The Centers for Disease
Control have recently described opioid use and resultant deaths as an epidemic.
At this point in time, treating this disease well with medication requires
skill and time that are not generally available to primary care doctors in most
practice models. Suboptimal treatment has likely contributed to expansion of
the epidemic and concerns for unethical practices. At the same time, access to
competent treatment is profoundly restricted because few physicians are willing
and able to provide it.
This “Practice Guideline” was developed to assist in
the evaluation and treatment of opioid use disorder, and in the hope that,
using this tool, more physicians will be able to provide effective treatment.
Although there are existing guidelines for the treatment of opioid use
disorder, none have included all of the medications used at present for its
treatment. Moreover, few of the existing guidelines address the needs of
special populations such as pregnant women, individuals with co-occurring
psychiatric disorders, individuals with pain, adolescents, or individuals
involved in the criminal justice system.
This Practice Guideline was developed
using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA)
Appropriateness Method (RAM) – a process that combines scientific evidence and
clinical knowledge to determine the appropriateness of a set of clinical
procedures. The RAM is a deliberate approach encompassing review of existing
guidelines, literature reviews, appropriateness ratings, necessity reviews, and
document development.
For this project, American Society of Addiction Medicine
selected an independent committee to oversee guideline development and to
assist in writing. American Society of Addiction Medicine's Quality Improvement
Council oversaw the selection process for the independent development
committee. Recommendations included in the guideline encompass a broad range of
topics, starting with the initial evaluation of the patient, the selection of
medications, the use of all the approved medications for opioid use disorder,
combining psychosocial treatment with medications, the treatment of special
populations, and the use of naloxone for the treatment of opioid overdose.
Topics needing further research were noted.
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