By vgreene, 4 November, 2019 DSM-51 definition: problematic use w/clinically significant impairment/distress in a 12-mo period. Mild=2-3, Mod=4-5, Severe=6+ of these:
By vgreene, 4 November, 2019 Consider if misuse behavior signs or unanticipated challenges to tapering If opioid use disorder diagnosed arrange medication assisted tx buprenorphine etc
By vgreene, 4 November, 2019 Expert consult if: pregnancy (risks for spontaneous abortion/premature labor); serious mental illness/suicidal ideation; or if expertise needed from clinician familiar w/ buprenorphine initiation
By vgreene, 4 November, 2019 Closely monitor pts unwilling/unable to taper: Offer OD education, naloxone, encouragement. Eval for opioid use disorder1 if misuse signs. If on high doses despite worse pain/function, consider transition to buprenorphine (even w/o opioid use disorder)