ASAM Provider Guide

National Practice Guideline for the Treatment of Opioid Use Disorder - 2020 Update

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2 Key Points Î ASAM defines addiction as "a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences." • The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) uses the term "opioid use disorder" (OUD). Î According to the 2018 National Survey on Drug Use and Health, an estimated 10.3 million people aged 12 or older misused opioids in the past year, including 9.9 people who misused prescription pain relievers and 808,000 people who used heroin. Î The leading causes of death in people using opioids for nonmedical purposes are overdose and trauma. Î Injection (intravenous [IV], or intramuscular [IM]) 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 guide is intended to aid clinicians in their clinical decision-making and patient management. The Practice Guideline pocket guide 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 guide is being used as the basis for regulatory or payer decisions, improvement in quality of care should be the goal. Table 1. Testing/Screening History Laboratory Social and Environmental Factors • Concomitant medical conditions (hepatitis, HIV, TB, acute trauma, pregnancy) • Alcohol • Other substance use including tobacco • CBC, LFTs, • Hepatitis A, B & C, HIV, STIs • Confirmatory urine drug testing • Pregnancy(?) • Food insecurity • Housing • Transportation challenges • Domestic violence • Significant mental health issues

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