ASAM Provider Guide

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

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6 Treatment Treatment Options Î MAJOR REVISION – All FDA-approved medications for the treatment of OUD should be available to all patients. Clinicians should consider the patient's preferences, past treatment history, current state of illness, and treatment setting when deciding between the use of methadone, buprenorphine, and naltrexone. Î NEW – There is no recommended time limit for pharmacological treatment. Î MAJOR REVISION – Patients' psychosocial needs should be assessed, and patients should be offered or referred to psychosocial treatment based on their individual needs. • However, a patient's decision to decline psychosocial treatment or the absence of available psychosocial treatment should not preclude or delay pharmacotherapy, with appropriate medication management. • Motivational interviewing or enhancement can be used to encourage patients to engage in psychosocial treatment services appropriate for addressing individual needs. ÎThe venue in which treatment is provided should be carefully considered. • Methadone can be provided only in opioid treatment programs (OTPs) and acute care settings (under limited circumstances). • Buprenorphine can be prescribed by waivered clinicians in any setting including OTPs and office based opioid treatment (OBOT) in accordance with Federal law (21 CFR §1301.28). • Naltrexone can be prescribed in any setting by any clinician with the authority to prescribe medication. • Clinicians should consider a patient's psychosocial situation, co-occurring disorders, and risk of diversion when determining which treatment setting is most appropriate (see The ASAM Criteria 1 for additional guidance). Î Patients with active co-occurring alcohol use disorder or sedative, hypnotic, or anxiolytic use disorder (or who are in treatment for a substance use disorder involving use of alcohol or other sedative drugs including benzodiazepines or benzodiazepine receptor agonists) may need a more intensive level of care than can be provided in an office-based setting. • Persons who are regularly using alcohol or other sedatives, but do not meet the criteria for diagnosis of a specific substance use disorder related to that class of drugs, should be carefully monitored. Î MAJOR REVISION – The prescribing of benzodiazepines or other sedative-hypnotics should be used with caution in patients who are prescribed methadone or buprenorphine for the treatment of an OUD. • While the combined use of these drugs increases the risk of serious side effects, the harm caused by untreated OUD can outweigh these risks. • A risk-benefit analysis should be conducted when deciding whether to co- prescribe these medications.

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