CME credit available from Harvard Medical School through October 2022.
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.
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
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
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.
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.