Diagnosis
Î A tobacco use query and counseling on cessation of tobacco products
and electronic nicotine delivery devices should be completed routinely
for all patients, including those who present for evaluation and
treatment of OUD.
Î An assessment of social and environmental factors should
be conducted (as outlined in the ASAM Standards) to identify
facilitators and barriers to addiction treatment, and specifically to
pharmacotherapy.
• Before a decision is made to initiate a course of pharmacotherapy for the patient
with OUD, the patient should receive a multidimensional assessment in fidelity
with The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related,
and Co-Occuring Conditions (the "ASAM Criteria"
3
). Addiction should be
considered a bio-psycho-social-spiritual illness, for which the use of medication(s)
is only one component of overall treatment.
Diagnosis
ÎOther clinicians may diagnose OUD, but confirmation of the diagnosis by
the provider with prescribing authority, and who recommends medication
use, must be obtained 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: Examples include
4
:
• the Objective Opioid Withdrawal Scale (OOWS)
a
• the Subjective Opioid Withdrawal Scale (SOWS)
a
• the Clinical Opioid Withdrawal Scale (COWS)
a
a
Visit ASAM.GuidelineCentral.com for calculators
Î Urine drug testing during the comprehensive assessment process, and
frequently during treatment, is recommended. The frequency of drug
testing is determined by a number of factors including: the stability of
the patient, the type of treatment, and the treatment setting.
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