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Diagnosis
Î MAJOR REVISION –The use of benzodiazepines and other sedative-
hypnotics should not be a reason to withhold or suspend treatment
with methadone or buprenorphine.
• While the combined use of these medications increases the risk of serious side
effects, the harm caused by untreated OUD can outweigh these risks.
• A risk-benefit analysis should be conducted, and greater support should be
provided including careful medication management to reduce risks.
Î A nicotine use query should be completed routinely for all patients
and counseling on cessation of the use of tobacco products and
electronic nicotine delivery devices (e.g., vaping) provided if indicated.
Î As part of comprehensive care, the patient should receive a
multidimensional assessment (as described in The ASAM Criteria
1
),
including an assessment of social and environmental factors, to
identify facilitators and barriers to addiction treatment and long-term
recovery (including pharmacotherapy).
• Addiction is a complex biopsychosocial illness, for which the use of medication(s)
is only one component of comprehensive treatment.
Diagnosis
ÎOther clinicians may diagnose OUD, but confirmation of the diagnosis
must be obtained by the prescriber before pharmacotherapy for OUD
commences.
Î OUD is primarily diagnosed on the basis of the history provided by
the patient and a comprehensive assessment that includes a physical
examination.
Î Validated clinical scales that measure withdrawal symptoms may be
used to assist in the evaluation of patients with OUD.
Î Drug testing is recommended during the comprehensive assessment
process and during treatment to monitor patients for adherence to
prescribed medications and use of alcohol, illicit, and controlled
substances.
• The frequency of testing is determined by several factors including stability of
the patient, type of treatment, and treatment setting. For additional information
see The ASAM Appropriate Use of Drug Testing in Clinical Addiction Medicine
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guidance document.
