NATIONAL PRACTICE GUIDELINE National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use ASAM National Practice Guideline for the Use of Medi- Robert J. Roose, MD, MPH cations in the Treatment of Addiction Involving Opioid Alexis Geier-Horan, ASAM Staff Use Beth Haynes, ASAM Staff Guideline Committee Members (alpha order): Penny S. Mills, MBA, ASAM, Executive Vice President Sandra Comer, PhD Special External Reviewer: Chinazo Cunningham, MD, MS Michael M. Miller, MD, FASAM, FAPA Marc J. Fishman, MD, FASAM Adam Gordon, MD, MPH, FASAM Treatment Research Institute Technical Team Mem- Kyle Kampman, MD, Chair bers (alpha order): Daniel Langleben, MD Amanda Abraham, PhD Ben Nordstrom, MD, PhD Karen Dugosh, PhD David Oslin, MD David Festinger, PhD George Woody, MD Kyle Kampman, MD, Principal Investigator Tricia Wright, MD, MS Keli McLoyd, JD Stephen Wyatt, DO Brittany Seymour, BA Abigail Woodworth, MS ASAM Quality Improvement Council (alpha order): John Femino, MD, FASAM Disclosure information for Guideline Committee Members, Margaret Jarvis, MD, FASAM, Chair the ASAM Quality Improvement Council, and External Margaret Kotz, DO, FASAM Reviewers is available respectively in Appendices III, IV, Sandrine Pirard, MD, MPH, PhD and V. Table of Contents EXECUTIVE SUMMARY ........................................................03 Purpose .....................................................................03 Background . 03 Scope of Guideline . 04 Intended Audience . 04 Qualifying Statement . 04 Overview of Methodology . 04 Summary of Recommendations . 05 Abbreviations and Acronyms . 10 National Practice Guideline Glossary . 10 INTRODUCTION . 14 Purpose .....................................................................14 Background on Opioid Use Disorder . 14 Scope of Guideline . 15 Intended Audience . 15 Qualifying Statement . 16 METHODOLOGY . 16 Overview of Approach . 16 Task 1: Review of Existing Guidelines . 16 Task 2: Identification of Hypothetical Statements and Appropriateness Rating . 17 Task 3: Comparative Analysis, Review, and Necessity Rating . 18 Task 4: Drafting the National Practice Guideline . 18 Task 5: External Review . 18 Adopted by the ASAM Board of Directors June 1, 2015 1 Kampman et al Adopted by the ASAM Board of Directors June 1, 2015 PART 1: ASSESSMENT AND DIAGNOSIS OF OPIOID USE DISORDER . 18 Comprehensive Assessment . 18 Diagnosing Opioid Use Disorder . 21 Summary of Recommendations . 22 Areas for Further Research . 23 PART 2: TREATMENT OPTIONS . 23 Introduction . 23 Pharmacotherapy Options . 23 Efficacy Considerations . 24 Summary of Recommendations . 26 Areas for Further Research . 27 PART 3: TREATING OPIOID WITHDRAWAL . 27 Background . 27 Assessment of Patient for Opioid Withdrawal . 27 Medications in Opioid Withdrawal . 28 Summary of Recommendations . 29 Areas for Further Research . 29 PART 4: METHADONE . 29 Background . 29 Patient Selection and Treatment Goals . 29 Course of Treatment . 30 Switching Treatment Medications . 30 Summary of Recommendations . 31 Areas for Further Research . 31 PART 5: BUPRENORPHINE . 32 Background . 32 Patient Selection and Treatment Goals . 32 Course of Treatment . 32 Switching Treatment Medications . 34 Summary of Recommendations . 35 Areas for Further Research . 35 PART 6: NALTREXONE . 35 Background . 35 Patient Selection and Treatment Goals . 36 Course of Treatment . 36 Switching Treatment Medications . 37 Summary of Recommendations . 37 Areas for Further Research . 37 PART 7: PSYCHOSOCIAL TREATMENT IN CONJUNCTION WITH MEDICATIONS FOR THE TREATMENT OF OPIOID USE DISORDER . 38.