Dependence

Opioid Use Disorder Criteria:

A minimum of 2-3 criteria is required for a mild substance use disorder diagnosis, while 4-5 is moderate, and 6-7 is severe (APA, 2013). Opioid Use Disorder is specified instead of Substance Use Disorder, if opioids are the drug of abuse. Note: A printable checklist version is linked below

Related Resources: 
Description: 
The APA's breakdown on changes to substance-related addictive disorder diagnoses introduced by DSM-5. The document goes over substance use disorder, addictive disorders and briefly states the APA's position on caffeine use disorder.
Source: 
APA DSM-5
field_vote: 
Tags: 
Description: 
Describes the substance use disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
field_vote: 
Physician stage in practice: 
Description: 
Brief critique and explanation of the changes in terminology and classification for substance use disorder as described in DSM-5. The author highlights the impact of the changes in vocabulary as well as the potential fallacies created by them.
Source: 
Join Together
field_vote: 
Tags: 
Description: 
Form for use in the clinic to support evaluation for possible opioid use disorder based on DSM-5 diagnostic criteria.
Source: 
APA
field_vote: 
Commonly Used Forms: 

Many patients who abuse opioids will not have any obvious physical symptoms. However, there are some signs to look for during the physical exam.

Related Resources: 
Description: 
Photograph classification system for identifying skin lesions of injection drug users.
Source: 
Substance Abuse and Mental Health Administration (SAMHSA)
field_vote: 
Tags: 

Though pre-induction guidelines are slightly different for patients dependent on long- vs. short-acting opioids, the induction and dosing process is the same. Give the first dose when the patient is in mild to moderate opioid withdrawal on the COWS scale.

Induction Day 1

Related Resources: 
Description: 
This PDF Document contains the Clinical Opioid Withdrawal Scale (COWS), a common instrument used to assess a patient's opioid withdrawal severity.
Source: 
California Society of Addiction Medicine (CSAM)
field_vote: 
Patient Handouts: 

After determining that a patient is appropriate for buprenorphine treatment, the clinician should do the following before starting induction:

Product How Supplied (Buprenorphine / Naloxone mg) Induction Target Dose Instructions for Use
Suboxone®

Sublingual Film

Reckitt Benckiser
View ReferencesHide References
Actavis Elizabeth LLC. Buprenorphine HCl and naloxone HCl prescribing information. Actavis. 2013. Available at: https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=110562 Accessed on: 2014-10-07.
BioDelivery Sciences International . Bunavail prescribing information . BDSI. 2014. Available at: http://www.bdsi.com/siteres.aspx?resid=5a738443-a797-41cd-a39a-a8deb2a4a585 Accessed on: 2014-10-06.
Orexo US Inc. Zubsolv prescribing information. Zubsolv. 2013. Available at: https://www.zubsolv.com/wp-content/uploads/2015/01/ZubsolvFullPrescribingInformation.pdf Accessed on: 2015-04-02.
Reckitt Benckiser Pharmaceuticals Inc. Suboxone Prescribing Information. Reckitt Benckiser Pharmaceuticals. 2014. Available at: http://www.suboxone.com/content/pdfs/prescribing-information.pdf Accessed on: 2014-10-09.
Related Resources: 
Description: 
This provides prescribing information for Suboxone sublingual film and includes information on indications, dosing, contraindications, adverse reactions, drug interactions and use in specific populations.
Source: 
Reckitt Benckiser Pharmaceuticals
field_vote: 
Description: 
Prescribing information for Zubsolv sublingual tablets
Source: 
Zubsolv
field_vote: 
Description: 
This provides prescribing information for Bunavail buccal film and includes information on indications, dosing, contraindications, adverse reactions, drug interactions and use in specific populations.
Source: 
BDSI
field_vote: 
Description: 
This provides prescribing information for Buprenorphine sublingual tablets and includes information on indications, dosing, contraindications, adverse reactions, drug interactions and use in specific populations.
Source: 
Roxane Laboratories
field_vote: 
Description: 
This provides prescribing information for Buprenorphine HCl and naloxone HCl sublingual tablets and includes information on indications, dosing, contraindications, adverse reactions, drug interactions and use in specific populations.
Source: 
Actavis Elizabeth LLC
field_vote: 

Buprenorphine Product Formulations Comparison

Description: 
Compares the different formulations of buprenorphine products made by different drug companies.
Product How Supplied (Buprenorphine / Naloxone mg) Induction
Dosage Increments
(until opioid withdrawal signs and symptoms are suppressed)
Recommended Target Dose for Maintenance Instruction
field_vote: 
Commonly Used Forms: 
Tags: 
Description: 
A website that explains the 5 A's for tobacco cessation.
Source: 
US Department of Health and Human Services
field_vote: 
Description: 
Manual for diagnosing mental health problems with diagnostic criteria and diagnostic codes.
Source: 
APA
field_vote: 
Description: 
This newsletter article from NAABT.org lists and describes 15 ways patients can save money on buprenorphine treatment.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
field_vote: 
Patient Handouts: 

Pages

Subscribe to Dependence