2
Key Points
Î ASAM defines addiction as "a treatable, chronic medical disease
involving complex interactions among brain circuits, genetics, the
environment, and an individual's life experiences. People with addiction
use substances or engage in behaviors that become compulsive and
often continue despite harmful consequences."
• The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)
uses the term "opioid use disorder" (OUD).
Î According to the 2018 National Survey on Drug Use and Health,
an estimated 10.3 million people aged 12 or older misused opioids
in the past year, including 9.9 people who misused prescription pain
relievers and 808,000 people who used heroin.
Î The leading causes of death in people using opioids for nonmedical
purposes are overdose and trauma.
Î Injection (intravenous [IV], or intramuscular [IM]) of opioids or other
drugs increases the risk of being exposed to HIV, viral hepatitis, and
other infectious agents.
Î Recommendations using the term "buprenorphine" will refer to
the combination buprenorphine/naloxone formulations. When
buprenorphine only is recommended it will be referred to as
"buprenorphine monoproduct." When recommendations differ by
product, the formulation will be described.
Î This ASAM Practice Guideline pocket guide is intended to aid clinicians
in their clinical decision-making and patient management. The Practice
Guideline pocket guide strives to identify and define clinical decision
making junctures that meet the needs of most patients in most
circumstances. Clinical decision-making should involve consideration of
the quality and availability of expertise and services in the community
wherein care is provided. In circumstances in which the Practice
Guideline pocket guide is being used as the basis for regulatory or
payer decisions, improvement in quality of care should be the goal.
Table 1. Testing/Screening
History Laboratory
Social and Environmental
Factors
• Concomitant medical
conditions (hepatitis,
HIV, TB, acute
trauma, pregnancy)
• Alcohol
• Other substance use
including tobacco
• CBC, LFTs,
• Hepatitis A, B & C, HIV,
STIs
• Confirmatory urine drug
testing
• Pregnancy(?)
• Food insecurity
• Housing
• Transportation challenges
• Domestic violence
• Significant mental health
issues
