Psychiatric

Over 40% of opioid dependent individuals have co-occuring psychiatric disorders. The most common are depression, anxiety disorders, and bipolar disorder.

Psychiatric comorbidities may complicate buprenorphine treatment in terms of treatment priorities, stabilization concerns, and medication interactions. To make a sound treatment decision, you need to distinguish between independent and substance-induced disorders using the criteria below:

Related Resources: 
Description: 
This document describes how to manage medications for co-occuring psychiatric disorders in a patient receiving buprenorphine.
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Physician Clinical Support System (PCSS)
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Description: 
Provides physicians with information on how to work with a patient who has co-occurring disorders, including how to engage the patient in treatment and how to develop a successful therapeutic relationship.
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Substance Abuse and Mental Health Services Administration (SAMHSA)
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Physician stage in practice: 
Description: 
This chapter of TIP 43 discusses the prevalence, etiology, screening, diagnosis, and treatment of psychiatric disorders that co-occur with opioid addiction.
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Substance Abuse and Mental Health Services Administration (SAMHSA)
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Physician stage in practice: 
Description: 
This set of guidelines aids physicians in providing detoxification and substance abuse treatment, specifically examining co-occurring medical and psychiatric conditions.
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Substance Abuse and Mental Health Services Administration (SAMHSA)
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Before Starting a Practice

DATA 2000 requires buprenorphine prescribers to be capable of referring patients to supportive services for psychosocial therapy. Psychosocial services are a crucial component in successful addiction treatment.

View ReferencesHide References
Meier, BR, Patkar, AA. Buprenorphine treatment: factors and first-hand experiences for providers to consider. Journal of Addictive Diseases. 2007; 26(1): 3-14. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17439863
Related Resources: 
Description: 
Search tool where a patient or physician can enter their zipcode and receive a listing of the closest buprenorphine counselors, pharmacies, treatment facilities, and support groups.
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The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Description: 
This is the American Society of Addiction Medicine's member directory which allows users to search by physician first name, last name, city, state, and specialty.
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American Society of Addiction Medicine (ASAM)
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Appropriateness for Office-Based Treatment With Buprenorphine

Description: 
This page describes points physicians should consider when determining if a patient is appropriate for office-based buprenorphine treatment.

You should answer the following questions for each patient before starting office-based buprenorphine treatment:

Diagnosis

Does the patient have a diagnosis of opioid use disorder?

  • Approximately how long has the patient been dependent?
  • On which opioid(s) is the patient dependent, and how is the drug ingested?
  • How much of the drug does the patient use daily/weekly?

Other Medications

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Physician stage in practice: 
Description: 
The ASI Self-Report Form asks questions about the following topics: your background and employment, your health and family relationships, your legal situation, and your drug and alcohol use.
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Center for Health Care Evaluation (CHCE)
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Resource Type: 
Description: 
This TIP, Substance Abuse Treatment for Persons With Co-Occurring Disorders, revises TIP 9, Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse. The revised TIP provides information about new developments in the rapidly growing field of co-occurring substance use and mental disorders and captures the state-of-the-art in the treatment of people with co-occurring disorders. The TIP focuses on what the substance abuse treatment clinician needs to know and provides that information in an accessible manner. The TIP synthesizes knowledge and grounds it in the practical realities of clinical cases and real situations so the reader will come away with increased knowledge, encouragement, and resourcefulness in working with clients with co-occurring disorders.
Source: 
U.S. Department of Health and Human Services, SAMHSA
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Resource Type: 
Description: 
This guideline discusses management of psychiatric medications in patients receiving buprenorphine/naloxone, and answers the question "How do I manage medications for co-occurring psychiatric disorders in a patient receiving buprenorphine/naloxone (bup/nx) for the treatment of opioid dependence?"
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PCSSmentor.com
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ASAM Patient Placement Criteria

Description: 
The ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders, Second Edition-Revised (Mee-Lee et al. 2001) lists the 5 basic levels of care available for adult substance users. These levels of care range from Early Intervention (for at-risk individuals) to Medically Managed Intensive Inpatient Treatment (for patients with severe disorders who require around-the-clock care). The Patient Placement Criteria classifies opioid maintenance therapy as a Level I treatment since it is most often conducted in outpatient settings.


According to the Patient Placement Criteria, the following 6 patient dimensions should be considered when formulating a treatment plan (Mee-Lee et al. 2001):

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Patient Assessment Checklist

Description: 
Before starting office-based buprenorphine treatment, the following Patient Assessment Questions should be answered for each patient. Topics addressed in these questions include: Diagnosis, Medications, Drugs/Alcohol, Psychiatric and Medical Comorbidities, Psychosocial Issues, Treatment, Patient Management, and Resources. If multiple issues are identified, consider whether they can be managed in your practice or if the patient requires a higher level of case, i.e. an Opioid Treatment Program or higher level.

Diagnosis

Does the patient have a diagnosis of opioid use disorder?

  • Approximately how long has the patient been dependent?
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Commonly Used Forms: 
Physician stage in practice: 
Description: 
Although professionals identify distinct personality disorders (anti-social, borderline, schizotypal, et al), some personality disordered individuals may not fit in a particular category and yet may clearly deserve this label. Although classified as mental disorders they may be classified separately and distinguished from the Axis I Clinical Syndromes for some purposes.
Source: 
BehaveNet®
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Description: 
Complete overview of substance-induced psychotic disorders.
Source: 
Encyclopedia of Mental Disorders
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Physician stage in practice: 

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