{ "schemaVersion": 2, "eyebrow": "Addiction Medicine", "title": "Opioid Use Disorder", "summary": "Diagnose opioid use disorder clinically with DSM-5 criteria, address overdose or psychiatric emergencies first, and promptly offer evidence-based medication treatment. Buprenorphine, methadone, and extended-release naltrexone have distinct initiation requirements, settings, and monitoring needs; withdrawal management alone is not treatment.", "seoDescription": "Physician guide to diagnosing opioid use disorder and selecting, initiating, and monitoring buprenorphine, methadone, naltrexone, and overdose prevention.", "clinicalQuestion": "How should clinicians diagnose opioid use disorder and initiate, select, and monitor medication treatment while reducing overdose risk?", "specialty": "Addiction Medicine", "audience": "U.S. physicians and medical trainees", "tags": [ "opioid use disorder", "OUD diagnosis", "buprenorphine initiation", "methadone", "naltrexone", "opioid withdrawal", "naloxone", "MOUD" ], "keyTakeaways": [ "Diagnose OUD from DSM-5 criteria and a clinical assessment; physiologic tolerance and withdrawal do not count when opioids are taken solely under appropriate medical supervision. [5][11][22]", "Do not delay OUD pharmacotherapy for completion of a full assessment; first identify overdose, intoxication, acute psychiatric instability, and other urgent medical conditions. [5]", "Buprenorphine, methadone, and naltrexone are the three FDA-approved medications for OUD; selection should reflect patient preference, prior treatment response, current opioid dependence, treatment setting, and access. [3][5]", "Standard buprenorphine initiation requires objective opioid withdrawal to reduce precipitated withdrawal risk; start 2–4 mg and titrate to suppress withdrawal and ongoing opioid use. [5]", "Withdrawal management without ongoing OUD treatment is not recommended because relapse, overdose, and overdose death risk increase after loss of tolerance. [5][11]", "Provide naloxone and overdose-response education to patients with OUD and to family or other likely bystanders. [5]" ], "sections": [ { "id": "diagnosis-and-initial-assessment", "eyebrow": "Diagnosis", "heading": "Confirm OUD clinically and triage immediate threats", "intro": "History and examination establish the diagnosis; laboratory testing supports safety and treatment planning.", "paragraphs": [ "OUD is diagnosed when at least 2 DSM-5 criteria occur within 12 months, with severity categorized as mild (2–3 criteria), moderate (4–5), or severe (6 or more). Tolerance and withdrawal should not be counted when opioids are taken solely under appropriate medical supervision. [5][11][22]", "The initial priority is identification and management of overdose, drug-related impairment, acute trauma, suicidal or homicidal ideation, psychosis, delirium, or other urgent medical or psychiatric conditions. A complete biopsychosocial assessment is important but should not delay initiation of pharmacotherapy for OUD. [5]", "Obtain opioid-specific history including agent(s), route, frequency and amount, last use, prior medication treatment, overdose history, and consequences of use. Assess alcohol, benzodiazepines and other sedative-hypnotics, stimulants, cannabis, nicotine, and other substance use; concurrent substance use warrants risk mitigation or a higher level of care but should not be used to withhold methadone or buprenorphine. [5]" ], "bullets": [ "Physical examination should assess intoxication, objective withdrawal, injection-related complications, cardiopulmonary disease, liver disease, pregnancy, and acute infection. [5]", "Use COWS, OOWS, SOWS, or CINA to quantify withdrawal when it informs medication initiation or reassessment; scales support but do not replace diagnostic assessment. [5]", "Recommended baseline testing includes CBC, liver enzymes, tuberculosis testing, hepatitis B and C testing, HIV testing, and consideration of sexually transmitted infection testing; offer hepatitis A and B vaccination when appropriate. [5]", "Perform pregnancy testing for women of childbearing potential and review contraception and reproductive goals. [5]", "Use drug testing during assessment and treatment to support medication adherence assessment and identify alcohol, illicit, and controlled substances. Interpret results in the context of assay limitations and clinical history. [5][15]", "Check the state PDMP to identify controlled-substance prescribing and potentially hazardous combinations; medications dispensed through opioid treatment programs may not appear in the PDMP. [5]" ], "subsections": [], "table": { "caption": "DSM-5 OUD severity and clinical consequence. [5][11][22]", "columns": [ "DSM-5 criteria in 12 months", "Severity", "Immediate clinical implication" ], "rows": [ [ "2–3", "Mild", "Confirm impairment or distress, assess overdose and progression risk, and individualize treatment intensity. [5][11][22]" ], [ "4–5", "Moderate", "Offer evidence-based medication treatment and harm-reduction interventions. [5]" ], [ "6 or more", "Severe", "Offer medication treatment promptly; assess need for more intensive services, co-occurring disorders, and overdose prevention. [5]" ] ] } }, { "id": "medication-selection", "eyebrow": "Pharmacotherapy", "heading": "Select medication by physiologic state, treatment setting, and patient priorities", "intro": "All three FDA-approved medications should be available; no medication has a prespecified maximum treatment duration. [3][5]", "paragraphs": [ "FDA identifies buprenorphine, methadone, and naltrexone as approved medications for OUD. Medication choice should be shared and based on patient preference, past treatment response, current opioid dependence, capacity for monitored dosing, risk of diversion, comorbidities, and access to an opioid treatment program. [3][5]", "Methadone and buprenorphine are agonist therapies that suppress withdrawal and craving. Naltrexone is an opioid antagonist for relapse prevention after complete opioid withdrawal; starting it in a physically dependent patient can precipitate severe withdrawal. [5]", "There is no recommended time limit for pharmacotherapy. If discontinuation is requested, address overdose risk from loss of tolerance, provide naloxone, and discuss continuation or transition to another medication. [5]" ], "bullets": [], "subsections": [], "table": { "caption": "Medication selection and practical constraints for OUD. [3][5]", "columns": [ "Medication", "Best-fit clinical context", "Key initiation requirement and limitation" ], "rows": [ [ "Buprenorphine", "Office-based or opioid treatment program care; patients able to manage office- or home-based initiation. [5]", "For current opioid dependence, wait for objective withdrawal; initiating too early can precipitate withdrawal. [5]" ], [ "Methadone", "Patients who may benefit from daily supervised dosing in an opioid treatment program or for whom buprenorphine has been unsuccessful. [5]", "Outpatient methadone for OUD is delivered through an opioid treatment program; accumulation, sedation, QT-related risk, and drug interactions require cautious titration. [5]" ], [ "Extended-release injectable naltrexone", "Relapse prevention in patients no longer physically dependent on opioids who prefer antagonist treatment or cannot use agonist therapy. [5]", "Requires complete opioid withdrawal; oral naltrexone is generally limited by poor adherence. [5]" ] ] } }, { "id": "buprenorphine", "eyebrow": "Buprenorphine", "heading": "Initiate buprenorphine after objective withdrawal", "intro": "Traditional initiation avoids precipitated withdrawal from displacement of full agonists at the mu-opioid receptor.", "paragraphs": [ "For patients with current opioid dependence, do not begin standard buprenorphine initiation until objective withdrawal is present. ASAM notes that withdrawal generally begins 6–12 hours after short-acting opioids and 24–72 hours after long-acting opioids; a COWS score of 11–12 or greater is generally consistent with sufficient withdrawal for conventional office-based initiation. [5]", "Begin with 2–4 mg and increase in 2–8 mg increments after assessing response. Following initiation, titrate to relief of withdrawal and craving and to enable cessation of nonprescribed opioid use. Evidence cited by ASAM suggests that doses of 16 mg/day or more may outperform lower doses; evidence above 24 mg/day is limited and higher doses may increase diversion risk. [5]", "Office-based and home-based initiation are both considered safe and effective when selected using clinical judgment, prior buprenorphine experience, and the patient’s capacity to recognize and manage withdrawal. Low-dose or microdosing initiation is described in the literature, but the supplied CDC source characterizes evidence as limited. [5][11]" ], "bullets": [ "See patients frequently early in treatment until stability is established; early weekly visits, drug testing including buprenorphine and metabolites, and medication counts or recall visits are diversion-reduction strategies. [5]", "Alcohol, benzodiazepines, and other sedative-hypnotics increase respiratory-depression risk, but FDA and ASAM advise that this should not automatically preclude or suspend buprenorphine treatment; use careful medication management and an individualized risk-benefit assessment. [5]", "When transitioning from buprenorphine to naltrexone, allow 7–14 days after the last buprenorphine dose to ensure absence of physical opioid dependence. [5]", "A transition from buprenorphine to methadone does not require a delay because moving from a partial to a full agonist does not typically precipitate withdrawal. [5]" ], "subsections": [], "table": { "caption": "Conventional buprenorphine initiation parameters. [5]", "columns": [ "Decision point", "Action" ], "rows": [ [ "Current opioid dependence", "Confirm objective withdrawal before first dose to reduce precipitated withdrawal. [5]" ], [ "First dose", "Buprenorphine 2–4 mg. [5]" ], [ "Titration", "Increase by 2–8 mg increments based on withdrawal, craving, sedation, and ongoing opioid use. [5]" ], [ "Dose adequacy", "Dose should suppress withdrawal and support discontinuation of nonprescribed opioid use; 16 mg/day or more may be more effective than lower doses. [5]" ], [ "Early monitoring", "Frequent visits, PDMP review, drug testing, and diversion controls tailored to stability. [5]" ] ] } }, { "id": "methadone", "eyebrow": "Methadone", "heading": "Use cautious methadone induction and opioid treatment program monitoring", "intro": "Methadone is effective but requires slow titration because of its long and variable half-life.", "paragraphs": [ "Methadone is recommended for patients with OUD who can provide informed consent and have no specific contraindication. In the United States, ongoing outpatient methadone treatment for OUD is provided through opioid treatment programs; acute-care administration is possible under limited circumstances. [5]", "The recommended initial dose is 10–30 mg, with reassessment as clinically indicated, typically 2–4 hours after dosing. For patients with absent or low opioid tolerance, use 2.5–10 mg. Federal limits cited by ASAM restrict the initial dose to no more than 30 mg and total first-day dose to no more than 40 mg. [5]", "After stabilization, usual daily dosing is 60–120 mg, although some patients need lower or higher doses. Do not increase daily during early induction; typical increases are no more than 10 mg approximately every 5 days, guided by withdrawal, craving, and sedation. [5]" ], "bullets": [ "Obtain cardiovascular history and assess QT-prolongation risk. Consider ECG for prior QTc greater than 450 ms, ventricular arrhythmia history, syncope, structural heart disease, electrolyte abnormalities, QT-prolonging medications, abnormal liver enzymes, or high methadone doses; ASAM consensus suggests ECG consideration above 120 mg/day. [5]", "For QTc 450–500 ms, discuss risk-benefit and correct modifiable risks. Do not start methadone with known QTc greater than 500 ms; if this develops during treatment, consider dose reduction, removal of contributing drugs or risks, and transition to buprenorphine. [5]", "Use caution with alcohol, sedative-hypnotics, and benzodiazepines, but do not withhold methadone solely because of benzodiazepine use when untreated OUD risk is greater; increase monitoring and medication-management support. [5]", "Patients transitioning from methadone to buprenorphine generally tolerate transfer best after reduction to 30–40 mg/day or less and development of mild-to-moderate withdrawal before buprenorphine. [5]" ], "subsections": [], "table": { "caption": "Methadone initiation and monitoring. [5]", "columns": [ "Phase", "Recommended approach" ], "rows": [ [ "Initial dose", "10–30 mg; reassess typically after 2–4 hours. Use 2.5–10 mg for low or absent tolerance. [5]" ], [ "First-day ceiling", "Initial dose no more than 30 mg; total first-day dose no more than 40 mg. [5]" ], [ "Titration", "Generally no more than 10 mg approximately every 5 days; avoid automatic daily escalation. [5]" ], [ "Usual maintenance range", "60–120 mg/day, individualized to withdrawal, craving, sedation, and treatment goals. [5]" ], [ "QT risk management", "Assess cardiac and medication risk; use ECG selectively for significant risk factors and consider above 120 mg/day. [5]" ] ] } }, { "id": "naltrexone-and-withdrawal", "eyebrow": "Antagonist Treatment", "heading": "Use naltrexone only after opioid abstinence and avoid detoxification-only care", "intro": "Antagonist treatment requires absence of physical opioid dependence; withdrawal management must connect to continuing OUD care.", "paragraphs": [ "Extended-release injectable naltrexone is recommended for relapse prevention in patients who are no longer physically dependent on opioids, can consent, and have no contraindication. The standard dose is 380 mg by deep gluteal intramuscular injection every 4 weeks; ASAM notes that some patients may benefit from dosing every 3 weeks, an approach supported by consensus rather than robust trial evidence. [5]", "Before naltrexone, patients should be adequately withdrawn from opioids. ASAM describes a general interval of about 6 days without short-acting opioids and 7–10 days without long-acting opioids such as methadone or buprenorphine; a naloxone challenge may help when physiologic dependence is uncertain. [5]", "Oral naltrexone is generally not recommended because adherence limits effectiveness; reserve it for unusual settings in which observed or otherwise highly reliable dosing is feasible. [5]" ], "bullets": [ "Do not offer withdrawal management alone as treatment for OUD. It does not provide ongoing relapse prevention and is associated with increased relapse, overdose, and overdose death risk after loss of opioid tolerance. [5][11]", "For opioid withdrawal, methadone and buprenorphine are more effective than alpha-2 agonists for symptom reduction, retention in withdrawal management, and completion. [5]", "Lofexidine is FDA-approved for symptoms of abrupt opioid withdrawal; clonidine is used off-label. Both are alpha-2 adrenergic agonists, but methadone and buprenorphine remain more effective withdrawal-management options. [5]", "Ultra-rapid opioid detoxification under anesthesia is not recommended because of serious adverse events and death. [5]" ], "subsections": [], "table": { "caption": "Naltrexone and withdrawal-management decisions. [5]", "columns": [ "Clinical situation", "Action" ], "rows": [ [ "Physical opioid dependence or acute withdrawal", "Do not initiate naltrexone; it can precipitate severe withdrawal. [5]" ], [ "Appropriate candidate for extended-release naltrexone", "Administer 380 mg deep gluteal IM every 4 weeks after complete opioid withdrawal. [5]" ], [ "Uncertain opioid-free status", "Consider a naloxone challenge before naltrexone, except during pregnancy. [5]" ], [ "Patient requests detoxification only", "Explain relapse and overdose risk; offer ongoing methadone, buprenorphine, or appropriate antagonist treatment rather than withdrawal management alone. [5][11]" ] ] } }, { "id": "monitoring-and-harm-reduction", "eyebrow": "Longitudinal Care", "heading": "Monitor response, address co-occurring conditions, and prevent overdose", "intro": "Retention alone is not a sufficient endpoint; monitor safety, opioid use, function, and engagement in patient-defined goals.", "paragraphs": [ "Medication management includes assessment of response, adherence, ongoing substance use, adverse effects, dose titration, education, and linkage to recovery and medical services. Do not discontinue OUD treatment solely because of continued use of opioids or other substances; instead reassess dose, medication choice, treatment intensity, and social supports. [5]", "Assess psychosocial needs and offer or refer for behavioral health services, but refusal or unavailability of psychosocial treatment must not delay medication treatment. Motivational interviewing or motivational enhancement can support engagement. [5]", "In 2022, an estimated 3.7% of U.S. adults needed OUD treatment, but only 25.1% received medication treatment; treatment gaps and inequities support routine clinical identification and low-threshold treatment access. [20]" ], "bullets": [ "Provide naloxone to all patients treated for or with a history of OUD and train family members or significant others in overdose response. [5]", "Naloxone should be administered for suspected opioid overdose and may be given during pregnancy to save the mother’s life. [5]", "Reassess mental health and suicide risk. Patients with suicidal or homicidal ideation require immediate evaluation and potentially hospitalization. [5]", "Pregnant patients with opioid dependence should receive methadone or buprenorphine as early as possible; withdrawal management or psychosocial care alone is not recommended. [5]", "Encourage breastfeeding for patients receiving methadone or buprenorphine unless contraindications are present. [5]", "For patients with pain and active untreated OUD, consider methadone or buprenorphine so pain and OUD are addressed concurrently. [5]" ], "subsections": [], "table": { "caption": "Longitudinal monitoring targets in OUD care. [5]", "columns": [ "Domain", "What to assess", "Action if concerning" ], "rows": [ [ "Medication response", "Withdrawal, craving, sedation, continued opioid use, adverse effects, adherence. [5]", "Adjust dose, medication, visit frequency, or level of care; do not stop treatment solely for continued use. [5]" ], [ "Other substance exposure", "Alcohol, benzodiazepines and other sedatives, stimulants, and nonprescribed controlled substances. [5]", "Conduct individualized risk-benefit assessment, coordinate prescribers, intensify monitoring, and address co-occurring substance use. [5]" ], [ "Safety", "Overdose history, naloxone access, psychiatric instability, infectious complications, pregnancy. [5]", "Provide naloxone, urgent psychiatric or medical referral when indicated, and appropriate infectious disease or obstetric care. [5]" ], [ "Treatment integrity", "PDMP, drug testing tailored to stability and setting, medication counts or observed dosing when needed. [5]", "Interpret results clinically and nonpunitively; use findings to improve safety and engagement. [5]" ] ] } } ], "faq": [ { "question": "Does opioid tolerance alone establish opioid use disorder?", "answer": "No. OUD requires at least 2 DSM-5 criteria within 12 months causing clinically significant impairment or distress. Tolerance and withdrawal do not count when opioids are taken solely under appropriate medical supervision. [5][11][22]" }, { "question": "When can buprenorphine be started after opioid use?", "answer": "For conventional initiation in a physically dependent patient, wait for objective withdrawal. ASAM describes typical onset 6–12 hours after short-acting opioids and 24–72 hours after long-acting opioids; a COWS score of 11–12 or higher generally indicates sufficient withdrawal. [5]" }, { "question": "Should benzodiazepine use prevent buprenorphine or methadone treatment?", "answer": "No. Concurrent benzodiazepines or other sedative-hypnotics increase risk, but untreated OUD can pose greater harm. Use an individualized risk-benefit assessment, careful medication management, and increased monitoring rather than automatically withholding agonist treatment. [5]" }, { "question": "Is detoxification an adequate treatment for opioid use disorder?", "answer": "No. Withdrawal management alone is not recommended because relapse, overdose, and overdose death are more likely after tolerance decreases. Link withdrawal care directly to ongoing medication treatment and follow-up. [5][11]" }, { "question": "Which patients should receive naloxone?", "answer": "Patients with OUD or a history of OUD should receive naloxone or a prescription, and likely bystanders should be trained in overdose response. Naloxone should be administered for suspected overdose. [5]" } ], "references": [ { "number": 1, "title": "Opioid Use Disorder: Endpoints for Demonstrating ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/114948/download", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 2, "title": "FDA Approves First Test to Help Identify Elevated Risk of Developing Opioid Use Disorder | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/medical-devices/medical-devices-news-and-events/fda-approves-first-test-help-identify-elevated-risk-developing-opioid-use-disorder", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 3, "title": "Information about Medications for Opioid Use Disorder ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/drugs/food-and-drug-administration-overdose-prevention-framework/information-about-medications-opioid-use-disorder-moud", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 4, "title": "Implementation of screening and assessment tools for ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2772724625000587", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 5, "title": "The ASAM National Practice Guideline for the Treatment of ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/journaladdictionmedicine/fulltext/2020/04001/the_asam_national_practice_guideline_for_the.1.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 6, "title": "Nonopioid Substance Use Disorders and Opioid Dose ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1526590014009985", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 7, "title": "Framework for opioid use disorder screening and ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0955395924003116", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 8, "title": "Evaluation of a primary care-based Medication for Opioid ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S2949875925001237", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 9, "title": "Medication-Assisted Treatment of Opioid Use Disorder", "detail": "journals.lww.com", "url": "https://journals.lww.com/hrpjournal/fulltext/2015/03000/medication_assisted_treatment_of_opioid_use.2.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 10, "title": "Management of opioid use disorders: a national clinical practice guideline - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5837873", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 11, "title": "CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9639433", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 12, "title": "Management of opioid use disorder: 2024 update to the national clinical practice guideline", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11573384", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 13, "title": "Opioid Use Disorder: Evaluation and Management - StatPearls - NCBI", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK553166", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 14, "title": "Management of Opioid Use Disorder, Opioid Withdrawal, and Opioid Overdose Prevention In Hospitalized Adults: A Systematic Review of Existing Guidelines", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9474657", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 15, "title": "Addressing Opioid Use Disorder in General Medical Settings - Medications for Opioid Use Disorder - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK574912", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 16, "title": "Telehealth-Delivered Opioid Agonist Therapy for the Treatment of Adults with Opioid Use Disorder: Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK537877", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 17, "title": "Buprenorphine Formulations for the Treatment of Opioid Use Disorders: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK525042", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 18, "title": "Management of opioid use disorder: 2024 update to the ...", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/39532476", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov" }, { "number": 19, "title": "Consensus Recommendations on the Treatment of Opioid ...", "detail": "www.acep.org", "url": "https://www.acep.org/home-page-redirects/latest-news/new-consensus-recommendations-on-the-treatment-of-opioid-use-disorder-in-the-ed", "authors": "www.acep.org", "host": "www.acep.org" }, { "number": 20, "title": "Treatment for Opioid Use Disorder: Population Estimates - CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/mmwr/volumes/73/wr/mm7325a1.htm", "authors": "www.cdc.gov", "host": "www.cdc.gov" }, { "number": 21, "title": "CDC Clinical Practice Guideline for Prescribing Opioids ...", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm", "authors": "www.cdc.gov", "host": "www.cdc.gov" }, { "number": 22, "title": "Opioid Use Disorder: Diagnosis | Overdose Prevention | CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-disorder-diagnosis.html", "authors": "www.cdc.gov", "host": "www.cdc.gov" }, { "number": 23, "title": "Treatment of Opioid Use Disorder | Overdose Prevention | CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/overdose-prevention/treatment/opioid-use-disorder.html", "authors": "www.cdc.gov", "host": "www.cdc.gov" }, { "number": 24, "title": "Use of Opioids for Adults With Pain From Cancer or Cancer ...", "detail": "ascopubs.org", "url": "https://ascopubs.org/doi/10.1200/JCO.22.02198", "authors": "ascopubs.org", "host": "ascopubs.org" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Opioid Use Disorder: Endpoints for Demonstrating ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/114948/download", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "in section III. D). The effects of the study drug on other (nonopioid) problematic drug use should also be evaluated as a secondary endpoint. The responder definition should be prespecified, taking into account the schedule of assessments, and may incorporate a grace period. Efficacy analyses should", "score": 0.3119197 }, { "number": 2, "title": "FDA Approves First Test to Help Identify Elevated Risk of Developing Opioid Use Disorder | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/medical-devices/medical-devices-news-and-events/fda-approves-first-test-help-identify-elevated-risk-developing-opioid-use-disorder", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "results can be mitigated, in part, through accurate, transparent product labeling and a health care provider training program. It is critical that users of the test (health care providers and patients) understand how to interpret the test result and use it not in isolation, but as part of a comprehe", "score": 0.3000688 }, { "number": 3, "title": "Information about Medications for Opioid Use Disorder ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/drugs/food-and-drug-administration-overdose-prevention-framework/information-about-medications-opioid-use-disorder-moud", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "Opioid Treatment Program Directory\n\nIt is estimated that over 6.1 million people aged 12 or older have an opioid use disorder (OUD). Medications for opioid use disorder (MOUD) are an effective treatment of OUD. FDA is working to facilitate treatment options and develop therapies to address OUD, prom", "score": 0.16146593 }, { "number": 4, "title": "Implementation of screening and assessment tools for ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2772724625000587", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "This review highlights the value of screening and assessment tools in identifying individuals and initiating opioid use-related care.", "score": 0.35347337 }, { "number": 5, "title": "The ASAM National Practice Guideline for the Treatment of ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/journaladdictionmedicine/fulltext/2020/04001/the_asam_national_practice_guideline_for_the.1.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "### Diagnosing Opioid Use Disorder\n\nOpioid use disorder is primarily diagnosed on the basis of the history provided by the patient and a comprehensive assessment that includes a physical examination and laboratory testing, including drug testing. Corroborating information reported by significant oth", "score": 0.44709876 }, { "number": 6, "title": "Nonopioid Substance Use Disorders and Opioid Dose ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1526590014009985", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by KL Huffman · 2015 · Cited by 43 — In the absence of improvement in pain or function, there is a low threshold (∼50 mg daily opioid dose) for addiction screening. For patients with a lifetime", "score": 0.36303747 }, { "number": 7, "title": "Framework for opioid use disorder screening and ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0955395924003116", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by HE Jack · 2024 · Cited by 3 — Existing screening and diagnostic practices. The community-based standard of care emphasizes low-threshold access to MOUD, particularly buprenorphine", "score": 0.33737868 }, { "number": 8, "title": "Evaluation of a primary care-based Medication for Opioid ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S2949875925001237", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Patients were satisfied with treatment and improved their quality of life. • Patients had high levels of retention and adherence to treatment.", "score": 0.2296306 }, { "number": 9, "title": "Medication-Assisted Treatment of Opioid Use Disorder", "detail": "journals.lww.com", "url": "https://journals.lww.com/hrpjournal/fulltext/2015/03000/medication_assisted_treatment_of_opioid_use.2.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "by HS Connery · 2015 · Cited by 796 — The evidence strongly supports the use of agonist therapies to reduce opioid use and to retain patients in treatment, with methadone maintenance remaining the", "score": 0.18488555 }, { "number": 10, "title": "Management of opioid use disorders: a national clinical practice guideline - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5837873", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Inclusion of values and preferences for balancing the magnitude of desirable and undesirable outcomes in management of opioid use disorder was based on relevant published literature, including studies of patient values and preferences, on the expertise of our review panel, and on consultations with ", "score": 0.77650476 }, { "number": 11, "title": "CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9639433", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Clinicians should reevaluate patients who are at higher risk for opioid use disorder or overdose (e.g., patients with depression or other mental health conditions, a history of substance use disorder, a history of overdose, taking ≥50 MME/day, or taking other central nervous system depressants with ", "score": 0.7640656 }, { "number": 12, "title": "Management of opioid use disorder: 2024 update to the national clinical practice guideline", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11573384", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "| 2020 National Practice Guideline for the Treatment of Opioid Use Disorder: Focused Update,54 American Society of Addiction Medicine | 2020 United States | This guideline updates the one from 2015, replacing it with new recommendations on the clinical management of opioid use disorder. It gives a t", "score": 0.7596005 }, { "number": 13, "title": "Opioid Use Disorder: Evaluation and Management - StatPearls - NCBI", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK553166", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "This activity focuses on the critical evaluation and management of opioid use disorder (OUD), a pervasive condition significantly diminishing patients' quality of life and contributing to a widespread epidemic in the United States. With over 16 million affected globally and 2.1 million in the United", "score": 0.7216064 }, { "number": 14, "title": "Management of Opioid Use Disorder, Opioid Withdrawal, and Opioid Overdose Prevention In Hospitalized Adults: A Systematic Review of Existing Guidelines", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9474657", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "one guideline was _not recommended_ for use by all three appraisers.41 Three guidelines had the highest score of 6.67 and included the Canadian Research Initiative in Substance Misuse (CRISM) National Guideline for the Clinical Management of OUD,33 the National Institute for Health and Care Excellen", "score": 0.6636041 }, { "number": 15, "title": "Addressing Opioid Use Disorder in General Medical Settings - Medications for Opioid Use Disorder - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK574912", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "ASAM, The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder. 2020 Focused Update: Provides national practice guidelines for the use of medications to treat OUD. www​.asam.org/docs/default-source​/quality-science​/npg-jam-supplement​.pdf?sfvrsn=a00a52c2\\_2\n\nDepartment of Veter", "score": 0.56575525 }, { "number": 16, "title": "Telehealth-Delivered Opioid Agonist Therapy for the Treatment of Adults with Opioid Use Disorder: Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK537877", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "The misuse of opioids (such as heroin, oxycodone, hydromorphone and fentanyl) has been an increasingly common health concern in Canada and the United States. The number of individuals enrolled in opioid use-related medical treatment programs in Ontario increased from 6,000 to over 40,000 from the ye", "score": 0.5272928 }, { "number": 17, "title": "Buprenorphine Formulations for the Treatment of Opioid Use Disorders: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK525042", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "One economic evaluation was a cost-effectiveness analysis using a Markov model with a time horizon of 12 months which was conducted from a US societal perspective.24 It involved movement between four mutually-exclusive health states: on treatment, not relapsed; on treatment, relapsed; off-treatment,", "score": 0.4787 }, { "number": 18, "title": "Management of opioid use disorder: 2024 update to the ...", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/39532476", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "by I Yakovenko · 2024 · Cited by 54 — This guideline update presents new recommendations based on the latest literature for standardized management of opioid use disorder.", "score": 0.43784812 }, { "number": 19, "title": "Consensus Recommendations on the Treatment of Opioid ...", "detail": "www.acep.org", "url": "https://www.acep.org/home-page-redirects/latest-news/new-consensus-recommendations-on-the-treatment-of-opioid-use-disorder-in-the-ed", "authors": "www.acep.org", "host": "www.acep.org", "snippet": "by K Hawk · 2021 · Cited by 139 — Based on literature review, clinical experience, and expert consensus, the group recommends that emergency physicians offer to initiate opioid", "score": 0.22594604 }, { "number": 20, "title": "Treatment for Opioid Use Disorder: Population Estimates - CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/mmwr/volumes/73/wr/mm7325a1.htm", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "†††† Statistical tests indicate differences between excellent or very good and fair or poor at the 0.05 significance level. \n§§§§ Any mental illness aligns with DSM-IV criteria and is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance ", "score": 0.3991562 }, { "number": 21, "title": "CDC Clinical Practice Guideline for Prescribing Opioids ...", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "Importantly, opioid dosage thresholds for caution in the treatment of pain are not applicable to opioid agonist treatment of opioid use disorder (345) because recommended dosages of methadone and buprenorphine for opioid use disorder (96) differ from those for pain management. No recommended duratio", "score": 0.39887524 }, { "number": 22, "title": "Opioid Use Disorder: Diagnosis | Overdose Prevention | CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-disorder-diagnosis.html", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "## Identifying OUD\n\nIf clinicians are concerned and suspect their patient may have OUD, they should discuss the concerns with the patient in a nonjudgmental manner. Clinicians can provide an opportunity for patients to disclose related concerns or problems. Concerns about OUD may be informed by\n\nCli", "score": 0.32933828 }, { "number": 23, "title": "Treatment of Opioid Use Disorder | Overdose Prevention | CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/overdose-prevention/treatment/opioid-use-disorder.html", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "A .gov website belongs to an official government organization in the United States.\n\nA lock ( ) or means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.\n\nCenters for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Pro", "score": 0.2540696 }, { "number": 24, "title": "Use of Opioids for Adults With Pain From Cancer or Cancer ...", "detail": "ascopubs.org", "url": "https://ascopubs.org/doi/10.1200/JCO.22.02198", "authors": "ascopubs.org", "host": "ascopubs.org", "snippet": "_Recommendation 5.2._ For patients with renal or hepatic impairment who receive opioids, clinicians should perform more frequent clinical observation and opioid dose adjustment (Type: Informal consensus, benefits outweigh harms; Strength of recommendation: Strong).\n\nQuestion 6: How should breakthrou", "score": 0.51091194 } ], "publishedAt": "2026-08-20T23:52:06.762503Z", "updatedAt": "2026-08-20T23:52:06.762503Z", "readingMinutes": 7, "slug": "opioid-use-disorder" }