Opioid Use Disorder

Over 2.5 million Americans have opioid use disorder, but many do not receive treatment.^1-3 This module provides a process to identify patients with opioid use disorder, presents evidence for medication assisted treatment with buprenorphine, naltrexone and methadone, and recommends prescribing naloxone to prevent overdose.

Opioid use disorder (OUD) is problematic use that leads to clinically significant impairment or distress⁴

Primary care providers play an integral role in identifying patients with OUD. Tools like SBIRT – Screening, Brief Intervention, and Referral to Treatment – provide a framework for beginning conversations to link patients with treatment.⁵ 

Treating OUD encompasses behavioral interventions and in many cases medications. Medication Assisted Treatment (MAT) usually includes either methadone, buprenorphine (both only and combined with naloxone), or naltrexone. All of these options can improve retention in treatment and time without opioid misuse.⁶ Primary care providers can provide naltrexone and those who obtain a DEA X can prescribe buprenorphine.

People with OUD are at risk for overdose. Prescribe or recommend naloxone to anyone in treatment. It can be obtained without a prescription, using a standing order or other process, directly from the pharmacy.

Resources for Providers

• Prescribing Naloxone
• What is SBIRT?
• SBIRT Billing
• Providers’ Clinical Support System for Medication Assisted Treatment
• SAMHSA MATxApp

Buprenorphine Waiver Training

• PCSS-MAT Trainings
• SAMHSA Trainings

State specific resources

• Illinois – Intervention and treatment
• Illinois – Find treatment assistance at 1-833-2FINDHELP
• Maine – Opioid crisis materials
• Pennsylvania – Treating heroin and opioid addiction
• Pennsylvania – Opioid Dashboard

Information current at time of publication, December 2018.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition.

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, D.C.: 2013.
2. National Institute on Drug Abuse. Effective Treatments for Opioid Addiction. National Institute on Drug Abuse. drugabuse.gov/ publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction. Published 2016. Accessed November 29, 2018.
3. Wu L, Zhu H, Swartz MS. Treatment utilization among persons with opioid use disorder in the United States. Drug Alcohol Depend. 2016;169:117-127.
4. Substance Abuse and Mental Health Administration. Pocket Guide: Medication-Assisted Treatment of Opioid Use Disorder. Substance Abuse and Mental Health Administration. Accessed November 30, 2018.
5. Substance Abuse and Mental Health Services Administration. Coding for Screening and Brief Intervention Reimbursement. Substance Abuse and Mental Health Services Administration. samhsa.gov/sbirt/coding-reimbursement. Published September 2017. Accessed November 29, 2018.
6. Nielsen S, Larance B, Degenhardt L, et al. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev. 2016;(5):CD011117.