ASAM Opioid Addiction Treatment GUIDELINES Apps and Pocket Guides brought to you courtesy of Guideline Central. Enjoy!
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9 Î There is no recommended length of treatment with oral naltrexone or extended-release injectable naltrexone. • Duration depends on clinical judgment and the patient's individual circumstances. Because there is no physical dependence associated with naltrexone, it can be stopped abruptly without withdrawal symptoms. Î Switching from naltrexone to methadone or buprenorphine should be planned, considered, and monitored. • Switching from an antagonist such as naltrexone to a full agonist (methadone) or a partial agonist (buprenorphine) is generally less complicated than switching from a full or partial agonist to an antagonist because there is no physical dependence associated with antagonist treatment and thus no possibility of precipitated withdrawal. • Patients being switched from naltrexone to buprenorphine or methadone will not have physical dependence on opioids and thus the initial doses of methadone or buprenorphine used should be low. • Patients should not be switched until a significant amount of the naltrexone is no longer in their system, about 1 day for oral naltrexone or 30 days for extended- release injectable naltrexone. Î Patients who discontinue antagonist therapy and resume opioid use should be made aware of the increased risks associated with an opioid overdose, and especially the increased risk of death. Psychosocial Treatment in Conjunction with Medications for the Treatment of OUD Î Psychosocial treatment is recommended in conjunction with any pharmacological treatment of OUD. • At a minimum, psychosocial treatment should include the following : psychosocial needs assessment, supportive counseling, links to existing family supports, and referrals to community services. Î Treatment planning should include collaboration with qualified behavioral health care providers to determine the optimal type and intensity of psychosocial treatment and for renegotiation of the treatment plan for circumstances in which patients do not adhere to recommended plans for, or referrals to, psychosocial treatment. Î Psychosocial treatment is generally recommended for patients who are receiving opioid agonist treatment (methadone or buprenorphine). Î Psychosocial treatment should be offered with oral and extended- release injectable naltrexone. • The efficacy of extended-release injectable naltrexone to treat OUD has not been confirmed when it has been used as pharmacotherapy without accompanying psychosocial treatment.