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Î Assessment for psychiatric disorder should occur at the onset of
agonist or antagonist treatment.
• However, completion of all assessments should not delay or preclude initiating
pharmacotherapy for OUD.
• If not completed before initiating treatment, assessments should be completed as
soon as possible thereafter.
• Reassessment using a detailed mental status examination should occur after
stabilization with methadone, buprenorphine, or naltrexone.
Î MAJOR REVISION – Pharmacotherapy in conjunction with psychosocial
treatment should be offered to patients with OUD and a co-occurring
psychiatric disorder.
• 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 mediation management.
• Motivational interviewing or enhancement can be used to encourage patients
to engage in psychosocial treatment services appropriate for addressing their
individual needs.
Î Clinicians should be aware of potential interactions between
medications used to treat co-occurring psychiatric conditions
and OUD.
Î Assertive community treatment should be considered for patients with
co-occurring schizophrenia and OUD who have a recent history of, or
are at risk of, repeated hospitalization or homelessness.
Individuals in the Criminal Justice System
Î NEW – All FDA-approved medications for the treatment of OUD should
be available to individuals receiving healthcare within the criminal
justice system.
• The treatment plan, including choice of medication, should be based on the
patient's individual clinical needs.
Î Continuation of treatment after release results in a substantial
reduction in all-cause and overdose mortality.
• Treatment should be individualized, and patients should receive complete
information to make informed decisions in consultation with a medical and
treatment team.
Î NEW – Individuals entering the criminal justice system should NOT be
subject to forced opioid withdrawal.
• Patients being treated for OUD at the time of entrance into the criminal justice
system should continue their treatment.
• Patients with OUD who are not in treatment should be assessed and offered
individualized pharmacotherapy and psychosocial treatment as appropriate.
