Opioid Use Disorder

CME credit available from Harvard Medical School through October 2022.

Published Materials

• Summary Brochure
• Evidence Document
• Reference Card
• Patient Brochure
• Patient Brochure (Spanish)
• Tear Off
• Tear Off (Spanish)
• Poster

Over 2 million Americans have opioid use disorder (OUD), but only 1 in 5 receive treatment.^1,2

This module provides a process to identify and diagnose patients with opioid use disorder, describes the evidence for medication-based treatment with buprenorphine, naltrexone or methadone, and recommends prescribing naloxone to prevent overdose.

Defining opioid use disorder

OUD is problematic opioid use that leads to clinically significant impairment or distress.³

Primary care providers play an integral role in identifying patients with OUD. Adding questions about opioid misuse to annual screening questions about tobacco and alcohol, create an opportunity to discuss or uncover problematic behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT) provides a framework for assessing patients reporting problematic behaviors, engaging patients in behavior change, and linking them into any needed treatment.⁵

Medications to treat OUD

Three medications are FDA-approved to treat OUD: buprenorphine, methadone, and naltrexone extended-release injection. All of these options can improve retention in treatment, increase time without opioid misuse, and reduce mortality.

*Anyone licensed to prescribe opioids (e.g., M.D., D.O., nurse practitioner [N.P.], physician assistant [P.A.]) can complete the training and receive an X-waiver to prescribe buprenorphine. N.P. and P.A. prescribing regulations are subject to state law.

Treatment selection should be a shared decision between patients and clinicians, and is subject to availability and access.⁴ While medication-based treatment is sometimes provided along with behavioral therapy, it is so effective that it should be offered whether or not behavioral interventions are available.⁵

Naloxone

Patients with OUD are at high risk of overdose. Prescribe or recommend naloxone to anyone, regardless of whether or not they are in treatment. Naloxone 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
• Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool
• Drug Abuse Screening Tool (DAST-10)
• Providers’ Clinical Support System for Medication Assisted Treatment
• Find a buprenorphine prescriber
• Clinical Opioid Withdrawal Scale (COWS)
• Urine drug test tool

Buprenorphine Waiver Resources

• PCSS-MAT Trainings
• SAMHSA Trainings
• Apply for your X-waiver

State specific resources

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

Information current at time of publication, July 2019.

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

References

1. Han B, Compton WM, Jones CM, Cai R. Nonmedical Prescription Opioid Use and Use Disorders Among Adults Aged 18 Through 64 Years in the United States, 2003-2013. JAMA. 2015;314(14):1468-1478.
2. Wu LT, Zhu H, Swartz MS. Treatment utilization among persons with opioid use disorder in the United States. Drug and alcohol dependence. 2016;169:117-127.
3. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association,; 2013.
4. National practice guideline for the use of medications in the treatment of addiction involving opioid use. American Society of Addiction Medicine;2015.
5. National Academies of Sciences E, Medicine;. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press; 2019.