participants
			Expert Panelists
			TIP Chair
			TIP Expert Panelists
			SAMHSA’s TIP Champion
			Scientific Reviewers
			Buprenorphine
			Naltrexone
			Methadone
			Field Reviewers
		Publication Information
		Notes
OUDTIP_Part 1
	Part 1: Introduction to Medications for Opioid Use Disorder Treatment
		The Approach to OUD Care
		Overview of Medications for OUD
			Benefits
			Effectiveness
				Methadone
				Naltrexone
				Buprenorphine
			Cost Effectiveness and Cost Benefits
			Requirements and Regulations
		Duration of Treatment With OUD Medication
			Maintenance Treatment
			Medication Taper
			Medically Supervised Withdrawal
		Treatment Settings
		Challenges to Expanding OUD Medication
		Resources
		Notes
OUDTIP_Part 2
	Part 2: Addressing Opioid Use Disorder in General Medical Settings
	Scope of the Problem
	Screening
		Alcohol Screening
		Tobacco Screening
		Drug Screening
	Assessment
		Determine the Need for and Extent of Assessment
		Set the Stage for Successful Assessment
		Take a Complete History
			Medical history
			Mental health history
			Substance use history
			SUD treatment history
			Social history
			Family history
		Conduct a Physical Examination
			Opioid withdrawal
		Obtain Appropriate Laboratory Tests
			Urine or oral fluid drug testing
			Other laboratory tests
		Review the PDMP
		Determine Diagnosis and Severity of OUD
	Treatment Planning or Referral
		Making Decisions About Treatment
		Understanding Treatment Settings and Services
		Outpatient OUD treatment settings
			Outpatient medical settings
			Residential drug treatment settings
		Determining OUD Service Intensity and Ensuring Follow-Through
			Referring Patients to Behavioral Health and Support Services
			Helping patients who are not ready to engage in OUD treatment
		Preventing Opioid-Related Overdose
	Resources
		Alcohol and Drug Use Screening
		Tobacco Screening
		Buprenorphine Treatment Locator
		Buprenorphine Training, Mentorship, and Waivers
		Medication Treatment for OUD
		Syringe Exchange
		Opioid-Related Overdose Prevention
		Opioid Withdrawal Scales
		Patient and Family Education on Medications To Treat OUD
		Referral and Treatment Locators
		Screening, Assessment, and Drug Testing Resources
		Treatment Planning
	Appendix
	General Instructions
	Notes
OUD-TIP_Part 3
	Part 3: Pharmacotherapy for Opioid Use Disorder
	Scope of the Problem
	Chapter 3A: Overview of Pharmacotherapy for Opioid Use Disorder
	Introduction to Medications That Address OUD
		Methadone
		Naltrexone
		Buprenorphine
		Choosing an OUD Medication
		Comparative Effectiveness
		Duration of Medication
	Principles of OUD Pharmacotherapy
		Basic Function
		Intrinsic Activity
	Overview of Medication Indications and Dosing
	Chapter 3B: Methadone
	Formulations
	Pharmacology
	Bioavailability
	Dosing Considerations
	Contraindications
		Precautions and Warnings
			Respiratory depression
			Concurrent substance use disorders involving benzodiazepines or alcohol
			QTc prolongation and cardiac arrhythmia
		Drug Interactions
		Side Effects
		Assessment
		Patient Selection
		Informed Consent
	Initiating Methadone Treatment
		Day 1
			First dose for patients with opioid tolerance
			First dose for patients without current opioid dependence
		Dose Titration (Weeks 1 to 2)
		Dose Titration (Weeks 3 to 4)
		Serum Levels
		Dose Stabilization (Week 5 and Beyond)
		Take-Home Medication
			Assessing responsible handling of take-home doses
	Duration of Methadone Treatment
		Dose Tapering and Methadone Discontinuation
	Methadone Dosing Summary
	Enhancing Access to OUD Medication in OTPs
	Chapter 3C: Naltrexone
	Formulations
	Pharmacology
		Bioavailability
	Dosing Considerations
		XR-NTX
			Contraindications
			Precautions and warnings
			Side effects
			Assessment
			Patient selection
			Informed consent
			Initiating XR-NTX treatment
			Duration of treatment
		Oral Naltrexone
			Indications and contraindications, precautions and warnings, side effects, and assessment.
			Dosing
			Duration of treatment
	Naltrexone Dosing Summary
		XR-NTX
		Oral Naltrexone
	Chapter 3C Appendix
	Chapter 3D: Buprenorphine
	Formulations
		History of Approvals
		Implants
		Injectables
	Pharmacology
	Bioavailability
		Metabolism and Excretion
	Dosing Considerations
		Contraindications
		Precautions and Warnings
		Drug Interactions
		Side Effects
		Assessment
		Patient Selection
		Informed Consent
	Initiating Buprenorphine Treatment
		Office-Based Induction
		Home Induction
		Induction
			Patients who are currently physically dependent on opioids
			Patients with a history of OUD who are not currently physically dependent on opioids
			Patients who are currently taking methadone
		Dose Stabilization
		Risk Evaluation and Mitigation Strategy
		Transmucosal Buprenorphine Dosing Summary
			Induction and stabilization
			Maintenance
			Duration of treatment
		Initiation of Buprenorphine Implants
			Implant procedure
			Wound care
			Stabilization
			Removal
		Initiation of Buprenorphine Extended-Release Injection
			Storage
			Administration
			Medical management
	Duration of Buprenorphine Treatment
		Successful Buprenorphine Treatment
		Dose Tapering and Buprenorphine Discontinuation
	Chapter 3D Appendix
	Chapter 3E: Medical Management Strategies for Patients Taking OUD Medications in Office-Based Settings
	Patient Selection
	Patient Management and Treatment Monitoring
		Course of Treatment
		Role of the Treatment Plan and Treatment Agreement in Medical Management
		Medical Management Strategies
			Referral to counseling and other psychosocial supports
			Frequency of medical management visits
			Drug testing in ongoing medical management
			Assessing buprenorphine adherence
			Discontinuing medication for OUD
			Patient follow-up
	Administrative Considerations
		Patient Limits
			Physicians
			Nurse practitioners and physician assistants
		Diversion Control Policies for OBOT With Buprenorphine
		Storage of Buprenorphine
		Records for Dispensers
			Recordkeeping for ordering, storing, and dispensing buprenorphine in the office
			Recordkeeping for prescribing buprenorphine
		DEA Inspections
	Emergency Protocols and Patient Safety Measures
	Recommendations for Staff Member Training
	Chapter 3E Appendix
	Chapter 3F: Medical Management of Patients Taking OUD Medications in Hospital Settings
	Hospitalized or ED Patients Taking Medication for OUD
		Pain Management
		Buprenorphine
		Methadone
		Naltrexone
	Hospitalized or ED Patients Not Taking Medication for OUD
		Buprenorphine Induction in the Hospital Setting
		Methadone Induction in the Hospital Setting
		Naltrexone Induction in the Hospital Setting
	Medical Management Plan
	Notes
OUDTIP_Part 4
	Part 4: Partnering Addiction Treatment Counselors With Clients and Healthcare Professionals
	Overview and Context
		Scope of the Problem
		Setting the Stage
		Distinguishing OUD From Physical Dependence on Opioid Medications
		Understanding the Benefits of Medication for OUD
		Reviewing the Evidence on Counseling in Support of Medication To Treat OUD
		Using a Recovery-Oriented Approach To Treat Patients With OUD
			Acknowledge many pathways to recovery
			Promote recovery for clients with OUD
			Provide person-centered care
			Promote family and social support
			Provide trauma-informed care
	Quick Guide to Medications
		Understanding the Neurobiology of OUD
		Learning How OUD Medications Work
			Buprenorphine
			Methadone
			Naltrexone
		Knowing What Prescribers Do
			Administer buprenorphine
			Administer methadone
			Administer naltrexone
			Set expectations
	Counselor–Prescriber Communications
		Obtaining Consent
		Structuring Communications With Prescribers
		Helping Clients Overcome Challenges in Accessing Resources
	Creation of a Supportive Counseling Experience
		Maintaining the Therapeutic Alliance
		Educating Patients About OUD and a Chronic Care Approach to Its Treatment
		Counseling Patients on Overdose Prevention and Treatment
		Consider working with the program administrators to set up a program to distribute naloxone directly to patients. Many states allow organizations to do this under a standing order from a physician. Clients are more likely to access naloxone if their ...
		Helping Patients Cope With Bias and Discrimination
		Helping Patients Advocate for Themselves
		Addressing Discrimination Against Clients Who Take OUD Medication
			Help clients address employment-related issues
			Understand potential legal issues
			Address issues in dealing with healthcare providers
			Demonstrate awareness of pregnancy and parenting issues
		Helping Clients Find Accepting Mutual-Help Groups
			Prepare clients who take medication for OUD to attend mutual-help meetings
			Facilitate positive mutual-help group experiences
		Facilitating Groups That Include Patients Taking OUD Medication
	Other Common Counseling Concerns
	Notes
OUD-TIP_Part 5
	Part 5: Resources Related to Medications for Opioid Use Disorder
		General Resources
			Facts, Figures, and General Information
			Groups and Organizations
			SAMHSA Publications
		Resources for Medical and Behavioral Health Service Providers
			General Information
			Practice Guidelines and Decision-Support Tools
			Assessment Scales and Screening Tools
		Resources for Counselors and Peer Providers
			Organizations
			Publications and Other Resources
		Resources for Clients and Families
			Organizations
			Publications and Other Resources
			Treatment Locators
			Patient Success Stories
			Online Boards and Chat Rooms
		Provider Tools and Sample Forms
			Provider Screening and Assessment Tools and Aids
			Provider Informational, Educational, and Decision-Making Tools
			Sample Provider Forms
				General forms
				Buprenorphine forms
				Naltrexone forms
		Glossary of TIP Terminology
		Notes
                        

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