How to Refer Patients to an Addiction Specialist
Clinical tips and advice about:
- When to refer patients to specialized substance abuse treatment
- How to find addiction specialists and psychosocial treatment providers in your area
- How to talk to a patient about referral to an addiction specialist
- What information to provide patients when you refer them for buprenorphine or other substance abuse treatment
Plus resources on each page with additional tips and tools!
| Written by Clinical Tools, Inc. [1] Reviewed by experts in buprenorphine treatment [2] Publication date February 9, 2009. |
Download Entire Guide [3] |
When to Refer Patients to Specialized Substance Abuse Treatment
Primary care physicians who do not prescribe buprenorphine should refer opioid-dependent patients to a specialist either another physician or a substance abuse treatment center whenever:
- A brief assessment and intervention is not an adequate treatment.
- You suspect or confirm that patients are using or abusing opioids or other illicit drugs.
- Patients have a complicated medical or substance abuse history and require intensive treatment.
- Patients request a referral to substance abuse treatment.
Primary care physicians who are prescribing buprenorphine should consider referral to an addiction specialist or substance abuse treatment center in certain cases:
- Patient has a complicated medical, psychiatric, social, or substance abuse history and requires more intensive or structured treatment than you can provide in the office setting.
- Patient is non-compliant with your office policies or treatment protocol.
- Patient is requesting transfer from high-dose methadone maintenance or is dependent on other high-dose long-acting opioids or short-acting opioids.
- You are over your patient-prescribing limit (physicians can treat up to 30 patients simultaneously during the first year that they are waivered, 100 patients every subsequent year).
Remember that all physicians who are prescribing buprenorphine and managing patient care themselves should refer patients to psychosocial treatment services.
Locating Addiction Specialists and Psychosocial Treatment Providers
Physicians who do not want to prescribe buprenorphine should maintain a list of local treatment providers where they can refer patients when an opioid use disorder is identified or suspected.
Physicians who are starting a buprenorphine practice should assemble a list of treatment providers in their area where you can refer patients for psychosocial treatment. It is also helpful to contact a few other buprenorphine providers in your area in case a consultation is needed, a complication arises, for back-up for vacations, or for other unforeseen emergencies (so that patients can still get treatment or prescriptions if you are unavailable).
Talking to Patients About Referral to an Addiction Specialist
Some patients will resist or flatly deny substance abuse. However, if you suspect substance abuse and referral to addiction treatment is warranted, then you must discuss the issues with the patient. Explain to patients and their significant others that:
- Addiction is a treatable chronic disease
- You want to give them the best treatment and so you are referring them to a specialist much like you would do for other chronic diseases
- When stabilized, patients may return to the primary care provider for on-going care, while the addiction specialist can continue to provide the buprenorphine treatment
Skillful, empathetic interviewing is key and specific approaches should be followed when discussing substance abuse with patients.
Try these sensitive interviewing techniques when recommending a referral:
- Use the "Ask-Tell-Ask" approach:
- Ask permission to discuss something with them
- Tell them your concerns
- Ask what they thought about what you said
- Remember your role as a health provider - explain that you need to discuss drug use because you are concerned about their health and explain why you are recommending a referral. Point out the direct relationship between their drug use and any health or social consequences they might have experienced.
- Provide as much information as possible about the provider/clinic where you are referring the patient; if you speak with confidence and knowledge about the treatment center, patients are more likely to respond more positively.
- Maintain the patient's privacy - conduct the interview in private and do not bring up the substance abuse or referral around other staff members, family, or friends without the patient's permission.
Providing Information to Patients Referred for Buprenorphine or Other Substance Abuse Treatment
Patients who have been referred for buprenorphine treatment may be anxious about what to expect. You can help ease patient concerns by providing some patient education materials about topics, such as:
- substance abuse treatment
- including information about how buprenorphine works
- what treatment entails
- benefits of treatment and recovery
See our list of downloadable patient education materials [15].
Summary
- Physicians who do not prescribe buprenorphine should refer opioid-dependent patients to a physician who can treat them. Physicians who prescribe buprenorphine may also find it necessary to refer a patient to a specialist, for example, if the patient is non-compliant, has other complicating conditions, or is currently on a high dose of methadone.
- Online data bases of buprenorphine providers and treatment centers can help you find addiction specialists.
- When talking to a patient about referral, emphasize that addiction is a treatable, chronic disease; a referral is indicated as it would be for any chronic disease; and that the patient may return to the primary practice for ongoing care.
- Use sensitive interviewing techniques, such as "Ask-Tell-Ask" when recommending a referral
- Provide printed patient education material when making a referral
