Assessment

Some patients are better suited than others for buprenorphine treatment. Additionally, some patients are more challenging than others, either due to complicated medical or psychiatric issues, or problematic behaviors.

When first starting your buprenorphine practice, you may want to treat "easier" patients until you feel 100% comfortable with the induction and stabilization processes. Use a checklist and/or treatment screening form to assess patients before initiating treatment.

Related Resources: 
Description: 
Aids physicians in screening patients for opioid use disorders. Included are examples of screening instruments, recommendations of laboratory tests to complete, and medical disorders related to substance abuse.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Physician stage in practice: 

Transfer from Methadone Form

Description: 
This form provides a list of important considerations when determining whether a methadone patient is a candidate for transfer to buprenorphine treatment, including social, medical, and psychiatric history.

 

 Request Transfer from Methadone Maintenance to Office-Based Opioid Treatment 
Utilizing Buprenorphine 


Client Name: ______________________________
Date: ______________________________________
Admission Date: ___________________________
ID#: ________________________________________
DOB: _______________________________________

 

Transfer Criteria (please check the appropriate box and fill in as much information as possible):

[] On 30mg or less of Methadone.

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Commonly Used Forms: 
Physician stage in practice: 
Description: 
Described on the ASAM website as, "the most widely used and comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions.
Source: 
ASAM
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Topics: 
Description: 
A website that explains the 5 A's for tobacco cessation.
Source: 
US Department of Health and Human Services
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CAGE-AID

Description: 
Screening test for alcohol and drugs.

One of the most commonly used standardized screening tools for detecting drug use problems is the CAGE-AID, a variation on the CAGE instrument that was originally created to screen for alcohol use. Brown et al., (1998) modified the CAGE questionnaire to add screening for drug use (AID stands for "adapted to include drugs"). The authors were able to obtain 70.9% sensitivity and 75.7% specificity with this modified scale.

Each letter in the acronym CAGE represents one question in the 4-item scale:

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Description: 
Practical tools and guidance for treating chronic pain in adults who have a history of substance use disorders. Topics include chronic pain management, treatment with opioids, substance abuse assessments and referrals.
Source: 
SAMHSA
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Urine Testing

Description: 
Basic information on urine testing in potential opioid-dependent patients.

This table provides basic information on urine testing in potential opioid-dependent patients.

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Resource Type: 
Physician stage in practice: 

Unlikely Candidates for Office-Based Treatment

Description: 
This is a list of factors or issues that may make a certain patient unsuitable for office-based buprenorphine treatment.

Certain circumstances and/or issues can make a patient a less-than-ideal candidate for office-based buprenorphine treatment, including the following:

  • Multiple previous failed treatment attempts and relapses

  • No response to buprenorphine during past attempts

  • High level of physical dependence and the resulting risk for severe withdrawal

  • Dependence on high doses of benzodiazepines, alcohol, or other central nervous system depressants

  • Significant psychiatric comorbidity

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DSM-5 Criteria for Opioid Withdrawal

Description: 
Lists DSM-5 Criteria for Opioid Withdrawal

Opioid withdrawal occurs in opioid-dependent individuals who reduce or stop their opioid use or who take an opioid antagonist (precipitated withdrawal). Because of its high affinity but low activity at opioid receptors, buprenorphine can act as an antagonist in some patients.

DSM-5 Criteria for Opioid Withdrawal


A. Either of the following:

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