5
Comprehensive Assessment
2. After first addressing any urgent biomedical or psychiatric signs or
symptoms, patients should undergo a comprehensive assessment
that includes:
a. assessment for StUD based on diagnostic criteria (eg, current Diagnostic and
Statistical Manual of Mental Disorders [DSM]); CC-S);
b. a StUD-focused history and physical examination (CC-S);
c. a mental status exam to identify co-occurring psychiatric conditions, such as
signs and symptoms of psychosis, ADHD, mood or anxiety disorders, cognitive
impairment, and risk of harm to self or others (CC-S); and
d. a full biopsychosocial assessment (CC-S).
3. Clinicians treating StUD should conduct routine baseline laboratory
testing (CC-S).
a. Clinicians should conduct other clinical tests as necessary based on each
patient's clinical assessment findings (CC-C).
In non-acute care settings, clinicians should order the following
clinical tests for most patients:
• Complete blood count (CBC)
• Comprehensive metabolic panel (CMP) (eg, renal panel, liver function test [LFTs])
• Screening for infectious diseases in accordance with current guidance
• HIV and HCV for all patients
• Hepatitis B virus (HBV) for patients at increased risk for infection
• Screening for STIs (eg, gonorrhea, chlamydia, syphilis)
• Pregnancy testing for all patients with childbearing potential
Clinicians can also consider ordering the following clinical tests:
• Tuberculosis (TB) for patients at increased risk for infection
• HAV for patients at increased risk for infection
• Other clinical tests as necessary based on clinical assessment, such as creatine kinase
(CK) if signs of rhabdomyolysis are present (eg, increased muscle tone/rigidity,
elevated temperature)
4. When evaluating patients with long-term or heavy stimulant use,
clinicians should exercise:
a. an elevated degree of suspicion for cardiac disorders (CC-C),
b. a lower threshold for considering electrocardiogram (ECG) testing based on
findings of the history and physical exam (CC-C),
c. a lower threshold for considering CK testing for rhabdomyolysis based on
history and physical exam findings (CC-S), and
d. an elevated degree of suspicion for renal disorders (CC-C).
