By vgreene, 23 October, 2017 Prefers injectable ER naltrexone office based tx when opioid agonist contraindicated or unavailable or unacceptable
By vgreene, 23 October, 2017 Offer optional psychosocial intervention: individual counseling and/or contingency mgmt,9 considering pt preferences and provider training/competence10 [NA]
By vgreene, 23 October, 2017 Use addiction-focused medical mgmt:8 Monitor w/ random urine testing and self-reporting; f/u closely and discuss test results; educate about opioid-use health risks, incl death from OD; encourage abstinence from alcohol and other drugs, group mutual-help
By vgreene, 23 October, 2017 Assess tx response5 periodically & systematically: Use standardized, valid instruments6 [W]; assess and address barriers to recovery, incl adjusting/initiating meds; encourage ongoing relapse prevention efforts, individualized on basis of tx response [S];
By vgreene, 23 October, 2017 Start recommended opioid-antagonist maintenance regimen: injectable extended-release naltrexone3,4 [S]
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. Treat w/d sx w/ medication, as psychosocial intervention alone not recommended d/t high risk of rel
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 Assess pt stability need for in pt w d tx tx any w d sx initiate maintenance tx use addiction focused medical mgmt offer psychosocial intervention1
