Psychosocial

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.

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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

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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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Day 1

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Induction for Nonphysically Dependent Patients

This dosing flow chart depicts clinical dosing guidelines for nonphysically dependent patients. Guidelines are provided for if the patient has a history of opioid dependence, if the patient is currently dependent on opioids, and if opioid agonist side effects are observed.

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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.
Source: 
Center for Health Care Evaluation (CHCE)
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Description: 
The Diagnostic and Statistical Manual 5 (DSM 5) established new criteria for a "Substance Use Disorder" diagnosis. They are summarized in this article.
Source: 
About.com
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DSM-5 Criteria for Opioid Use Disorder

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The following are the DSM-5 diagnostic criteria for Opioid Use Disorder

1. A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

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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.
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U.S. Department of Health and Human Services, SAMHSA
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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: 

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