ASAM Provider Guide

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

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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 ).

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