3
Diagnosis
Assessment
Î The first clinical priority should be given to identifying and making
appropriate referral for any urgent or emergent medical or psychiatric
problem(s), including drug-related impairment or overdose.
Î NEW – Comprehensive assessment of the patient is critical for
treatment planning. However, completion of all assessments should
not delay or preclude initiating pharmacotherapy for OUD. If not
completed before initiating treatment, assessments should be
completed soon thereafter.
Î Completion of the patient's medical history should include screening
for concomitant medical conditions including psychiatric disorders,
infectious diseases (viral hepatitis, HIV, and tuberculosis [TB]), acute
trauma, and pregnancy.
Î A physical examination should be completed as a component of the
comprehensive assessment process. The prescriber (the clinician
authorizing the use of a medication for the treatment of OUD) should
ensure that a current physical examination is contained within the
patient medical record before (or soon after) a patient is started on
pharmacotherapy. (See Table 1)
Î Initial laboratory testing should include a complete blood count, liver
enzyme tests, and tests for TB, hepatitis B and C, and HIV. Testing
for sexually transmitted infections should be strongly considered.
Hepatitis A and B vaccinations should be offered, if appropriate.
Î Women of childbearing potential should be tested for pregnancy,
and all women of childbearing potential should be queried regarding
methods of contraception.
Î Patients being evaluated for OUD, and/or for possible medication
use in the treatment of OUD, should undergo (or have completed) an
assessment of mental health status and possible psychiatric disorders
(such as is outlined in The ASAM Criteria
1
and The ASAM Standards
2
).
OUD is often co-occurring with other substance use disorders.
Evaluation of a patient with OUD should include a detailed history of
other past and current substance use and substance use disorders.
Î The use of cannabis, stimulants, alcohol, and/or other addictive
drugs should not be a reason to withhold or suspend OUD treatment.
However, patients who are actively using substances during OUD
treatment may require greater support including a more intensive level
of care (see The ASAM Criteria
1
and The ASAM Standards
2
).
