Key Points
Î ASAM defines addiction as "a primary, chronic disease of brain
reward, motivation, memory, and related circuitry," with a
"dysfunction in these circuits" being reflected in "an individual
pathologically pursuing reward and/or relief by substance use and
other behaviors."
• The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)
uses the term "opioid use disorder" (OUD).
Î According to the 2013 National Survey on Drug Use and Health,
4.5 million individuals in the United States were current (past month),
nonmedical users of prescription opioids and 289,000 were current
(past month) users of heroin.
Î The leading causes of death in people using opioids for nonmedical
purposes are overdose and trauma.
Î The injection route use (intravenous or even intramuscular) of opioids
or other drugs increases the risk of being exposed to HIV, viral
hepatitis, and other infectious agents.
Î Recommendations using the term "buprenorphine" will refer to
the combination buprenorphine/naloxone formulations. When
buprenorphine only is recommended it will be referred to as
"buprenorphine monoproduct." When recommendations differ by
product, the formulation will be described.
Î This ASAM Practice Guideline pocket card is intended to aid clinicians
in their clinical decision-making and patient management. The
Practice Guideline pocket card strives to identify and define clinical
decision making junctures that meet the needs of most patients
in most circumstances. Clinical decision-making should involve
consideration of the quality and availability of expertise and services
in the community wherein care is provided. In circumstances in which
the Practice Guideline pocket card is being used as the basis for
regulatory or payer decisions, improvement in quality of care should
be the goal.
