By vgreene, 23 October, 2017 Discuss OTP options for opioid-agonist maintenance tx:5,6 buprenorphine (only)7,8 or methadone (when available)9 [S]; consider pt preferences, co-occurring mental health conditions, psychosocial problems
By vgreene, 23 October, 2017 Refer to licensed, certified opioid tx program (OTP)1 for maintenance tx
By vgreene, 23 October, 2017 If w/d sx: ✓indications for in-pt tx unstable medical/mental health condition, incl suicide/OD risk; co-occurring alcohol/sedative-hypnotic use disorder. Take into account pregnancy-specific factors.3 Treat w/d sx by starting maintenance agonist tx
By vgreene, 23 October, 2017 Assess: hx, PE, mental status exam, med hx (incl OTC), lab tests as indicated, COWS for severity of w/d sx
By vgreene, 23 October, 2017 Prefers to attend licensed, certified Opioid Treatment Program (OTP) for methadone or buprenorphine/naloxone tx
By vgreene, 23 October, 2017 Assess pt stability and need for in-pt w/d tx; tx w/d sx as needed; refer to OTP1 for maintenance tx; educate pt; offer psychosocial intervention2
By vgreene, 23 October, 2017 Offer optional psychosocial intervention [S]: individual counseling and/or contingency mgmt,11 considering pt preferences and provider training/competence12 [NA]
By vgreene, 23 October, 2017 Use addiction-focused medical mgmt [S]:10 Monitor w/ random urine testing and self-reporting; f/u closely and discuss test results; educate about opioid-use health risks, incl fetal/maternal OD death; encourage abstinence from alcohol and other drugs, gro
By vgreene, 23 October, 2017 Assess tx response7 periodically & systematically: Use standardized, valid instruments [W];8 assess and address barriers to recovery, incl adjusting/initiating meds; encourage ongoing relapse prevention efforts, individualized on basis of tx response [S];
