20
Treatment
Figure 1. Evaluation and Treatment
Physical
History
• Concomitant medical conditions
(hepatitis, HIV, TB, acute trauma,
pregnancy)
• Other substance use including
tobacco
• Offer hepatitis B vaccine (?)
• Offer contraception (?)
• Withdrawal management (WM)
Laboratory
• CBC, LFTs, HIV,
hepatitis A, B & C
• Urine drug testing (frequently)
• STDs(?)
• Pregnancy(?)
Social and
Environmental Factors
Select
treatment
site
Identify and refer urgent problems
LEGEND
Diagnosis/Evaluation
Treatment
Results, Notes, Status
Important Comments
Consider
medications
for OUD
Consider
medications
for WM
Consider
psychosocial
treatment needs
• Buprenorphine
• Methadone
• Lofexidine
• Clonidine
• Other ancillary
meds
Initiate Treatment
• Buprenorphine
• Methadone
• XTR-Naltrexone
• Counseling
• Relapse
Prevention
• Food insecurity
• Housing
• Transportation
• Interpersonal
violence
Level 1:
Outpatient/
primary care
Level 2: Intensive
outpatient/PHP
Level 3:
Residential
Level 4: Hospital
Consider Overdose Prevention
(See Naloxone Recommendations)
Medication
Management
Monitoring
Relapse Risk
Progress and
Outcome Monitoring
Ongoing Treatment and Monitoring
Adjust treatment plan as needed:
• Medication dose
• Psychosocial services
• Recovery support services
• Level of Care/Treatment site
• Switch medications?
Mental Health Status
• (See Co-Occurring
Psychiatric Disorders)
