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Special Populations
Adolescents
Î Clinicians should consider treating adolescents who have OUD using
the full range of treatment options, including pharmacotherapy.
Î Opioid agonists (methadone and buprenorphine) and antagonists
(naltrexone) may be considered for treatment of OUD in adolescents.
• Federal laws and FDA approvals should be considered when recommending
pharmacotherapy for adolescent patients. Psychosocial treatment is recommended
in the treatment of adolescents with OUD.
Î MAJOR REVISION – Psychosocial treatment is recommended in the
treatment of adolescents with OUD.
• The risk benefit balance of pharmacological treatment without concurrent
psychosocial treatment should be carefully considered and discussed with the
patient and her or his parent or guardian as appropriate.
• A patient's decision to decline psychosocial treatment or the absence of available
psychosocial treatment should not preclude or delay pharmacological treatment
of OUD, with appropriate medication management.
• Motivational interviewing or enhancement can be used to encourage patients
to engage in psychosocial treatment services appropriate for addressing their
individual needs.
Î Concurrent practices to reduce infection (e.g., sexual risk reduction
interventions) are recommended as components of comprehensive
treatment for the prevention of sexually transmitted infections and
blood-borne viruses.
Î Adolescents may benefit from treatment in specialized treatment
facilities that provide multidimensional services.
Co-occurring Psychiatric Disorders
Î A comprehensive assessment including determination of mental
health status should evaluate whether the patient is stable.
• Patients with suicidal or homicidal ideation should be referred immediately for
treatment and possibly hospitalization.
Î Management of patients at risk for suicide should include:
a. reducing immediate risk
b. managing underlying factors associated with suicidal intent
c. monitoring and follow-up.
Î All patients with psychiatric disorders should be asked about suicidal
ideation and behavior.
• Patients with a history of suicidal ideation or attempts should have adherence for
OUD and psychiatric disorder medications monitored more closely.
