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
